Question of the Week # 367

367)  A 62 year old woman presents to your office with complaints of vaginal spotting for the past three months. Occasionally, she also had vaginal bleeding. She is concerned with this new development because she has not has not had a menstrual period for the past  ten years. She  has never taken hormone replacement therapy. She also reports burning and irritation upon sexual intercourse. She denies any fever or dysuria. She has no other past medical problems and otherwise, feels healthy. On pelvic examination, vaginal epithelium is smooth, dry and shiny with complete loss of rugae. There are no obvious masses or polyps. Vaginal pH is 6.5 . Urinalysis is normal and is negative for nitrite or leucoesterase. Which of the following is the most appropriate next step in management?

A) Endometrial biopsy

B) Vaginal Estrogen Cream

C) Vaginal Lubricant Cream

D) Oral Estradiol

E) Check serum estradiol levels

8 Responses

  1. b

  2. a

  3. B) Vaginal Estrogen Cream.

    • Okay…based on Dr.Red’s explanation on the next Q its

      A) Endometrial biopsy

      We need to rule out the endometrial cause of bleeding before concluding that its from Atrophic Vaginits esp since she’s post menopausal and at a high risk of developing endometrial ca

      • So, the ans is (a)Endometrial Biopsy
        but in Question 378: Ans is Vaginal estrogen cream since Endometrial cause of bleeding is already rule out by Ultrasound.

      • I agree with you. I got the point what Dr. Red explained. Thank you so much Dr. Red.

  4. b, this is atrophic vaginitis

  5. Every post menopausal bleeding should be investigated. There are two options: transvaginal usg (to check the endometrial stripe thickness) and Endometrial biopsy. Even though this lady has features of atrophic vaginitis, we should investigate her to rule out endometrial cancer. If the result come out negative, treat her as atrophic vaginitis.
    Answer: A

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