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Presentation of  Atrophic vaginitis

A 64 y old woman presents with vaginal bleeding similar to “spotting” that has occurred daily for 1 mo. Her last menses was at age 50 and she has been healthy her entire life. She denies fever,weight loss, or abdominal pain.Physical examination is normal.
the most likely diagnosis is?
  • a.Atrophic vaginitis
  • b.Endometriosis
  • c.Uterine leiomyoma
  • d.Endometrial carcinoma
  • e.Polycystic ovarian syndrome

The answer is ( a ).
The most commoncause of postmenopausal vaginal bleeding is atrophic vaginitis (with or without trauma).
Endometriosis is the most common cause of infertility;patients present with dyspareunia (painful intercourse), abnormal vaginal bleeding, and pelvic pain. Uterine leiomyomas (uterine fibroids) change in size with the menstrual cycle but regress in size during menopause. Often the fibroid is palpable on pelvic examination. Polycystic ovarian syndrome (Stein-Leventhal syndrome) affects younger women (15–30). The etiology of polycystic ovary syndrome is unknown; patients present with amenorrhea, obesity, hirsutism, and infertility. All postmenopausal women with vaginal bleeding require a biopsy to rule out endometrial carcinoma.

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