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Old 11-21-2012
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Default Vaginal bleeding in 48 year old woman

A 48-year-old woman presents to her gynecologist for vaginal bleeding. She states that after a year of hot flashes and irregular cycles, she finally stopped menstruating 4 months ago. Two days ago, she began having some vaginal bleeding that was very similar to her prior menses. She is concerned because she heard that the first sign of endometrial cancer in postmenopausal women is vaginal bleeding. She is an otherwise healthy woman with no medical problems. She exercises three times a week and takes multivitamins. She had three children when she was between the ages of 29 and 35. She used oral contraceptive pills for contraception from the time she was 18 until she got married at the age of 28. What is the most appropriate next step in managing this woman’s vaginal bleeding?

(A) Abdominal ultrasound
(B) Endometrial biopsy
(C) Follow-up examination in 6 months
(D) Luteinizing hormone and follicle stimulating hormone serum levels
(E) Prescription of testosterone cream
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Old 11-21-2012
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Originally Posted by heartbeat View Post
A 48-year-old woman presents to her gynecologist for vaginal bleeding. She states that after a year of hot flashes and irregular cycles, she finally stopped menstruating 4 months ago. Two days ago, she began having some vaginal bleeding that was very similar to her prior menses. She is concerned because she heard that the first sign of endometrial cancer in postmenopausal women is vaginal bleeding. She is an otherwise healthy woman with no medical problems. She exercises three times a week and takes multivitamins. She had three children when she was between the ages of 29 and 35. She used oral contraceptive pills for contraception from the time she was 18 until she got married at the age of 28. What is the most appropriate next step in managing this woman’s vaginal bleeding?

(A) Abdominal ultrasound
(B) Endometrial biopsy
(C) Follow-up examination in 6 months
(D) Luteinizing hormone and follicle stimulating hormone serum levels
(E) Prescription of testosterone cream
B. Quite self explanatory I believe.
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Old 11-21-2012
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B endometrial biopsy
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B) Endometrial biopsy
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Old 11-21-2012
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I had confusion with some definitions which was clear after did this Q, i like to shared with you, may someone benefit.
Menopause is defined as the time when there has been no menstrual periods for 12 consecutive months and no other biological or physiological cause can be identified. (A woman may still, however, be able to become pregnant unless 12 consecutive months have passed without a period.)
In MTB3 define as:3 months of amenorrhea with elevation of FSH and LH.
Perimenopause is define as the period of transition to natural menopause during which the body undergoes endocrinologic and biologic changes resulting from declining ovarian hormone production, increase FSH level; symptoms can include irregular menstrual periods, hot flashes, vaginal dryness, insomnia, and mood swings. Perimenopause can last over six years (four years is average) and usually ends after twelve months of amenorrhea.
Quote:
The correct answer is C.This woman presents with symptoms of perimenopause (hot flashes and menstrual irregularities) of 1 year, and amenorrhea for 4 months. Because she has not had amenorrhea for a full year, she is still considered to be perimenopausal, and this episode of bleeding likely represents an anovulatory menstrual cycle. She should continue to monitor her vaginal bleeding and can be offered medications to lessen her symptoms (i.e.,oral contraceptive pill).
Answer B is incorrect. Nulliparity and unopposed estrogenic states are associated with increased risk of endometrial cancer, neither of which applies to this woman. Indeed, 10 years on the oral contraceptive pill places this woman at a lower risk for endometrial cancer. Endometrial biopsy is the standard of care if vaginal bleeding occurs more than 1 year after amenorrhea in a postmenopausal woman.
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Old 11-22-2012
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Quote:
Originally Posted by heartbeat View Post
I had confusion with some definitions which was clear after did this Q, i like to shared with you, may someone benefit.
Menopause is defined as the time when there has been no menstrual periods for 12 consecutive months and no other biological or physiological cause can be identified. (A woman may still, however, be able to become pregnant unless 12 consecutive months have passed without a period.)
In MTB3 define as:3 months of amenorrhea with elevation of FSH and LH.
Perimenopause is define as the period of transition to natural menopause during which the body undergoes endocrinologic and biologic changes resulting from declining ovarian hormone production, increase FSH level; symptoms can include irregular menstrual periods, hot flashes, vaginal dryness, insomnia, and mood swings. Perimenopause can last over six years (four years is average) and usually ends after twelve months of amenorrhea.
Well, menopause or peri menopause, any woman above the age of 35 needs a precautionary biopsy for any DUB to R/O Endometrial Hyperplasia (Or Cancer).

It's strange how Uworld and Fa differ so much. I have my exam tomorrow. Grossly underprepared, but will stick to what I know.
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Old 11-22-2012
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Originally Posted by Nik7733 View Post
Well, menopause or peri menopause, any woman above the age of 35 needs a precautionary biopsy for any DUB to R/O Endometrial Hyperplasia (Or Cancer).

It's strange how Uworld and Fa differ so much. I have my exam tomorrow. Grossly underprepared, but will stick to what I know.
Yup it's not suitable time to change what you already known beside UW is most accurate bank.
Good luck Sr tomorrow
Don't forget to share your experience
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