A 64yo woman has been on HRT for 9yrs. She had regular withdrawal bleeds until 3 yrs ago and
since then has been taking a no bleed prep. Recently she noticed a brown vaginal discharge.
Choose the single most appropriate initial inv?
a. Cervical smear
b. High vaginal swab
c. TFT
d. Transvaginal US
answer: D
check endometrial thickness, if >5mm then biopsy
Once patient has become amenorrheic on HRT,
significant subsequent bleeding episodes require
evaluation (endometrial cancer)
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