SHORT ANSWER MANAGEMENT POP QUIZ:
For a patient with abnormal uterine bleeding (AUB):
- List THREE classes of hormonal medications you would recommend
- List TWO classes of NONhormonal medications you would recommend
- List THREE surgeries used to treat AUB
CFP articles are great exam study resources!
For example -- check out this article from 2015 on Abnormal Uterine Bleeding.
Try reading the case stem and covering up the investigations paragraph -- ask yourself what investigations would you order for this patient. Then have a look at the recommended investigations. Did you get them all? Did you request an endometrial biopsy?
I can't emphasize enough the importance of the endometrial biopsy in perimenopause. It is an easy test -- if you can put in an IUD, you can do an endometrial biopsy!! It is a necessary test -- for perimenopausal patients with AUB, you should almost always do one to rule out endometrial cancer! It is a helpful test -- if it is negative, you can manage the patient symptomatically and save them a gynecologic referral!
How do you manage the patient symptomatically? Stop the bleeding! Your options are hormones (combined hormonal contraceptives, progestins, and the LNG-IUS), nonhormones (NSAIDs or Antifibrinolytic a.k.a. transexamic acid) and surgery (ablation, myomectomy and hysterectomy -- now rarely necessary due to the efficacy of the LNG-IUS!)
Remember, on an exam, avoid saying "I'm a resident" or "I''ll discuss this with my supervisor." Instead, you are a confident and skilled family physician who is proficient in procedures within our scope of practice -- regardless of whether you feel confident to do them in "real life." Confidently say or write that you would perform an endometrial biopsy -- and when you are in practice, I encourage you to give it a try! It's not as daunting as you think.