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Original Question

A 58-year-old woman presents to her obstetrician/gynecologist complaining of 4 months of intermittent, light vaginal bleeding unassociated with any particular activity. She reports her last menses occurred 7 years ago, and she has had mild hot flashes and mild vaginal dryness and irritation since then. She has no other complaints. The patient denies health problems other than hypertension well controlled on a single antihypertensive agent and Type 2 diabetes mellitus, diagnosed approximately 5 years ago, well controlled on oral medications. On examination, the patient is moderately overweight but in no distress. Her temperature is 99°F, heart rate is 95 beats/min (bpm), and blood pressure is 128/88 mm Hg. The skin has no lesions. Her heart and lung examinations are unremarkable. The abdominal examination reveals normoactive bowel sounds, no tenderness, guarding, or rebound, and no masses, but the examination is difficult secondary to central obesity. The speculum examination reveals minimal dark blood in the vaginal vault and no visible cervical, vaginal, or vulvar abnormalities. Pelvic bimanual examination reveals a small, anteverted, smoothly contoured uterus. The ovaries are not palpable. The complete blood count reveals a hemoglobin of 13.2 g/dL and a hematocrit (Hct) of 39%. 1.what is the diagnosis? 2. what is next diagnostic step? 3. what is next step in therapy ?

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