55 year old female patient Salma, wife of Muhammad Iqbal, married since 36 years

(consanguineous marriage), housewife, resident of Surjani Town, parity of 5 (all children

alive), reported to the Civil OPD on 5th April 2023 at around 9:00 AM with the
presenting complaint of post menopausal bleeding since 3 months.

History of Presenting Complaint:

According to the patient, she was in her usual state of health when she started bleeding
vaginally 3 months ago. The bleeding was characterized by bright red blood flow, and
was significant enough to soak through 3-4 clothes per day. In addition, Salma reported
experiencing pelvic pain, dysuria, urine hesitancy, and dyspareunia. Notably, there was
no post-coital bleeding, weight loss, or loss of appetite. A Pap smear was conducted 1
month ago and yielded negative results. The patient had her menarche at the age of 12
and had normal regular menstruation before menopause, with a 3-day duration. She
reached menopause 13 years ago.

Treatment History:
On 23rd January 2023, Salma got an ultrasound from Alkhidmat that showed a mass in
her ovary, and she was prescribed medicine (a red and white small capsule) by a local
doctor which was effective initially. However, over time, the bleeding worsened, and
clots started appearing in the blood. Salma also started bed wetting 2 months ago.

Past History:
Salma has a past history of leukorrhea, which is foul-smelling, and it is a family problem
that she tried getting treated many times, but to no avail. She also developed
hemorrhoids and constipation after the delivery of her 2nd child, and she got the
hemorrhoids treated. The patient also has hypertension since 5 years and takes
medicines for it.

Past Obstetric History:

Salma has a parity of 5, with all of her children born through normal delivery. She had a
2-year gap between each delivery and all of her children are alive. She faced no
complications during any of her past deliveries.

Family History:
Salma has a family history of leukorrhea. There is no history of cancer, diabetes, or any
other chronic illness in the family.

Personal History:
Salma reports that she has insomnia but no lack of appetite or addiction.

Socioeconomic History:
Six family members live in a single-story house with 3 rooms, proper ventilation, and
sunlight. The family drinks tap water and there are 2 breadwinners.