Patient Information Sheet 1

A 48 years old lady, Para 2, last child birth 10 years ago with chief complaint of
excessive menstrual bleeding with clots and flooding and prolonged monthly period
for 3 years duration. It is associated with pelvic pain and urinary incontinence. She
also complaint of fatigue and tiredness.

Over the past months she has also experienced lethargy and weakness

She recently visited her primary care physician for tiredness and was diagnosed with
moderate anaemia (haemoglobin of 90 g/L [9 g/dL]).

She has an enlarged abdomen which can be mistaken for weight gain or pregnancy.

Initially, lower abdominal swelling is not associated any symptoms apart from vague
abdominal discomfort especially after meal. There is no history of nausea, vomiting,
loss of weight and loss of appetite.

However, there was history of bowel and bladder discomfort (constipation, difficulty in
initiation of micturition and sometime urgency.

She denied use of hormonal therapy and contraception before.

Menarche at age of 13 years and menstrual irregularities was reported for 10 years
prior to presentation. She had history of regular monthly menstrual cycle with normal
flow which last about one week duration before. Latest pap smear was 2 years ago
and told to have normal smear.

No relevant past medical history like chronic infection, renal failure.

No relevant past surgical history.

Family history is remarkable for a sister who underwent hysterectomy at age 49 for
uterine fibroids.

No Known drug allergy.