Endometrial Physiology Underpins Menstrual Health Discussion
Endometrial Physiology Underpins Menstrual Health Discussion
SOAP Note: Response
Hello, I support your proposed diagnostic tests for this client. However, alternative diagnostic tests can be ordered to help the clinician diagnose properly. CBC was recommended to rule out pregnancy or iron deficiency anemia. This blood test can also be ordered to evaluate the client’s level of Follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This test would help the clinician in confirming PCOS diagnosis. The client will be diagnosed with PCOS if the results indicate an LH-to-FSH ratio that exceeds 3-to-1 (3:1). Endometrial Physiology Underpins Menstrual Health Discussion
Secondly, the clinician should order a pelvic ultrasound. Uterine fibroids are associated with heavy menstrual bleeding (Al-Hendy et al., 2021). A pelvic ultrasound will indicate the presence of a single or two fibroids. Additionally, the test results would indicate other aspects of fibroid (s), including size, shape, type of uterine polyps, or location. Thus, the clinician would rely on pelvic ultrasound results to detect uterine polyps.
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Furthermore, CA125 Test is recommended for this client. According to Jain et al. (2022), endometriosis significantly contributes to excessive bleeding, including heavy menstrual periods. A high CA125 level would indicate the possibility of a tumor. Additionally, laparoscopy should be ordered. Goncalves et al. (2021) reported that laparoscopy is the most accurate diagnostic test for endometriosis. Hence, the clinician would rely on this diagnostic test to confirm endometriosis. Endometrial Physiology Underpins Menstrual Health Discussion
Additionally, I support an ablation procedure as an appropriate treatment for reducing the client’s excessive bleeding. However, an alternative treatment therapy is recommended for this client. The client should be given NSAIDs such as Motrin IB due to their efficacy in reducing bleeding during menstrual periods (Barcikowska et al., 2020). Alternatively, the client can be treated with naproxen sodium (Aleve), effectively preventing excess blood loss during menstruation.
References
Al-Hendy, A., Bradley, L., Owens, C. D., Wang, H., Barnhart, K. T., Feinberg, E., … & Stewart, E. A. (2021). Predictors of response for elagolix with add-back therapy in women with heavy menstrual bleeding associated with uterine fibroids. American Journal of Obstetrics and Gynecology, 224(1), 72-e1.
Barcikowska, Z., Rajkowska-Labon, E., Grzybowska, M. E., Hansdorfer-Korzon, R., & Zorena, K. (2020). Inflammatory markers in dysmenorrhea and therapeutic options. International journal of environmental research and public health, 17(4), 1191.
Goncalves, M. O., Siufi Neto, J., Andres, M. P., Siufi, D., de Mattos, L. A., & Abrao, M. S. (2021). Systematic evaluation of endometriosis by transvaginal ultrasound can accurately replace diagnostic laparoscopy, mainly for deep and ovarian endometriosis. Human Reproduction, 36(6), 1492-1500. Endometrial Physiology Underpins Menstrual Health Discussion
Jain, V., Chodankar, R. R., Maybin, J. A., & Critchley, H. O. (2022). Uterine bleeding: how understanding endometrial physiology underpins menstrual health. Nature Reviews Endocrinology, 18(5), 290–308
Respond to your colleagues’ posts and explain how you might think differently about the types of tests or treatment options your colleagues suggested and why. Use your learning resources and/or evidence from the literature to support your position.
Week 8- Initial Post
Patient Information:
GA, 38-year-old Caucasian Female
S.
CC: Frequent menstrual bleeding
HPI: GA is a 38-year-old Caucasian female presenting today with complaints of frequent menstrual bleeding. Her cycle is approximately 17-36 days, lasting 5-10 days with her heaviest days needing to change her super tampon every 2 hours. She has stopped taking her OCP and has noticed an increase in the frequency of menstruation once doing so. She has a history of bilateral tubal ligation 5 months ago. She also states she has gained approximately 27 lbs since her surgery. She complains of fatigue during the day.
Current Medications: Not Given
Allergies: Not Given
PMHx: No history provided
Soc & Substance Hx: Include occupation and major hobbies, family status, vaping, tobacco and alcohol use (previous and current use, how many times a day, how many years), and any other pertinent data. Always add some health promotion questions here, such as whether they use seat belts all the time or whether they have working smoke detectors in the house, the condition of the living environment, text/cell phone use while driving, and support systems available.
