Question

For the treatment of excessive bleeding in a case of DUB, which one of the following therapies used is termed as 'Medical Curettage'?

• A. Combined estrogen progestogen pill
• B. Danazol
• C. High doses of progestogens
• D. GnRH analogue

Hint:

Ask which therapy makes the endometrium shed completely in one go, similar to what a curette does.

Answer 1

The Correct Option is C

Step 1: Understanding the Question.
Dysfunctional uterine bleeding, or DUB, is heavy or irregular bleeding from the uterus without any structural cause like a fibroid or polyp. The question asks which hormone therapy for controlling this bleeding is nicknamed "medical curettage."

Step 2: Key Concept or Approach.
DUB is managed in steps, first controlling the acute bleeding episode, then preventing it from coming back. Several hormone options exist for this, combined pills, progestogens alone, danazol, and GnRH analogues, and each works through a different mechanism. A surgical curettage scrapes away the whole endometrial lining at once, so a therapy earns the "medical curettage" label only if it produces that same complete, one time shedding of the lining through the drug alone.

Step 3: Detailed Explanation.
Combined estrogen progestogen pills control bleeding by giving a steady, regular hormone cycle, which helps prevent the irregular shedding of DUB. This is a very common first line option but does not cause one complete shed, so it is not the therapy that carries the "medical curettage" nickname.
Danazol is an androgen like drug that suppresses the ovaries and thins the endometrium gradually, useful in some resistant cases, but again it does not act through a single complete shedding event.
High doses of progestogens are given for several days and then withdrawn. This produces a complete, controlled shedding of the endometrium once the drug is stopped, an effect very similar to a surgical curettage but done with medicine instead of an instrument. Because of this effect, gynaecology textbooks call this specific approach "medical curettage."
GnRH analogue therapy works by shutting down the pituitary ovarian axis, creating a temporary, low estrogen, menopause like state that stops bleeding by stopping ovarian hormone production altogether, not by causing one complete withdrawal shed.

Step 4: Final Answer.
High doses of progestogens are the therapy termed "medical curettage," since stopping the drug causes the endometrium to shed completely in one withdrawal bleed, mimicking a surgical curettage.