Post Menopausal Uterine Bleeding

HISTORY:

Post-menopausal bleeding for ‍ ‍hoursdays

Type: ‍spottinglightmoderateheavy, ‍with smallwith largewithout clots

Pattern: ‍constantintermittent

‍pelvic pain

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍vaginal discharge, ‍clear, ‍thin

‍fishy smell

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍fatigue



Gynecological history:

Menopause: ‍ years old

G‍01234 P‍01234 A‍01234

Last Pap smear: ‍ ‍monthsyears ago ‍never





EXAM:

Pelvic:

- External genitalia: ‍normal, ‍inguinal lymphadenopathy

- Vagina: ‍normal, discharge ‍normal, ‍malodorous

- Cervix: ‍normal

- Uterus: ‍normal, ‍no cervical motion tenderness

- Adnexa: -R ‍normal, -L ‍normal

- Tests performed: ‍Pap test, ‍HPV DNA, ‍vaginal culture, ‍chlamydia/gonorrhea, vaginal pH ‍< 4.5> 4.5, whiff test with KOH ‍negative

- Performed with chaperone



ASSESSMENT:

‍Endometrial hyperplasia ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍coagulation profile, ‍TSH, ‍FSH, ‍β-hCG

- Pelvic ultrasound

- Endometrial biopsy if endometrial thickness > 4 mm

- Stop hormone replacement therapy

- Referral to gynecologist

- Follow-up in ‍ ‍weeksmonths

- Return if bleeding worsens, if new symptoms develop such as pelvic pain or weight loss, or if symptoms do not improve with treatment