Uncontrolled life-threatening bleeding may require uterine artery embolization (occlusion of the blood vessels supplying the uterus), laparotomy (surgical opening of the abdomen), occasionally leading to hysterectomy (removal of the uterus) as a last resort.A possible complication from protracted vaginal blood loss is iron deficiency anemia, which can develop insidiously. Eliminating the cause will resolve the anemia, although some women require iron supplements or blood transfusions to improve the anemia. Epidemiology
Prepubertal
The most common cause of vaginal bleeding is usually considered to be a foreign body inserted into the vaginal canal, which is frequently associated with pelvic pain, foul discharge, or recurrent genitourinary infections. This event can be due to normal self-exploration or can be indicative of sexual abuse.Genitourinary injury is also a common cause, and is often the most common cause of hospitalization or emergency department visits for prepubertal vaginal bleeding, comprising up to 45% of such cases. The most common genitourinary injury is the straddle injury, which often occurs during a fall, often on a sharp edge, and can cause lacerations between the labial folds. Treatment
While many forms of vaginal bleeding are normal and do not require treatment, other forms will require medical attention. Hormonal management is usually the first option used to treat acute abnormal uterine bleeding. These hormonal medications include birth control pills, medroxyprogesterone acetate (brand name Depo-Provera), and conjugated equine estrogen. Long-term treatments include hormonal IUD insertion, birth control pills, progestin pills or progestin shots (Depo-Provera), and NSAIDs such as ibuprofen Certain medications may not be safe for certain women.
In accordance with this decision, Tour organizers removed Armstrongs name and results from the races history.Witnesses testified that code words used for EPO included "Edgar", "Poe", "Edgar Allan Poe", and "Zumo" (Spanish for juice). Dynepo
Dynepo is the brand name for a form of EPO  developed by Shire Pharmaceuticals. The first development steps were performed by HMR and Aventis. Aventis obtained the license in Europe in 2002. The company expected to launch the product in Europe in 2006, although patents held by the American biotechnology company Amgen, Inc. may have precluded its sale in the United States.Dynepo was made in cultured human cells. It was therefore expected to have an authentic human form of sialic acid and other oligosaccharide residues. It was hoped that this would make a longer-acting product than existing brands. There were concerns that such production would also make Dynepo undetectable in the urine tests for EPO used, at that time, to detect doping by athletes. Dynepo was withdrawn from European markets on 17 February 2009, for commercial reasons. On July 1, 2009, professional cycling team Silence–Lotto announced that Thomas Dekker was tested positive for Dynepo on a test taken on December 24, 2007, while Dekker was riding for Rabobank. References
External links
 Media related to Erythropoiesis-stimulating agents at Wikimedia Commons
"Erythropoietin". Drug Information Portal. U.S. National Library of Medicine. "Epoetin alfa". Drug Information Portal. U.S. National Library of Medicine. "Epoetin beta". Drug Information Portal. U.S. National Library of Medicine. "Darbepoetin Alfa". Drug Information Portal. U.S. National Library of Medicine. "Methoxy polyethylene glycol-epoetin beta".