A 60-year-old woman is attending the clinic complaining of post-menopausal bleeding for the last 3 months. She was found to have a uterine fibroid of 5 cm in size, noted in a recen... A 60-year-old woman is attending the clinic complaining of post-menopausal bleeding for the last 3 months. She was found to have a uterine fibroid of 5 cm in size, noted in a recent ultrasound. Upon review of the previous medical records, the ultrasound performed 5 years ago showed the same size and location of the fibroid. Which of the following is the most appropriate next step in management? A. Myomectomy B. Hysterectomy C. Uterine artery embolization D. Obtain an endometrial sample
Understand the Problem
The question describes a clinical scenario of a post-menopausal woman with bleeding and a uterine fibroid, asking us to determine the most appropriate next step in her management. We're given four possible options: myomectomy, hysterectomy, uterine artery embolization, and obtaining an endometrial sample. The question requires knowledge of gynecological conditions and their management guidelines.
Answer
Obtain an endometrial sample to rule out endometrial cancer, which is crucial in postmenopausal bleeding.
The most appropriate next step in management is to obtain an endometrial sample. Postmenopausal bleeding warrants investigation to rule out endometrial cancer, even in the presence of a known fibroid.
Answer for screen readers
The most appropriate next step in management is to obtain an endometrial sample. Postmenopausal bleeding warrants investigation to rule out endometrial cancer, even in the presence of a known fibroid.
More Information
Postmenopausal bleeding (PMB) is defined as bleeding that occurs more than 12 months after a woman's last menstrual period. Although fibroids can cause abnormal bleeding, new-onset PMB always requires investigation for more serious causes such as endometrial hyperplasia or cancer.
Tips
It's important to remember that in postmenopausal women, any new bleeding should be considered suspicious until proven otherwise. While fibroids can cause bleeding, they don't rule out the possibility of more serious conditions like endometrial cancer.
Sources
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