Episode Chapters
- More Listener Love21:10Transgender Care23:19Paper Chase #1 - Metoprolol to Prevent Acute COPD Flare6:33Diabetic NeuropathyFree Chapter20:17Food Allergies, Part 1Free Chapter27:53Paper Chase #2 - Dapagliflozin in Patients with Heart Failure and Reduced EF6:14TIDBSI: Tramadol16:45Food Allergies, Part 210:51Paper Chase #3 - HOPE Trial for Prednisolone in Hand Arthritis8:04Destigmatizing Therapy20:49Paper Chase #4 - Postdischarge Visits with PCPs6:18Precharting10:12Pre/Post Menopausal Vaginal Bleeding18:48Paper Chase #5 - Periop Management of A-Fib on DOACs6:32Mailbag13:52
Vaginal bleeding - an Ob/Gyn concern, right? Not so fast. Turns out, we can handle quite a bit of this in primary care. Neda and Dr. Megan Jones dive into diagnosis and management of bleeding in both the pre and post-menopausal woman.
Primary Care RAP Written Summary April 2020 1 MB - PDF
Ian L., Dr - April 18, 2020 9:24 PM
Is one vaginal ultrasound for post menopausal bleeding sensitive and specific enough for the 5mm cut off .?
Neda F., MD - April 20, 2020 6:40 AM
Hi Ian. Here's Dr. Jones' response: "Yes a transvaginal ultrasound looking at endometrial thickness (<5mm) is very sensitive & specific for a non-invasive measure to rule out hyperplasia/CA in a postmenopausal woman. If the thickness is <5mm, then atrophy is most likely & this can be treated with local estrogen. If >5mm, then biopsy is warranted.
If recurrent vag bleeding onsets with repeat vag ultrasound showing endometrial thickness <5mm then further investigation would be warranted to eval if a polyp or focal area of hyperplasia/CA is present. This would be more invasive with endometrial biopsy or hysteroscopy/D&C."