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A 15-year-old girl who experiences continuous heavy bleeding with menses
76%
57/75
A 49-year-old woman who wants to help decrease the symptoms of menopause but does not want the high estrogen levels found in hormone replacement therapy
11%
8/75
A 23-year-old woman with idiopathic hirsuitism
5%
4/75
A 6-year-old girl who is experiencing puberty
3%
2/75
A 26-year-old woman who has a stillbirth and wishes to suppress milk production
4%
3/75
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The 15-year-old girl described in the correct answer choice is suffering from active dysfunctional uterine bleeding (DUB). The treatment of choice for heavy bleeding associated with anovulatory cycles is OCPs. OCPs have many uses, one of which involves stabilization of the endometrium during dysfunctional uterine bleeding. If the bleeding is moderate and nonstop, a high dose OCP can be used. If bleeding is severe, IV estrogen can be used. Promotion of hemostasis is the ultimate result. Outside of this context, it is important to remember that the increase in coagulation caused by OCPs (desired in DUB) results in a contraindication to use in any patients who are hypercoagulable (e.g. factor V Leiden). Albers et al. outline the process of diagnosing DUB. Pregnancy, medications, iatrogenic causes, systemic conditions and obvious genital tract pathology can usually be ruled out as causes of DUB in women of childbearing age by detailed history, physical examination and laboratory investigation. Once these are excluded, DUB can be diagnosed, both, ovulatory or anovulatory. van Rooijen et al. examine the effects of exogenous estrogen on plasma concentrations of hemostatic factors (antithrombin, fibrinogen, prothrombin, among others). Within just two hours, rapid haemostatic activation was induced, as evidenced by alterations in hemostatic parameters when compared to baseline. Illustration A shows an algorithm for the evaluation of menorrhagia. Incorrect answers: Answer 2: Estrogen levels found in the OCP are higher than that used for HRT. Answer 3: The treatment of choice for idiopathic hirsuitism is spironolactone. Answer 4: The treatment of choice for precocious puberty is GnRH agonists (e.g. leuprolide). Answer 5: There is no recommended pharmacologic treatment to suppress milk production.
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