A 38-year-old woman presents with painless post-coital bleeding. She had a cone biopsy for carcinoma in situ five years ago. Her last smear was three months ago, following this. Her last period was six weeks ago.Mostproable diagnosis is:
The recurrence of abnormal vaginal bleeding in a patient with a previous history of a cone biopsy would raise concerns of carcinoma of the cervix.
Her last smear was nearly five years ago,indicating she defaulted from follow-up after her cone biopsy.
Six weeks amenorrhoeamight raise concerns about an ectopic pregnancy but the absence of pain makes this unlikely.
It would always be wise to perform a pregnancy test and scan if in any about.
Carcinoma of cervix
Ectopic pregnancy
Endometrial carcinoma.
Uterine fibroids.