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Emily is a 43 year old nurse who has come in complaining of some spotting and light vaginal loss between her usual period over the previous 3 cycles. She is otherwise healthy. 10 years ago she had an abnormal pap smear with CIN2 that was treated with LLETZ procedure. (Large Loop Excision of Transformation Zone) She has had 2 children vaginally.
Her last pap smear was 6 months ago and normal. Vaginal examination at that time was normal.
She is taking the oral contraceptive pill containing 35mcg Ethinyl estradiol and 350 mcg levonorgestrel and has not missed a pill.