Diagnosis, Treatment & Management of Endometriosis

Diagnosis, Treatment & Management of Endometriosis

Instructions/Descriptions

Diagnosis, Treatment & Management of Endometriosis

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Case Study 1

A 32-year-old African American female presents to the clinic with a concern of dysmenorrhea over the past three years. Within the last year, she has experienced painful intercourse. She has been in a monogamous relationship with one male partner for the past five years. They have tried to have children with no success. Menarche was at age 10 and her cycles are 21 days apart that last six to seven days. The first day of her last cycle was 10 days ago and she reports that it was normal. She denies any vaginal itching or discharge. On her gynecological exam, there was no swelling, no external lesions, no erythema, no urethral swelling, and no vaginal discharge. The cervix was pink without lesions or discharge. The uterus was small, retroverted, and non-tender. The adnexa was small and non-tender. Nodules were noted along the cul de sac.

Differential Diagnoses

Endometriosis- A disorder where endometrial tissue is found to be on the outside of the uterus and usually affects women of childbearing age (Riazi, Tehranian, Ziaei, Mohammadi, Hajizadeh, & Montazeri, 2015). Symptoms include pelvic pain before and during menstruation, pain during and after sexual intercourse, irregular menstrual cycle, irregular bleeding, urinary frequency, diarrhea, gynecological infections, allergies, headaches, muscle, joint, and bone pain, and fatigue (Riazi, Tehranian, Ziaei, Mohammadi, Hajizadeh & Montazeri, 2015).

Adenomyosis- According to Harada, Khine, Kaponis, Nikellis, Decavalas, & Taniguchi (2016), “Adenomyosis is a benign uterine disorder characterized by the presence of heterotopic endometrial glands and stroma in the myometrium and reactive fibrosis of the surrounding smooth muscle cells of the myometrium.” Adenomyosis is usually found in females who are unsuccessful with pregnancy (Harada, Khine, Kaponis, Nikellis, Decavalas, & Taniguchi, 2016).

Female infertility- The absence of becoming pregnant after having unprotected sex for one full year (Lindsay & Vitrikas, 2015). In the United States, roughly 1.5 million women have reported being infertile (Lindsay & Vitrikas, 2015). This disorder can be affected by the problems of other reproductive organs. Ovulation complications, uterine abnormalities, and tubal obstruction play a major role in infertility (Lindsay & Vitrikas, 2015).

Diagnosis, Treatment & Management

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Knowing that the patient has been suffering from dysmenorrhea for quite some time it is evident that further evaluation for endometriosis is needed as the patient is presenting with positive signs and symptoms. A thorough history and physical exam are warranted. Screening and diagnostic testing should include a pelvic ultrasound, laparoscopy, laboratory testing of the peritoneum, and a urinalysis to rule out pregnancy (Tharpe, Farley, & Jordan, 2017).

Suggested treatment is Nonsteroidal anti-inflammatory drugs such as ibuprofen 400-800mg by mouth every six hours along with danazol 200mg twice daily for six to nine months (Tharpe, Farley, & Jordan, 2017). Although the patient has mentioned that she and her partner have been trying to get pregnant with no success, temporary ovulation suppression is suggested. According to Hillard (2014), “Surgical therapies can often be avoided, particularly in women who wish to preserve child-bearing capabilities with the use of androgen medical therapy.”

Management & Patient Education

Management recommendations would consist of daily exercise, eating a diet low in sugar and high in omega 3, find ways to reduce stress such as meditation, eliminate tobacco and alcohol use (Lindsay & Vitrikas, 2015). Provide the patient with education on her disorder and what the options are for treatment (Tharpe, Farley, & Jordan, 2017). If the patient chooses medication therapy to explain to take the medication as prescribed and explain the side effects that the patient may experience (Tharpe, Farley, & Jordan, 2017). Keep all scheduled appointments with your provider so there is no delay in treatment. As the healthcare provider, be an active listener to the patient’s concerns and needs and answer all questions. Provide the patient with best practice suggestions and support.

References

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Harada, T., Khine, Y. M., Kaponis, A., Nikellis, T., Decavalas, G., & Taniguchi, F. (2016). The Impact of Adenomyosis on Women’s Fertility. Obstetrical & gynecological survey, 71(9), 557-568. doi:10.1097/OGX.0000000000000346

Hillard, P. A. (2014). Menstrual suppression: current perspectives. International journal of women’s health, 6, 631-637. doi:10.2147/IJWH.S46680

Lindsay, T. J., & Vitrikas, K. R. (2015). Evaluation and Treatment of Infertility. American Family Physician, 91,(5), 308-314. Retrieved from https://www.aafp.org/afp/2015/0301/p308.html

Riazi, H., Tehranian, N., Ziaei, S., Mohammadi, E., Hajizadeh, E., & Montazeri, A. (2015). Clinical diagnosis of pelvic endometriosis: a scoping review. BMC women’s health, 15, 39. doi:10.1186/s12905-015-0196-z

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health

Diagnosis, Treatment & Management of Endometriosis

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