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Heavy Menstrual Bleeding — UKMLA MCQ

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MediumObstetrics & GynaecologyHeavy Menstrual BleedingUKMLA

A 42-year-old woman with heavy menstrual bleeding (HMB) fails medical therapy (tranexamic acid, hormonal treatments). According to NICE, what is the recommended next investigation before surgical intervention?

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Correct answer: C — Hysteroscopy and endometrial biopsy

For women with HMB unresponsive to medical therapy, NICE advises hysteroscopy and endometrial sampling to exclude endometrial pathology before definitive surgical procedures. Pelvic ultrasound is often done earlier, but direct visualization and biopsy are key. Ablation is considered after appropriate assessment.

Reference: NICE Heavy Menstrual Bleeding Guideline