Fam Hx: Not Given
Surgical Hx: bilateral tubal ligation 5 months ago
Mental Hx: Not Given
Violence Hx: Not given
Reproductive Hx: G2 P2, bilateral tubal ligation, LMP unknown
ROS: (vague, more information needed)
GENERAL: 27 lb weight gain and fatigue
GENITOURINARY/REPRODUCTIVE: Heavy bleeding, unknown LMP, bilateral tubal ligation
O.
• HEENT: wnl, hair dry, neck supple without adenopathy
· CV: RSR without murmur or gallop
· Lungs: clear to auscultation
· Abd soft, non-tender, BS all 4 quadrant.
· VVBSU: WNL
· Cervix: firm, smooth, parous, w/o CMT
· Uterus: mid mobile nontender, approximately 10 cm
· Adnexa: without masses or tenderness
· Extremities: negative Homan’s, reflexes 2+ = bilaterally, no edema Endometrial Physiology Underpins Menstrual Health Discussion
Diagnostic results: CBC, CMP, thyroid panel, prolactin level, and HCG blood test to rule out pregnancy. Transvaginal ultrasound to rule out fibroids/ectopic pregnancy with an endometrial biopsy. Vaginal swab for BV. A transvaginal ultrasound is the gold standard for imaging of a fibroid (Barjon & Mikhail, 2022). For women over 35, an endometrial biopsy should also be obtained in the suspicion of a fibroid (Barjon & Mikhail, 2022).
Additional Questions: When was your LMP? Are you breastfeeding? I would like more information on her PMH and family history. Does hypothyroidism run in her family? Have any other previous surgeries? Are you in a monogamous relationship? What kind of deliveries did she have with her 2 children? I would also like to ask her more regarding her decision to have a tubal. Are you having feelings of regret or are you happy to have had the tubal? I think mental health being postpartum in conjunction with a big decision not to have more children is important to examine. What are your thoughts on going back onto a birth control pill? Other forms of contraceptives? IUD? Thoughts on an ablation procedure? Has your diet changed? Are you exercising?
A.
Hypothyroidism ICD-10: E03.9: this is a result of low levels of thyroid hormone with varied etiology and manifestations (Patil et al., 2022). Patient’s with this diagnosis typically experience dry skin/hair, fatigue, muscle cramps, weight gain, menstrual cycle abnormalities, and more (Patil et al., 2022). Patient is experiencing several of these symptoms thus making it important to do a thyroid panel to rule out the diagnosis.
Menorrhagia: This is the most common diagnosis related to the systemic endocrine process (hypothyroidism, Von Willibrand’s disease, polyps, fibroids, or trauma) (Walker et al., 2023). This bleeding can be severe and result in symptomatic anemia (Walker et al., 2023). Endometrial Physiology Underpins Menstrual Health Discussion The patient has menorrhagia and has been dealing with this since her procedure. Finding the underlying cause will be crucial to help with the patient’s symptoms.
Abnormal uterine bleeding: This is a broad term describing irregularities of menstrual cycles involving frequency, regularity, duration, and volume of flow outside of pregnancy (Davis & Sparzak, 2022). The patient complains of menorrhagia thus making this an appropriate diagnosis. I also understand that in some cases with insurance and policy, IUD insertions may or may not be covered depending on the diagnosis. With the diagnosis of abnormal uterine bleeding, insurances are likely to cover the procedure compared to an encounter for contraception.
PID: This is defined as inflammation of the upper genital tract due to an infection (Jennings & Krywko, 2023). This affects the uterus, tubes, and/or ovaries (Jennings & Krywko, 2023). It is typically spread from the lower genital tract and is related to sexually transmitted diseases (Jennings & Krywko, 2023). Unsure if patient has any abnormal odor, discharge, or pain with the bleeding, but would like to still rule out the chance of this diagnosis.
Anemia: Iron deficiency anemia is the most common form of anemia worldwide (Warner & Kamran, 2022). Complaints will typically include, fatigue and dyspnea on exertion (Warner & Kamran, 2022). Since the patient is having increased bleeding with menstruation and complains of fatigue, a CBC should be ordered to rule out anemia. Endometrial Physiology Underpins Menstrual Health Discussion
Uterine fibroid: These are common benign neoplasms in women (Barjon & Mikhail, 2022). Although they are benign, they can have a great effect on the everyday physical and mental well-being of women with this condition (Barjon & Mikhail, 2022). Common symptoms of this diagnosis include metrorrhagia, menorrhagia, or a combination (Barjon & Mikhail, 2022). Less common symptoms include pelvic pain, bowel problems, or signs and symptoms of related anemia (Barjon & Mikhail, 2022). The patient presented with these signs and symptoms and even some of the less common side effects.
