Question

45 yo F is evaluated for heavy menstrual bleeding. Reports heavy unpredictable bleeding of variable flow and duration over past year. Last period 12 days ago. Has a hx of provoked deep venous thrombosis 3 years ago following an intercontinent flight. Most appropriate management?

Answer 1

The management for a 45-year-old female with heavy menstrual bleeding and a history of deep venous thrombosis should focus on non-hormonal or progestin-only therapies and investigation for underlying disorders, considering the thrombotic risk associated with estrogen-containing treatments.

Step-by-step explanation:

The most appropriate management for a 45-year-old female evaluated for heavy menstrual bleeding with a history of provoked deep venous thrombosis (DVT) would require a careful balance between managing the bleeding and avoiding increased thrombotic risk. Given the history of DVT, treatments that do not increase the risk of blood clots should be considered. Hormonal therapies such as combined oral contraceptives, which can regulate menstrual cycles and decrease bleeding, are often contraindicated in women with a history of thrombosis. Instead, the management approach may involve the use of progestin-only therapies or non-hormonal options such as tranexamic acid. Furthermore, an assessment for possible underlying disorders, such as bleeding disorders, fibroids, or adenomyosis, might be necessary. The patient’s unpredictable heavy bleeding may also suggest a possible transition to peri-menopause, where hormonal fluctuations can lead to such symptoms. It is crucial for the patient to consult with her healthcare provider to explore appropriate management options tailored to her personal medical history and current symptoms.