USMLE Step 2 Quiz
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OBSTETRICS AND GYNECOLOGY
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History: A 35-year-old woman, G2P2, with obesity and hypothyroidism (often misses levothyroxine) presents with 4 months of heavy menstrual bleeding with clots. She recently started a high-stress job and reports poor sleep. She uses a copper IUD placed 2 years ago and takes ibuprofen intermittently. Presenting issue: Menses now last 9–10 days and she feels fatigued and lightheaded. Exam shows conjunctival pallor; uterus is normal size and nontender. Diagnostics: Urine pregnancy test is negative. Hgb 9.4 g/dL, MCV 72 fL, ferritin low. TSH is mildly elevated. Transvaginal US shows a normal endometrial stripe and no masses. Considerations: She wants contraception to continue and prefers to avoid surgery.
What is the most appropriate initial treatment for this condition?
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