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Heavy menstrual bleeding from fibroids — MCCQE Part 1 MCQ

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EasyAbnormal BleedingHeavy menstrual bleeding from fibroidsMCCQE Part 1

41-year-old woman presents with heavy regular menses. She has a bulky irregular uterus and iron deficiency. Which of the following is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Check pregnancy test/CBC, assess structural causes and discuss medical versus procedural options

Check pregnancy test/CBC, assess structural causes and discuss medical versus procedural options is best because fibroids commonly cause heavy regular bleeding and anaemia. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Always exclude pregnancy in reproductive-age bleeding.

Reference: SOGC abnormal uterine bleeding guidance