In a non-sexually active female with vaginal bleeding for over a month and a hemoglobin of 11 g/dL, what is the most appropriate next step in management?

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

Answer: (D)

Persistent abnormal vaginal bleeding over a month signals potential gynecologic pathology that warrants specialized evaluation. When bleeding is ongoing, the priority is to determine the underlying cause—structural issues like fibroids or polyps, hormonal imbalances, endometrial pathology, or other conditions—while also assessing and treating any resulting anemia. Involving obstetrics/gynecology ensures a coordinated, thorough workup and appropriate testing (such as imaging or biopsy) guided by the patient’s age, risk factors, and exam findings. Iron supplementation may help with the mild anemia, but it doesn’t address the source of bleeding. A pelvic ultrasound and any endometrial sampling would be pursued as part of the gynecologic evaluation rather than used as the immediate first step in primary care.