This week, as you continue exploring common gynecologic conditions, you consider diagnosis, treatment, and management strategies for patients. You also explore ways to educate patients on these conditions.

Learning Objectives – NURS 6551: Week 5: Case Study: Patient bleeding in between her menstrual periods

By the end of this week, students will:

• Assess patients with common gynecologic conditions
• Evaluate differential diagnoses for common gynecologic conditions
• Analyze treatment and management plans for patients with common gynecologic conditions
• Analyze strategies for educating patients on the treatment and management of common gynecologic conditions
• Understand and apply key terms, principles, and concepts related to common gynecologic conditions
• Evaluate common gynecologic conditions in patients
• Analyze treatment modalities for common gynecologic conditions

Learning Resources 

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones and Bartlett Publishers.

• • Chapter 24, “Normal and Abnormal Uterine Bleeding” (pp. 575-599)

This chapter differentiates normal uterine bleeding from abnormal and dysfunctional uterine bleeding. It also examines causes of abnormal bleeding and identifies assessment strategies for diagnosing and managing these conditions.

• • Chapter 25, “Hyperandrogenic Disorders” (pp. 603-618)

This chapter explores the etiology, clinical presentation, and impact of hyperandrogenic disorders. It also provides strategies for assessing, diagnosing, and managing patients with these conditions, including adolescents and pregnant women.

• • Chapter 26, “Benign Gynecologic Conditions” (pp. 621-652)

This chapter explains the incidence, presentation, assessment, and management of common benign gynecologic conditions. It also explores differential diagnoses for these conditions and types of treatment options.

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.

• • Chapter 7, “Care of the Woman with Reproductive Health Conditions”

• • • “Care of the Woman with Amenorrhea” (pp. 372-376)

This section differentiates between primary and secondary amenorrhea and describes treatment options for managing patients with this condition.

• • • “Care of the Woman with Abnormal Uterine Bleeding” (pp. 368-372)

This section explains the causes of dysfunctional uterine bleeding and recommends treatment options for managing this condition.

• • • “Care of the Woman with Endometriosis” (pp. 395-398)

This section identifies the prevalence of endometriosis in women. It also provides strategies for diagnosing, treating, and managing patients with this condition.

• • • “Care of the Woman with Fibroids” (pp. 398-401)

This section describes the classification of fibroids and their prevalence in women of childbearing age. It also presents methods for identifying, diagnosing, and treating this common benign tumor.

• • • “Care of the Woman with Polycystic Ovarian Syndrome” (pp. 433-437)

This section identifies the criteria for a polycystic ovarian syndrome diagnosis. It also presents treatment options for this disorder, including therapeutic options and alternative measures.

Optional Resources – NURS 6551: Week 5: Case Study: Patient bleeding in between her menstrual periods

Centers for Disease Control and Prevention. (2012b). Women’s health. Retrieved from http://www.cdc.gov/women/

National Institutes of Health. (2012). Office of Research on Women’s Health (ORWH). Retrieved from http://orwh.od.nih.gov/

U.S. Department of Health and Human Services. (2012a). Womenshealth.gov. Retrieved from http://www.womenshealth.gov/

Discussion: Diagnosing and Managing Gynecologic Conditions

Gynecologic conditions can be difficult to diagnose for a variety of reasons, including overlapping symptoms, lack of patient knowledge, or even patient fear or embarrassment about sharing information. Your role provides you the opportunity to develop a relationship of trust and understanding with these patients so that you can gather the appropriate details related to medical history and current symptoms. When caring for this patient population, it is important to make these women an integral part of the process and work collaboratively with them to diagnose and develop treatment and management plans that will meet their individual needs. For this Discussion, consider diagnosis, treatment, and management strategies for the patients in the following four case studies:

Case Study 1:A 32-year-old African American female is concerned about increasing dysmenorrhea over the past three years. In the past year, this was associated with painful intercourse. She has been in a monogamous relationship with one male partner for the past five years. They tried to have children without success. Menarche was at age 10; menstrual cycles are 21 days apart and last for 6–7 days. The first day of her last menstrual period was 10 days ago and was normal. She denies vaginal itching or discharge. On gynecologic exam there was no swelling, external lesions, or erythema, urethral swelling, or vaginal discharge. Cervix is pink without lesions or discharge. Uterus was small, retroverted, and non-tender. Adnexa were small and non-tender. Nodules are noted along the cul de sac.

