A30-year woman 2+0. hypertension have menorrhagia. Which of the follow ing is the best treatment for her?
Ans-B MIRENA (Ref: Novaks 15/e p788; Williams Gynae l/e p187-188]Best treatment among the given options for a 30-year woman 2+0, with hypertension and menorrhagia, is MI REIS A.In this question, the female patient is 30 years old. i.e. very young so we should not choose hysterectomy or endometrial ablation as the management of choice because in future she might desire pregnancy. The patient is hypertensive, hence OCPs are contraindicated, so our answer by exclusion is Mirena, which is logically also correct, as this patient has 2 children so she might not desire pregnancy presently f Mirena controls bleeding and have contraceptive benefit).Heavy menstrual bleeding that doesn't respond to oral medication may be managed by endometrial ablation using coagulation, resection or vaporization provided that patient is willing to forgo future fertility. Alternatively, future fertility is desired, a levonorgestrel-releasing intrauterine device can provide a virtually equal clinical outcome. Novaks 15/ep788Levonorgestrel Intrauterine System (MIRENA)* It is a T-shaped intrauterine device which releases levonorgestrel at the rate of 20 meg daily.* This low hormone minimizes the systemic progestin side effects and more patients will continue this therapy than cyclic progesterone.* It exerts its clinical effect by preventing endometrial proliferation and consequently reduces both the duration of bleeding and the amount of menstrual loss.* The levonorgestrel-releasing system is also advocated as an alternative to surgery in dysfunctional uterine bleeding." The LNG /US can be used in all women as the first line of treatment of menorrhagia in place of oral medications. It is particularly useful in reproductive-aged women who desire contraception. Williams Gynae 1/e p187-188
Combined pills
MIRENA
Hysterectomy
Transcervical resection of endometrium