Step 2

Obstetrics 2

A 48-year-old woman, gravida 1 para 1, comes to the office for evaluation of increasingly heavy menses. For the last 6 months, her menses have lasted for 4-5 days, occurring every 20-25 days, with heavy bleeding, cramps, and passage of clots. Her last menstrual period was 2 days ago. She had one cesarean delivery 20 years ago for the birth of her daughter and states she does not desire any more pregnancies. She takes lisinopril for hypertension, which is well-controlled. She does not drink alcohol or use tobacco or illicit drugs. Temperature is 37.1° C (98.6° F), blood pressure 118/72 mmHg, pulse 112 beats/min, and body mass index (BMI) is 26 kg/m2. On physical examination, the patient appears pale and fatigued. On pelvic examination, the uterus is mobile and appears uniformly enlarged. Speculum examination reveals a normal vagina and cervix. Transvaginal ultrasound is performed reveals an enlarged uterus and asymmetric thickening of the myometrium consistent with adenomyosis.

Which of the following is a possible treatment option for the patient?

  • A) Expectant management
  • B) Fallopian tube ligation
  • C) Hysterectomy
  • D) Intrauterine device
  • E) Oral contraceptive pills

Authors

Manya Kumar

Editor

Dr. Ted O'Connell

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