Clinical Case 2

A 52-year-old lady presents with vaginal bleeding over the last five days. She has not had a period for over two years. She has previously been diagnosed with a DVT and takes warfarin for this. She has missed all her follow up appointments for her warfarin dosing and continues to take 4mg per day. She recently had atraumatic epistaxis which self-resolved. Her PMH includes type 2 diabetes, hypertension and she is a chronic smoker.

On examination, she has a large BMI but general and systemic examination were unremarkable with normal observations.