Vaginal Bleeding

Postmenopausal Bleeding

• Next step:
  • Endometrial sampling or D&C
    
  • endometrial sampling = endometrial biopsy
    • simple hyperplasia next step:
      • high dose progesterone
    • atypical hyperplasia or adenocarcinoma, next step:
      • TAH + BSO
        
      • Total Abdominal Hysterectomy (gets the cancer)
        Bilateral Salpingo-oophorectomy (gets the stimulus)
    • Mets, next step:
      • TAH + BSO + chemo (carboplatin and paclitaxel)

Primary dysmenorrhea

• Management:
  • 1st line: NSAIDs (SOR A)
  • Combined oral contraceptives if the patient desires contraception
  • Combined oral contraceptives and IM and subQ progestin-only contraceptives are effective when dysmenorrhea caused by endometriosis