Risk (and pretest probability)
Nuliparity, obesity, anovulatory cycles, family history of colon cancer, age >40 are risk factors, diabetes, tamoxifen use, PCOS are all risk factors for this.
What is endometrial cancer?
Patient states she had regular monthly periods but recently missed her period x 2 months. She looked it up online and is convinced she has PCOS and desires lab testing/ultrasound to confirm. This is the most appropriate screening test you order for her presenting condition.
What is a pregnancy test?
Patient noted she skipped her period, had some mild spotting and recent weight gain. You order this.
What is a pregnancy test?
Patient had nexplanon placed and presents with irregular bleeding. You advise this is most effective in controlling nexplanon irregular bleeding.
Patient with heavy menses, soaking pad and tampon every 2 hours. She's having fatigue but feels that she is always that way. You want to screen her for anemia with these 2 labs.
What are CBC AND ferritin?
This condition affects ultrasounds negative predictive value of endometrial stripe <4mm for endometrial cancer.
What are fibroids/leiomyomas?
Pt states period is irregular. Reviewing her periods they are on the 5th one month, then late 4-5 days the following month and seems to never occur on the same day. You advise this.
Patient with history of DM reporting irregular periods every 2-3 months for past 2 years when previously regular as a teenager and in her 20s. She's also had some increase weight loss, increase thirst and urination which has worsened within the last year. Pregnancy test is negative. This is the more likely diagnosis than PCOS.
What is uncontrolled DM?
Patient reports she is having heavy bleeding - soaking through tampon and pad every 1-2 hours. She's nervous because her period is about to start. You prescribe this.
What is high dose progesterone? (acceptable 20mg provera daily x 10 days or depo-provera)
Patient 45 yo G2P2002 who recently had increase in flow of her period, much heavier with clots. Thinking maybe starting to have some hot flashes. "Is this perimenopause?" she asks. Her ultrasound ordered by her previous doctor was normal. You offer this.
What is endometrial biopsy?
This hormone, specifically resistance/sensitivity patterns to this hormone, is theorized as a contributor of abnormal uterine bleeding in patients with obesity, metabolic syndrome or type 2 diabetes.
What is insulin?
Patient in her 20s stated she's never had regular periods happening every 3-4 months 2-3 days.. Has facial growth on her chin which she shaves. Mild elevation in her BMI. She has mild elevated free testosterone, normal estrogen, normal SBH, normal TSH. Ultrasound has multiple follicles on ovaries without dominant follicle. You tell her she has this.
What is PCOS?
Patient with heavy regular periods. She also has hypertension and diabetes complicated by CKD stage 2 - that she is struggling to control. She does not like hormones given side effects it has given her in the past. You prescribe this.
Patient 55 yo LMP 15 months ago. Patient noted a few days of period like bleeding about 2 months ago, but didn't come in because she figured it was her period just figuring out how to stop. You advise this.
What is order ultrasound or EMB?
Patient has endometrial hyperplasia and is started on treatment with depoprovera. You advise every 3 months endometrial sampling to monitor for this complication.
What is endometrial cancer? (Acceptable hyperplasia with atypia)
Patient diagnosed with PCOS due to irregular periods and high testosterone on lab confirmed and is here for hormonal management. You note on your exam presence of round face, hump on her upper back, upper body obesity, and mildly elevated blood pressure. You ask about any abdominal rashes/skin changes - patient endorses purple streaks. You consider this diagnosis and order dexamethasone suppression test.
What is cushings? (acceptable adrenal disorder)
Patient presents with weight gain, fatigue, and amenorrhea following her most recent delivery which was complicated by massive postpartum hemorrhage requiring several unit transfusion. Prior to pregnancy she had normal periods. She is not breastfeeding because her "milk didn't come in." This is at the top of your differential.
What is hypopituitarism (Sheenan's syndrome)?
Patient with history of painful and heavy bleeding - where she is needing to miss 2-3 days of work as a teacher. History of laparoscopic surgery for endometriosis, but continued with weekly heavy periods. She cannot tolerate mood side effects of a variety of COC, has family history of breast cancer sensitive to progesterone so she is too worried to take this. She's not ready for surgery. You advise this as an option.
What is leuprolide (lupron)?
Patient is 37 yo G0 with history of obesity, pcos with heavy menses; increasing clots and soaking through pads every 2 hours. Her lab work up found mild anemia, normal thyroid. She was prescribed OCPs after 3 months she sees no difference. Her ultrasound was only significant for 2 fibroids <3cm each. You advise this.
What is endometrial biopsy?