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History of Present Illness
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The patient’s current clinical picture is consistent with anovulatory bleeding secondary to polycystic ovary syndrome (PCOS).
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What signs and symptoms of anovulatory bleeding does the patient have?
Hint: See Anovulatory Bleeding in PPP
What is the treatment of choice for anovulatory bleeding in patients with PCOS that do not desire pregnancy?
Hint: See Anovulatory Bleeding and Figure 50-3 in PPP
What nonpharmacologic treatment recommendations can be made for patients with PCOS that do not desire pregnancy?
Hint: See Anovulatory Bleeding in PPP
What risks and adverse effects of therapy would you discuss with the patient?
Hint: See Dysmenorrhea and Table 50-1 in PPP
If the patient had a contraindication to first-line therapy, which progestin option would you recommend for the patient?
Hint: See Anovulatory Bleeding and Figure 50-3 in PPP
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What pharmacologic treatment recommendations can be made for the patient in the future if she desires pregnancy?
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Anovulatory bleeding is a common condition. Assessment of the patient’s desire for pregnancy should be among the first steps. In patients with anovulatory bleeding due to PCOS that do not desire pregnancy, the use of a combined hormonal contraceptive that contains a progestin with reduced or antiandrogenic effects is preferred. Progestin-only options –oral, depot, or intrauterine devices – may also be used. In a patent with anovulatory bleeding secondary to PCOS, and desires pregnancy, letrozole is the treatment of choice.
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American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 194: polycystic ovary syndrome.
Obstet Gynecol. 2018;131:e157–171.
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American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 557: management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women.
Obstet Gynecol. 2013;121:891–896.
[PubMed: 23635706]
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American College of Obstetricians and Gynecologists. ACOG committee opinion no. 136: management of abnormal uterine bleeding associated with ovulatory dysfunction.
Obstet Gynecol. 2013;122:176–185.
[PubMed: 23787936]
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M. Abnormal uterine bleeding in premenopausal women.
Am Fam Physician. 2019;99:435–443.
[PubMed: 30932448]
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Azziz
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et al. Polycystic ovary syndrome. Nat Rev Dis Prim. 2016;2:16057.
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