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 25-year-old woman, who has never been pregnant, complains of chronic pain in her pelvis and sacrum during her menstrual cycle. Her temperature is 37.2 degrees Celsius. During the examination, there is tenderness in her posterior vaginal fornix and uterine motion tenderness. A pelvic ultrasound shows no abnormalities. What is the subsequent diagnostic test recommended?
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?