Length of Hospital Stay in Adolescents Receiving High-Dose Oral Contraceptive Pills with and without Conjugated Equine Estrogen for the Treatment of Acute Abnormal Uterine Bleeding

Abstract

Study objective: Compare the length of hospital stay (LOHS) of adolescents admitted for severe anemia (hemoglobin ≤8 g/dL) due to acute abnormal uterine bleeding (AUB) treated with high-dose combined oral contraceptive pills (HD-OCPs) vs those treated with HD-OCPs and intravenous conjugated equine estrogen, also referred to as dual therapy.

Design, setting, and participants: This is a single-institution retrospective cohort study of adolescents hospitalized for the management of acute AUB and severe anemia between July 1, 2004, to January 1, 2020. Subjects were excluded if they were pregnant, had a malignancy, thrombocytopenia, treated with other hormonal therapies, or if bleeding stopped prior to admission.

Main outcome measures: Primary outcome was LOHS. Secondary outcomes were rates of complications and side effects secondary to the hormonal medication.

Results: There were 113 subjects included in the study. Seventy-four (65%) received HD-OCPs only, and the remainder received dual therapy. Mean subject age was 13.8 years for both groups. Those who received HD-OCPs alone were hospitalized for an average of 38.4 vs 45.6 hours for those who received dual therapy (P = .0007). The only reported side effect in either group was nausea and/or vomiting, which was higher in the group who received dual therapy than those treated with HD-OCPs alone (85% vs 51.4% respectively, P value = .001).

Conclusion: Adolescents who received dual therapy had a longer hospital stay than those who received HD-OCPs alone. There were no complications related to the medication regimens in either group, but those receiving dual therapy had significantly higher rates of anti-emetic use.

Keywords: Abnormal uterine bleeding; Heavy menstrual bleeding; Intravenous conjugated equine estrogen; Oral contraceptive pills.