Which treatment may be indicated if a patient suffers from heavy vaginal bleeding and is hemodynamically unstable?

In cases of heavy vaginal bleeding accompanied by hemodynamic instability, intravenous estrogen therapy is often indicated as it can quickly help stabilize the patient. The primary role of intravenous estrogen is to promote hemostasis and manage acute bleeding episodes, particularly in situations where rapid restoration of hemostatic balance is necessary. Estrogen helps to stimulate the endometrium, promoting clotting and reducing uterine bleeding effectively.

Dilation and curettage, while useful for certain causes of abnormal uterine bleeding, is typically not the first-line treatment in an unstable patient due to the need for stabilization first. Combination oral contraceptives are generally used for long-term management of menstrual irregularities rather than immediate action in emergency situations. Oral iron supplementation addresses iron deficiency anemia but is not a treatment for the active bleeding and does not provide the immediate intervention needed in a hemodynamically unstable patient.

Thus, intravenous estrogen therapy is the most appropriate choice for immediate intervention in the context of significant bleeding and instability.