Ugeskrift for Læger

Postcoital bleeding in premenopausal women

Postcoital bleeding is a common symptom in premenopausal women and is often caused by benign conditions, e.g., infections, polyps, or physiological changes. Although cervical cancer is a rare outcome in premenopausal women with postcoital bleeding, many women are referred to gynecological clinics, resulting in unnecessary procedures. Through an investigation of the latest literature, this review finds a very low incidence of malignancy among women referred for postcoital bleeding in Denmark. Thus, there is a need for a national guideline that defines the diagnostic pathways for premenopausal women with postcoital bleeding.

The elimination of cervical cancer in Danmark

In 2020, WHO introduced an ambitious goal to eliminate cervical cancer by reaching and maintaining an incidence rate of below 4 per 100,000 women years, building on three key pillars: Vaccination, screening for and treatment of precancerous lesions with corresponding targets defined. This review describes the Danish status of targets where a continued high adherence to HPV vaccination and more women between the ages of 30-59 being screened is crucial. The authorities should prioritise monitoring the pillars important for the elimination and intervene in case Denmark is not on target.

Intravenous iron preoperatively for woman with severe anaemia

Iron deficiency is the main cause of anaemia, especially in premenopausal due to heavy menstrual bleeding. In this case report, an asymptomatic woman presented with a haemoglobin level of 3.9 mmol/l. Due to uterine fibroids, she was scheduled for myomectomy, and she was treated with IV iron. Fourteen days post infusion her haemoglobin level was 6.3 mmol/l. This highlights the importance of screening women for heavy menstrual bleeding causing iron deficiency, and encourage at-risk women to take iron supplements. Furthermore, one should be aware of IV iron therapy as an alternative to blood transfusion in treating iron deficiency anaemia.

Life-threatening vaginal bleeding after starting rivaroxaban treatment

This is a case report of a 44-year-old premenopausal woman who was admitted to hospital due to uncontrollable and life-threatening vaginal bleeding after starting rivaroxaban treatment for atrial fibrillation. She had a medical history with menorrhagia due to an intrauterine fibroma. She did not respond sufficiently to factor X supplement or other non-surgical medical interventions. The bleeding subsided after bilateral embolization of aa. uterinae.