Monday, February 8, 2010

Next Step?

A 60 year old woman with diabetes and hypertension presents with one episode of vaginal bleeding. She said she had menopause several years ago. She is unsure about her medications, but takes something for her "sugars," "high blood pressure," "bones," and "hot flashes." She has no children. She is obese.

Challenge: What is your next step in management?

2 comments:

Suheil said...

Fractional Curettage for histopathopathology to look for Endometrial Carcinoma and USG as an adjunct to look for endometrial thickening.. Hysteroscopy guided biopsy would be ideal.. Looking for Endometrial carcinoma..

Craig Chen said...

Yes, tissue is the issue!
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Next Step?

Endometrial carcinoma is the most common gynecologic malignancy, and the most common type (Type I) is due to excess estrogen in the absence of progestins. The first diagnostic test is endometrial biopsy, but hysteroscopy with dilation and curettage or transvaginal ultrasound (distinguishes between atrophy and anatomic lesions) are alternatives.

Source: UpToDate.