Question

38-year-old nulligravid woman presents due to persistent AUB. The patient's menstrual periods previously occurred monthly & consisted of 4 days of moderate bleeding & light cramping. However, for the past 8 months, she has had intermenstual spotting & bleeding that have occurred at varying intervals & last 3-7 days. She was started on combo OCPs 4 months ago, which has not improved the bleeding pattern. Temp: 37.2C (99F); BP: 126/76; HR: 86/min; BMI: 29kg/m2. Speculum exam shows dark red blood in the posterior vaginal vault but no cervical or vaginal lesions. Remainder of the pelvic exam is normal. Lab results:

hemoglobin: 12.2g/dL (Normal: 12-16)
prolactin: 5 ng/mL (normal: < 20)
TSH: 1.8 uU/mL (normal: 0.5-5.0)
Urine hCG is negative. Pelvic US shows an anteverted uterus & no adnexal masses. Which of the following is the best next step in the management of this patient?
A. Coagulation studies
B. Endometrial ablation
C. Endometrial biopsy
D. Hysterosalpingogram
E. Progesterone withdrawal test

Answer 1

An Endometrial biopsy is the best next step in managing the case of a 38-year-old with persistent abnormal uterine bleeding, as it helps to exclude endometrial hyperplasia or malignancy. The correct answer is option: C. Endometrial biopsy

Step-by-step explanation:

The best next step in the management of this 38-year-old nulligravid woman with persistent abnormal uterine bleeding (AUB) is an Endometrial biopsy (C). Given her age and the fact that nonpharmacological interventions such as combination oral contraceptive pills have not resolved her symptoms, it is critical to assess for any potential endometrial pathology.

The normal lab results and unremarkable pelvic ultrasound suggest that other potential causes of AUB, such as thyroid dysfunction, pregnancy, or structural abnormalities, are not present. An endometrial biopsy is a standard procedure in the evaluation of persistent AUB in women aged 35 years and older to exclude endometrial hyperplasia or malignancy, even in the presence of normal imaging studies.