Tham khảo tài liệu 'phương pháp điều trị sản khoa - tình huống số 4', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 13 A 66-year-old nulliparous woman who underwent menopause at age 55 years complains of a 2-weck history of vaginal bleeding. Prior to menopause she had irregular menses. She denies the use of estrogen replacement therapy. Her medical history is significant for diabetes mcllitus controlled with an oral hypoglycemic agent. On examination she weighs 190 lb height 5 3 BP is 150 90 and temp is 99 F. The heart and lung examinations arc normal. The abdomen is obese and no masses arc palpated. The external genitalia appear normal the uterus is normal size without adnexal masses. What is the next step What is your concern ì 20 CASE 1 11 J s. OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 13 Postmenopausal Bleeding Summary A 66-ycar-old diabetic nulliparous woman complains of postmenopausal vaginal bleeding. Prior to menopause which occurred at age 55 she had irregular menses. She denies the use of estrogen replacement therapy. Her examination is significant for obesity and hypertension. Next step Perform an endometrial biopsy. Your concern Endometrial cancer. Analysis Objectives 1. Understand that postmenopausal bleeding requires endometrial sampling to assess for endometrial cancer. 2. Know the risk factors for endometrial cancer. 3. Know that endometrial cancer is staged surgically. Considerations This patient has postmenopausal vaginal bleeding. The biggest concern should be endometrial cancer. She also has numerous risk factors for endometrial cancer including obesity diabetes hypertension prior anovulation irregular menses late menopause and nulliparity. The endometrial sampling or aspiration can be performed in the office by placing a thin flexible catheter through the cervix. It is the initial test of choice to assess for endometrial cancer. This patient is not taking unopposed estrogen replacement therapy which would be another risk factor. If endometrial cancer were diagnosed the patient would need surgical staging. If the endometrial sampling is negative for .
