A 30-year-old woman para 2+0, hypertension have menorrhagia. Which is best treatment for her?
Ans. is b, i.e. MirenaRef: Novak 15th/ed, p788; Williams Gynae 1st/ed, p187-l88In this particular question, female 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.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 may not desire pregnancy presently.Thus, Mirena serves 2 purposes in this female-I. Controls bleedingII. Contraceptive benefit.In future, if she desires pregnancy, she may get mirena removed.Our answer is further supported by the following lines -"The LNG IUS can be used in all women as a first line of treatment of menorrhagia inplace of oral medications. It is particularly useful in reproductive aged women who desire contraception." - Ref: Williams Gynae 1st/ed, p188"Heavy menstrual bleeding that doesnot 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 if future fertility is desired, a levonorgestrel releasing intrauterine device can provide virtually equal clinical outcome." - Ref: Novak 15th/ed, p788
Combined pills
Mirena
Hysterectomy
Transcervical resection of endometrium
Disorders in Menstruation