Intermenstrual bleeding — DRCOG MCQ

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HardGynaecologyIntermenstrual bleedingDRCOG

A 32-year-old has 3 months of intermenstrual bleeding. She uses condoms, cervical screening is current, and she is haemodynamically stable without pelvic pain. What is the most appropriate initial assessment?

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Correct answer: C — Pregnancy testing, speculum examination and targeted STI testing

The best answer is “Pregnancy testing, speculum examination and targeted STI testing”. Initial assessment should establish pregnancy status and look directly for cervical or vaginal causes such as cervicitis, ectropion, polyps or a suspicious lesion, with STI testing guided by risk and findings. Current cervical screening does not replace examination of symptomatic bleeding. Ultrasound or endometrial assessment may follow when the history, examination, age or persistence suggests uterine pathology, but neither should displace the essential first clinical assessment. Antenatal decisions combine gestation, maternal stability, fetal risk and whether care can safely remain in the community. Screening, diagnostic testing and urgent assessment are not interchangeable. The UK pathway should be followed with clear safety-netting whenever symptoms may evolve before the next routine appointment.

Reference: NICE NG12: Suspected cancer recognition and referral: https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer Cambridge University Hospitals NHS Foundation Trust: Cervical ectropion: https://www.cuh.nhs.uk/patient-information/cervical-ectropion/