A 32-year-old woman visits the gynaecology department with complaints of painful, heavy periods and difficulty getting pregnant. She is worried as she and her partner plan to start a family soon. Upon examination, an ultrasound scan shows a submucosal uterine fibroid measuring 4.5 cm. What is the most suitable treatment option for her fibroids?
A 35-year-old woman is suffering from menorrhagia and dysmenorrhoea, causing her to miss work and experience significant distress. She has not yet had children but hopes to in the future. An ultrasound of her pelvis reveals a 2 cm intramural fibroid and is otherwise normal. What is the best course of treatment for her symptoms?
A 50-year-old woman comes to the clinic complaining of heavy and prolonged menstrual bleeding that has been ongoing for six months, despite being treated with mefenamic and tranexamic acid. Upon conducting a transvaginal ultrasound, an endometrial thickness of 15mm is observed. What would be the next appropriate course of investigation?
A 24-year-old woman presents to a gynaecology clinic with persistent pain during sexual intercourse. Despite previous attempts with NSAIDs and progesterone-only hormonal treatments, her symptoms have not improved. She has a medical history of migraine with aura. The pain is most severe with deep penetration and worsens towards the end of her menstrual cycle. She also experiences dysmenorrhoea. During pelvic examination, tender nodularity is noted at the posterior vaginal fornix.
What is the most appropriate course of action for managing this patient’s likely diagnosis?
An 80-year-old woman presents to the clinic with complaints of persistent urinary incontinence, exacerbated by laughing or coughing. Despite undergoing supervised pelvic floor exercises for four months, she still experiences a significant impact on her quality of life. While surgical intervention was discussed, she prefers medical management. What medication would be the most suitable for managing her symptoms?
A 26-year-old woman visits her GP clinic with concerns about her chances of getting pregnant. She typically takes the combined contraceptive pill but missed her pills on days 2 and 3 of the first week of her current packet. On day 4, she engaged in unprotected sexual intercourse (UPSI). As a solution, you prescribe ulipristal acetate as an emergency contraceptive.
What is the appropriate time for her to resume her regular hormonal contraception?
A 29-year-old woman comes to the outpatients’ department for evaluation. She has a medical history of polycystic ovarian syndrome and has been trying to conceive for the past eight months without success. During the examination, she is found to be hirsute. Her height and weight measurements reveal a BMI of 24 kg/m². What is the best course of action for managing this patient?
A 14-year-old female presents with worries about not having started her periods yet. Her sisters all began menstruating at age 13. During the examination, it was observed that the patient is short, has not developed any secondary sexual characteristics, and has widely spaced nipples. Additionally, a systolic murmur was detected under the left clavicle. What finding is consistent with the most probable diagnosis for this patient?
A 52-year-old female visits her GP complaining of hot flashes, irritability, and a 7-month history of lighter periods that have become more irregular. The GP diagnoses her as perimenopausal and prescribes Elleste duet tablets (estradiol + norethisterone) as sequential combined HRT since she has not had a total abdominal hysterectomy. The GP discusses the potential risks with the patient. What is the most crucial risk to mention regarding the norethisterone component?
A 30-year-old nulliparous woman arrives at the emergency department with a positive home pregnancy test and symptoms of diarrhoea and mild abdominal discomfort that have been present for 6 hours. She has not been using any regular contraception and her last menstrual period was 8 weeks ago. The patient has a history of pelvic inflammatory disease. A transvaginal ultrasound shows a 40mm foetal sac at the ampulla of the fallopian tube without a visible heartbeat, and her serum B-HCG level is 1200 IU/L. What is the definitive indication for surgical management in this case?