A 50-year-old woman has presented to your clinic for postmenopausal bleeding. During the medical history, you inquire about her medical and family history to identify any factors that may elevate her risk of endometrial cancer. What factors are linked to an increased risk of endometrial cancer?
You are recommending hormone replacement therapy (HRT) for a 50-year-old woman who is healthy but is suffering from severe menopausal symptoms. She is curious about the advantages and disadvantages of various HRT options.
What is the accurate response concerning the risk of cancer associated with different types of HRT preparations?
A 36-year-old patient undergoing IVF for tubal disease presents with abdominal discomfort, nausea, and vomiting four days after egg retrieval. She has a history of well-controlled Crohn’s disease and is currently taking azathioprine maintenance therapy. On examination, her abdomen appears distended. What is the most likely diagnosis in this scenario?
Sophie is a 32-year-old mother of two, who is uncertain if she wants to have more children. She comes to you with a history of not having a period for the past 9 months. Sophie had regular menstrual cycles for 28 months after giving birth to her last child. She has never used any hormonal birth control or undergone any surgeries. Upon examination, her abdomen and gynecological areas appear normal, and there are no signs of hyperandrogenism. A pregnancy test confirms that she is not pregnant.
Lab results show a decrease in follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol levels, while prolactin, thyroid-stimulating hormone (TSH), and T4 levels are normal. A 10-day progestin challenge fails to induce a withdrawal bleed.
What is the underlying cause of Sophie’s amenorrhea?
A 55-year-old nulliparous woman presents to the gynaecology clinic with a 3-month history of postmenopausal bleeding. She has a medical history of type 2 diabetes mellitus and her last menstrual period was 5 years ago.
On transvaginal ultrasound, the endometrial thickness measures 7mm. The pipelle biopsy results indicate an increased gland-to-stroma ratio and some nuclear atypia.
What is the best course of action for management?
A 32-year-old woman visits her GP with complaints of left-sided pelvic pain and deep dyspareunia at 16 weeks of pregnancy. She has not experienced any vaginal bleeding, discharge, or dysuria. Her pregnancy has been uncomplicated so far, and she has a gravid uterus that is large for her gestational age. Her vital signs are stable, with a temperature of 37.1ºC, blood pressure of 110/70 mmHg, heart rate of 70 beats/min, and respiratory rate of 18 breaths/minute. She had an intrauterine system for menorrhagia before conception and has no other medical history. What is the most probable cause of her symptoms?
A 67-year-old postmenopausal woman comes to you with complaints of bloating, unintended weight loss, dyspareunia, and an elevated CA-125. What is the most appropriate term to describe the initial spread of this cancer, given the probable diagnosis?
A 16-year-old Ethiopian girl has come to the emergency department complaining of recurring urinary tract infections. During the examination, you and a chaperone observe that the girl may have undergone clitoridectomy, indicating that she may have been a victim of female genital mutilation (FGM). The girl requests antibiotics and that no one else be informed. In addition to treating the infection, what actions should you take?
A 25-year-old female presents to her GP with symptoms of vaginal candidiasis, including ‘cottage cheese’-like discharge, itching, and dyspareunia. She has had four previous presentations with similar symptoms in the past year. The patient is in good health and does not report any other symptoms. She is not taking any regular medications. What test would be most helpful in investigating a possible underlying cause for her recurrent vaginal candidiasis?
A 22-year-old female presents to her general practitioner seeking contraception. She has a past medical history of spina bifida, for which she uses a wheelchair. She has a family history of endometrial cancer, smokes 5 cigarettes a day and regularly drinks 20 units of alcohol per week. Her observations show:
Respiratory rate 18/min
Blood pressure 95/68 mmHg
Temperature 37.1ºC
Heart rate 92 bpm
Oxygen saturation 97% on room air
What would be a contraindication for starting the combined oral contraceptive pill for this patient?