Nursing

needs differential diagnosis and why diagnostic tests, and treatment options for the patient.

CORRECT SCENARIO :
A 46-year-old female chief complaint of no menstrual cycle for 4 months. Reports cycles had been irregular for last 4 years but then stopped having a cycle 6 months ago.

ANSWER

Abnormal Menstruation Cycle Case Study

Differential Diagnosis

Amenorrhea: Amenorrhea occurs when one misses their monthly menstrual periods or absence of menstrual bleeding. Amenorrhea can have structural issues with the sex organs which may be a sign of malfunctioning or underdeveloped ovaries (Rebar, 2015). There are two classifications of amenorrhea; primary and secondary amenorrhea. The patient is likely suffering from secondary amenorrhea which occurs when one stops having their menses for at least three months which were previously irregular. The causes can include stress, pregnancy, ongoing illness and chronic illness.

Pelvic inflammatory disease: An infection in the female reproductive organs. This happens when a sexually spread bacteria tends to extend from the vagina, uterus, ovaries and fallopian tubes. The disease is linked to irregular periods after the damage of the reproductive system including the ovaries, uterus and fallopian tubes. The patient is likely to have the pelvic inflammatory disease since she has been having irregular menstruation for about 4 years.

Polycystic Ovary Syndrome: Polycystic ovary syndrome is considered a disorder that involves irregular, infrequent or prolonged menstrual periods (Azziz et al., 2016). The ovaries tend to develop numerous follicles which fail to regularly release eggs. Some of the causes of POCS include low-grade inflammation and excess insulin. If the cells are resistant to the insulin action, the blood sugar levels tend to rise and where the body produces more insulin. Women with POCS have a high risk for high blood pressure, type 2 diabetes, and endometrial cancer and heart problems.

Uterine fibroids: Uterine fibroids lead to pressure against the uterine lining which causes more bleeding than usual. Fibroids lead to the growth of blood vessels that may lead to irregular and heavier periods. Considerably, fibroids occur within the uterine cavity which may impact the lining of the uterus and potentially cause irregular menstruation. Scarring of the uterus as a result of infection may cause the menstrual periods to stop at an early stage leading to premature menopause.

Diagnostic Tests

Blood tests: The blood tests are used to rule out certain medical disorders and determine certain hormone levels such as follicle-stimulating hormone, thyroid-stimulating hormone and cortisol. This will also indicate how well certain organs of the body are functioning.

Vaginal culture: Vaginal culture is a lab test that is used to identify infection in the female genital tract. The test is effective in determining the causes of irregular periods, pelvic pain and vaginitis. Abnormal results will indicate the presence of an infection in the urinary or genital tract. These infections include pelvic inflammatory disease, chronic swelling and sexually transmitted infections.

Pelvic speculum examination: The pelvic exam is used to check the cervix, vagina and other reproductive organs for complications (Qaseem et al., 2014). Therefore, the examination needs to be done to observe the internal vaginal tissue, external genitalia, mucosa and cervix.

Endometrial biopsy: This entails the examination of a small piece of tissue from the endometrium for histologic evaluation for cell abnormalities or cancer (Will and Sanchack, 2020). The sample tissue is obtained from the uterus lining to diagnose hormonal imbalance, endometriosis and cancerous cells.

Treatment Options for the Patient

Hormone therapy is a medication that focuses on female hormones. The hormone replacement therapy will allow the replacement of estrogen that the body has stopped making (Lobo, 2017). Physicians prescribe oral contraceptives that contain progesterone and estrogen that helps in controlling irregular periods. The hormone medication will also trigger periods in women that had missed their periods. Estrogen therapy is the most suitable treatment option for relieving menopausal hot flashes. The estrogen pills will resolve or reduce trouble symptoms linked to the patient.

References

Azziz, R., Carmina, E., Chen, Z., Dunaif, A., Laven, J. S., Legro, R. S., … & Yildiz, B. O. (2016). Polycystic ovary syndrome. Nature reviews Disease primers, 2(1), 1-18.

Lobo, R. A. (2017). Hormone-replacement therapy: current thinking. Nature Reviews Endocrinology, 13(4), 220-231.

Qaseem, A., Humphrey, L. L., Harris, R., Starkey, M., & Denberg, T. D. (2014). Screening pelvic examination in adult women: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 161(1), 67-72.

Rebar, R. (2015). Evaluation of amenorrhea, anovulation, and abnormal bleeding.

Will, A. J., & Sanchack, K. E. (2020). Endometrial Biopsy. StatPearls [Internet].