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 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) versus 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^st, 2004, to January 1^st, 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 length of hospital stay. 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 hours versus 45.6 hours for those who received dual therapy (p=0.0007). 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% versus 51.4% respectively, p-value=0.001).

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.