A woman who is not sexually active has vaginal bleeding for more than one month. Her hemoglobin is 11 g/dL. What is the most appropriate next step in management?

• A. Refer to OB/GYN
• B. Begin iron supplementation
• C. Schedule pelvic ultrasound
• D. Endometrial biopsy

Answer: (A)

Persistent abnormal vaginal bleeding in a nonpregnant patient requires specialized gynecologic evaluation to identify the underlying cause and guide appropriate testing and treatment. The fact that bleeding has continued for more than a month signals a potential structural, hormonal, or other pathologic issue that cannot be safely managed with iron alone. Iron supplementation may help with the mild anemia, but it doesn’t address the source of bleeding. A referral to obstetrics/gynecology ensures a thorough assessment and the right next steps, such as targeted imaging or endometrial sampling if indicated, to determine and treat the cause.