Mrs. E, a 55-year-old G1,P1 presents as a new patient, having just moved to the area. She admits to “missing” her annual GYN exams for “several years.” She describes herself as “healthy and active” and states that she engages in regular exercise (walking). 

Mrs. E has been married for 35 years, reports one sexual partner (spouse), and has never had an abnormal pap test.  She cannot remember when she had her last mammogram but thinks it was “about five years ago.” Her last menstrual period was “about four years ago” and she reports having “gone through” hot flashes that were mild but now nonexistent.

Mrs. E is 5ft 4in tall and weighs 135lbs. Vital signs on physical examination were good: BP 126/76; pulse 86bpm.

On physical examination:
HEENT: Normal, no adenopathy, thyroid normal
Chest: Heart RRR, lung sounds normal
Breast: No masses on clinical breast exam.  No adenopathy
Abdomen: Soft, + BS all 4 quadrants
External genitalia: Labial petechiae, sparse pubic hair, no lesions
Vestibule/Vagina: Atrophic changes
Cervix: Parous, clear, pap done (due to lack of previous records)
Bimanual: Uterus AV, non-tender, small
Adnexa: Left ovary 2X3cm, right ovary non palpable
Rectal exam: No occult blood, confirms bimanual findings

Palpable ovary in postmenopausal woman; vaginal atrophy.

Schedule Mrs. E for a transvaginal ultrasound, CA 125. Have her return to the clinic to discuss the results. A mammogram, DEXA scan, and management of vaginal atrophy will be discussed once the issue of ovarian disease has been thoroughly evaluated.