What are some options you can discuss with sarah

Reference no: EM133250400

Case: Sarah is a 41-year-old woman who is seeing you today for an annual exam. She has been pregnant twice and had 2 full-term vaginal births at age 33 and 35, respectively. Her husband had a vasectomy, which is their current method of contraception. She takes escitalopram, 10mg orally every day for depression which started after the birth of her first child. She has no known medication allergies and no surgical history other than wisdom teeth as an adolescent. Her menstrual periods are regular, approximately every 26-28 days, but heavier than she has previously experienced. Sarah estimates that the bleeding has slowly become heavier over the past 6-12 months. She has experienced a few episodes of bleeding through her clothing and has occasionally altered her activities due to the bleeding. VS obtained by the medical assistant are WNL. BMI is 27. She does not smoke, denies drug use, and ETOH use is rare (few drinks/month). There is no history of abnormal pap smears and the last pap and HR HPV was 2 years ago, both negative.

Question 1. Given the information above, what might you expect to find on her bimanual pelvic exam? Please be specific and provide references for your answer.

Question 2. What is your top working diagnosis (provide one) and what is your top differential diagnosis (provide one)? Please provide more than a few words and include the clinical decision-making that led to your decision, with references.

Question 3. What lab tests and imaging (if any) would you consider to support your diagnosis? Please include your rationale.

Question 4. What are some options you can discuss with Sarah to address the heavy bleeding?

Reference no: EM133250400

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