A 44-year-old gravida 2, para 2 presents for evaluation of a four-month history of intermenstrual bleeding. Menses occur at regular, 28-day intervals, and last 4–5 days with recently heavy flow. For the past four months she has had painless intermenstrual bleeding at unpredictable times throughout her cycle. Intermenstrual bleeding ranges from spotting to moderate flow and lasts one to two days. Her last menstrual period was three weeks ago. She is up to date on cervical cancer screening and routine gynecologic care. Medical history is significant for hypothyroidism, two prior cesarean deliveries, and bilateral tubal ligation. She is on levothyroxine and denies any medications allergy. She is sexually active with one male partner and denies any history of sexually transmitted infections or recent exposures.

A 50-year-old female, gravida 3, para 3, presents to the office requesting removal of an intrauterine device (IUD). She had a levonorgestrel IUD placed six years ago for contraceptive purposes and now that she is menopausal wishes removal. Last menstrual period was two years ago, and she has experienced vasomotor symptoms and vaginal dryness. She was never able to palpate the IUD strings nor were they visible on pelvic examinations. She is currently sexually active with a long-standing monogamous partner and has never been exposed to a sexually transmitted disease. She has a family history of breast cancer in first-degree relatives, and no significant past medical or surgical history. She is not taking medications and has no drug allergies.

A 50-year-old woman is seen in the office for the evaluation of postmenopausal bleeding. Pelvic ultrasound demonstrated an 11 mm endometrial lining. She has a history of diabetes and well-controlled hypertension. She has no known drug allergies. She has a history of prior cesarean sections. After review of technical aspects and risks, consent is obtained. She is placed in dorsal lithotomy position and the vagina is prepped with povidone-iodine. Vaginoscopy is performed using a 3 mm flexible hysteroscope. The vaginal mucosa and endocervical canal appear normal. She reports to the nurse that she is feeling lightheaded and warm. She subsequently states that her vision is blurred and loses consciousness.