Abnormal Uterine Bleeding Essay

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 Abnormal Uterine Bleeding Essay
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 Abnormal Uterine Bleeding Essay

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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 Abnormal Uterine Bleeding Essay
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 Abnormal Uterine Bleeding Essay
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? Abnormal Uterine Bleeding Essay
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). 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). Abnormal Uterine Bleeding Essay  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). Abnormal Uterine Bleeding Essay  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.
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. Abnormal Uterine Bleeding Essay
Recommend we start with a CBC to rule out anemia, CMP, thyroid panel to rule out hypothyroidism, HCG blood test, prolactin level, and transvaginal ultrasound to rule out any structural abnormalities and/or ectopic pregnancy. Will also obtain a vaginal swab to rule out BV and an endometrial biopsy in the suspicion of a fibroid. Informed the patient that it is difficult to find any specific EBP research with the correlation between her tubal and weight gain but would like to run more tests to rule out other medical conditions that would cause her to gain weight. Discussed healthy diet and exercise. Some women put on weight once they stop breastfeeding. If the ultrasound and BV swab are negative, would consider birth control to help with her irregularity and bleeding, whether it be an OCP or IUD will be left up to the patient. Discussed an ablation procedure as well instead of birth control to help with her bleeding if she is interested. Informed her that an endometrial biopsy would be needed before doing an ablation. Will inform patient of the results once obtained. If anemia is found, will discuss the use of iron supplementation.
No referrals are needed currently. Possible referral to endocrinology if hypothyroidism is indicated. Possible referral to OB/Gyn surgeon if ectopic pregnancy is present or the removal of any fibroids is indicated. Abnormal Uterine Bleeding Essay
References
Barjon, K., & Mikhail, L. N. (2022). Uterine Leiomyomata. In StatPearls. StatPearls Publishing.
Davis, E., & Sparzak, P. B. (2022). Abnormal Uterine Bleeding. In StatPearls. StatPearls Publishing.
Jennings, L. K., & Krywko, D. M. (2023). Pelvic Inflammatory Disease. In StatPearls. StatPearls Publishing.
Patil, N., Rehman, A., & Jialal, I. (2022). Hypothyroidism. In StatPearls. StatPearls Publishing.
Warner, M. J., & Kamran, M. T. (2022). Iron Deficiency Anemia. In StatPearls. StatPearls Publishing.
Walker, M. H., Coffey, W., & Borger, J. (2023). Menorrhagia. In StatPearls. StatPearls Publishing. Abnormal Uterine Bleeding Essay