discussion response
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CaseStudyresponse2655.docxCase Study #3
A 48-year-old Caucasian female is in the clinic concerned about prolonged menstrual bleeding for three weeks now. Her prior menstrual periods have been irregular for the past eight months, lasting no more than three days each. There have been one to two months when she had no menstrual cycles at all. She reports occasional hot flushes and mood swings.
Differential Diagnosis
Gynecologic complications can be difficult to diagnose and differentiate between many similar symptoms. The first diagnosis for the patient in this case study is menopause. Menopause usually occurs in women over the age of 45 and is defined as the time in a woman’s life when her menses stops. Signs and symptoms associated with menopause include irregular periods, vaginal dryness, hot flashes, chills, night sweats, sleep problems, mood changes, weight gain, slowed metabolism, thinning hair, dry skin, and loss of breast fullness. More often than not, women experience period irregularity throughout menopause, before their periods completely end. Menopause is caused by a natural decline of reproductive hormones. According to Santoro, Gonzales, and Luu (2019), “Most women who travers menopause experience significant symptoms and many require at least temporary pharmacological treatment for maintenance of quality of life” (para. 1). Dysfunctional uterine bleeding is a common cause of prolonged or irregular bleeding, and is especially common in women over 40 years of age during perimenopause.
The second diagnosis for the patient in this case study is uterine fibroids. Uterine fibroids are non-cancerous growths that occur in the uterus. Uterine fibroids can range in size and aren’t usually associated with an increased risk for uterine cancer. Uterine fibroids don’t always cause signs or symptoms, though women that do have symptoms usually present with heavy menstrual bleeding, menstrual periods lasting more than a week, pelvic pressure or pain, frequent urination, difficulty fully emptying the bladder, constipation, and backache or leg pains. There is not one exact cause for uterine fibroids, though they are commonly thought to be caused by genetic changes and hormones. According to Ahmed, Deif, Latif, and Mohmaed (2019), “Uterine fibroid (leiomyoma) is the most common benign uterine tumors in women of reproductive age. The majority of leiomyomas are asymptomatic, however up to 20% cause menorrhagia, pelvic pain and genitourinary symptoms” (para. 1).
The third diagnosis for the patient in this case study is endometrial hyperplasia. Endometrial hyperplasia is when the endometrium, or lining of the uterus, becomes abnormally thick. Endometrial hyperplasia can lead to endometrial cancer in some women, though it is not cancer alone. This condition is usually caused by hormones, usually being an excess in estrogen without progesterone. According to Giannella, Cerami, Setti, Bergamini, and Boselli (2019), abnormal uterine bleeding is one of the most common reasons women seek out gynecological evaluation (para. 1). Most commonly, the only sign or symptom of endometrial hyperplasia is abnormal vaginal bleeding, though less common symptoms include abnormal vaginal discharge or abnormal pap smear result.
The most likely diagnosis for the patient in this case study is menopause. The most common signs and symptoms of early menopause are irregular periods, menorrhagia, hot flashes, mood changes, and being over the age of 45. The woman in this case study is presenting with all of these signs and symptoms, making this the most likely diagnosis. I do feel that it is important to complete further testing and diagnostics to rule out any other cause or condition, though I feel that menopause is a likely diagnosis to consider and start with.
Treatment and Management Plan
Treatment of menopause is often done with hormone replacement therapy, though other treatments have been used including low-dose antidepressants, gabapentin, clonidine, and medications to treat or prevent osteoporosis. For the patient in this case study I would like to start her on hormone therapy in attempt to alleviate some of her symptoms. Because the case study does not specifically state if the patient still has her uterus or not, I am going to treat her as if she does with low dose estrogen and progestin. I will also ensure the patient does not have any history of cardiovascular or cancerous conditions prior to starting her on hormone replacement therapy. For this patient, I would prescribe 0.625mg/d CEE with 2.5mg/d MPA orally once daily for three months.
Patient Education
Patient education plays a large role in any patient/provider situation, including those involving a complex diagnosis with concerning symptoms. As a provider, it is my responsibility to provide education and resources involving various forms of GYN diagnosis, treatment plans, and information regarding follow-up and next steps.
References
Ahmed, A., Deif, O., Latif, S., & Mohamed, A. (2019). Serum protein and prolactin in evaluation of uterine fibroids. Egyptian Journal of Hospital Medicine, 76.Retrieved from https://eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/
Giannella, L., Cerami, L., Setti, T., Bergamini, E., & Boselli, F. (2019). Prediction of endometrial hyperplasia and cancer among premenopausal women with abnormal uterine bleeding. Biomed Research International.Retrieved from https://eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/
