A. Will continue treatment with tranexamic acid.
B. Counsel the patient directly for hysterectomy considering age, ET and BMI in mind.
C. Undertake outpatient hysteroscopy and endometrial biopsy
D. Undertake outpatient hysteroscopy and endometrial biopsy and discuss risk/benefits of insertion of Mirena LNG-IUS with the woman prior to hysteroscopy.
E. General anaesthetic day-case hysteroscopy and endometrial ablation
F. Request a full blood count, endocrine profile (FSH, LH, testosterone, prolactin, day 21 progesterone, estradiol, TFTs) and fasting glucose/HbA1c.
G. Hysteroscopic polypectomy
H. Undergo imaging, with biomarkers and MDT meeting before any treatment.
I. Laparotomy with hysterectomy
J. Staging Laparotomy with hysterectomy and bilateral salpingectomy
K. Hysteroscopic guided polypectomy with endometrial biopsy
L. Laparoscopic hysterectomy with bilateral salpingo-oopherectomy
M. LNG-IUS followed by EB after 3 months
For each patient described below choose the single most appropriate management option from the list. Each option may be used once, more than once, or not at all.
51. Mrs.X is a 48-year-old woman, para 3, BMI- 38, presenting to secondary care with a 3-year history of worsening HMB with irregularity of her menstrual cycle. She is unresponsive to a 4 month course of transexamic acid treatment. Her cervical smear 12 months ago was normal. The woman’s pelvic ultrasound shows endometrial thickness of 15 mm with no uterine structural abnormalities and normal ovaries. What is the further line of management?