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Case No. 166

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Post-Menopau...

Post-Menopausal Bleeding

Clinical Scenario
Cheryl is a 63-year-old female who presents to her family physician's office with a complaint of 3 recent episodes of vaginal bleeding. She hit menopause at the age of 56 years old. She luckily did not have much in the way of menopausal symptoms so she has never taken postmenopausal hormone therapy. On further history, she reports the bleeding started less than 1 month ago and she denies recent trauma. There are no identified patterns and it is not related to sexual activity. She is otherwise healthy, only taking an antihypertensive for her high blood pressure. She is otherwise not taking other medications or herbal supplements. She is adopted so she is unsure of family history of cancers. On exam, she appears to be in no acute distress. She has a BMI of 31. Otherwise, the rest of the exam is unremarkable.
Question
Which is not recommended as a first-line investigation in Cheryl's case?
  • Thorough physical examination including external and internal anatomy of female genital tract.
  • Transvaginal ultrasound
  • OR-based diagnostic dilatation and curettage
  • Office-based endometrial biopsy
  • Question
    Which is not recommended as a first-line investigation in Cheryl's case?
  • Thorough physical examination including external and internal anatomy of female genital tract.
  • Transvaginal ultrasound
  • OR-based diagnostic dilatation and curettage
  • Office-based endometrial biopsy
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