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Neal Rouzier’s Interesting Case Studies

These interesting and informative Case Studies were pulled and submitted by Neal Rouzier.

Questions will by typed out and just hover over the “answer” text to see what Neal has to say.

Doctor I’m bleeding!

A 45 year old pre-menopausal woman presents with prolonged periods and heavy bleeding. Ultrasound shows no fibroids or polyps. Endometrial stripe is normal and endometrial biopsy is negative. Any endometrial pathology has therefore been excluded. What is the treatment to diminish bleeding acutely?

1) BCP’s  2) Progesterone in high doses  3) Mirena  4) IUD  5) Tranexamic acid (Lysteda)  6) Uterine (endometrial) ablation


Question: Amenorrhea vs. Anovulation

Your 21 year old daughter, a track star, has had no period for 2 years. No symptoms, hot flashes or night sweats or hormonal complaints. Recent OB-GYN tested DEXA and found T-score of -2.4. PMD gave her BCP’s to protect her bones. She doesn’t wish to take and refuses BCP’s. How would you treat your daughter? If it was you, how would you treat yourself?


Question: An 80 year old female presents with history of vaginal bleed and endometrial proliferation.  The endometrial stripe measures 0.9 cm: biopsy is negative.  Patient can’t stop estrogen due to vasomotor symptoms and osteoporosis.  She did not tolerate Provera 5mg by PMD.  What is the treatment plan?


Question: A 52 year old female presents with severe hot flashes. Her FSH = 56 and her estradiol = 210.  What is the treatment plan?


Question: A 44 year old female on BCP’s for PCOS, present with PMS, fatigue, headaches and no libido.  Her total testosterone = 90 (high) and her free testosterone = 0.2 (low).  What is the treatment plan?


Have other interesting cases, feel free to send them along.  Hope this is helpful and hope to see you soon at another Worldlink event.


– Neal Rouzier, MD

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