Ep 10: A 36-year-old with heavy menstrual bleeding and inability to conceive

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.A 36-year-old woman, Para 0 + 1, presents with a 10-year history of inability to conceive despite regular unprotected coitus and a 2-year history of heavy menstrual bleeding. She reports prolonged periods lasting 8–10 days with passage of clots and associated dysmenorrhea. She denies post-coital bleeding but notes intermenstrual spotting occasionally. There is no history of chronic pelvic pain, weight loss, or systemic symptoms. On abdominal examination, there is a firm, irregular pelvic-abdominal mass corresponding to an 18-week gravid uterus. The mass is non-tender, nodular, and moves with the cervix. No ascites is detected. These are her laboratory results: Haemoglobin 8.9 g/dL, Serum Ferritin /dL, MCV 74 fL, 9 ng/mL, β-hCG Negative, FSH7 IU/L, LH 6 IU/L, TSH 2.1 µIU/L, and Prolactin14 ng/mL.