Case Study 2:

A 42-year-old African American female is in the clinic for a routine gynecologic exam. When asked, she admits to noticing bleeding in between her menstrual periods for the past several months. She has been pregnant three times and has three children. She is sexually active with one male sex partner in a monogamous relationship. During her bimanual exam, you note an irregular intrauterine non-tender mass about 4 cm in diameter. The mass is palpable abdominally. The remainder of her gynecologic exam was normal.

Case 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.

Case Study 4:

A 16-year-old Caucasian female comes to the clinic concerned because she has not had a menstrual period for three months. She’s a junior in high school and active in sports. She has lost about 10 lbs. in the past two months. She is currently 5 ft. 4 in. and weighs 100 lbs.

To prepare:

• Review Chapter 26 of the Schuiling and Likis text and Chapter 7 of the Tharpe et al. text.
• Review and select one of the four provided case studies. Analyze the patient information.
• Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
• Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.
• Consider strategies for educating patients on the treatment and management of the sexually transmitted infection you identified as your primary diagnosis.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Provide a minimum of three possible diagnoses and list them from highest priority to lowest priority. Explain which is the most likely diagnosis for the patient and why. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients on the disorder.

Read a selection of your colleagues’ responses.

By Day 6 Case Study: Patient bleeding in between her menstrual periods

Respond to at least two of your colleagues on two different days in both of the ways listed below. Respond to colleagues who selected different case studies than you did.

• Explain how missing information from the patient history might change the diagnoses for the patients in the case studies your colleagues selected.
• Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or contrasting perspectives.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS 6551: Week 5: Case Study: Patient bleeding in between her menstrual periods.

ADDITIONAL INFORMATION;

Patient bleeding in between her menstrual periods

Introduction

Bleeding in between periods is not normal. If you are bleeding and have no other symptoms, there may be something wrong with your body. Your doctor will need to look at your blood and pelvic exam before making a diagnosis.

This is a separate problem.

If you are experiencing bleeding between periods, it is highly likely that this is a separate problem. You may have noticed that your periods are heavier than usual and/or more frequent, or even skipped for an entire cycle.

This can be caused by many different things including:

• Irregular menses (i.e., longer or shorter than normal)

• Endometriosis (inflammation of the lining of the uterus)

• Polycystic ovarian syndrome (PCOS)

Your doctor will need to do some testing first in order to find out if there is something wrong with your reproductive organs before they proceed with any treatment options.

This usually means that something is wrong.

If you are bleeding between your menstrual cycles, this is not normal. It can mean that something is wrong, and it’s important to get it checked out right away.

• You may have an infection that causes bleeding between periods (menorrhagia). This is possible if you have a cervix (the lower part of the uterus) that sticks out farther than normal or if you have other abnormal changes in your reproductive organs such as polyps or cervical cancerous tumors. If this is the case, then there will be no pregnancy during those times when you do bleed from your vagina—it just means that something else must be causing these symptoms along with them!

• Another possibility for why someone would be bleeding after their period has ended could be due to an illness called endometriosis which affects millions worldwide each year; however, this condition only accounts for about 5% of all cases of menorrhagia/menstrual problems experienced by women worldwide today.*

Most often, it is not serious.

Most often, it is not serious. It can be treated with hormone therapy and sometimes surgery. The most common cause of bleeding between menstrual periods is endometriosis.

It is not normal to have this kind of bleeding.

• It is not normal to have this kind of bleeding.

• Pain or cramping in between periods, and spotting that isn’t related to your period can also be signs of a problem.

• If you have any type of bleeding—even if it’s just a little bit—that doesn’t come with your period, see your doctor right away!

It has many possible causes.

It is important to know the possible causes of bleeding between periods. There are many different reasons for this problem and your doctor will be able to diagnose it based on your symptoms.

If you’re experiencing light spotting or spotting that comes and goes for four weeks or more, then there could be a problem with your hormones or ovulation. This could also be caused by an infection in the reproductive tract (uterus). If you have severe pain with any type of bleeding during sex or exercise, it might be an indication that something is wrong with these organs as well!

The doctor will need to find the cause.

• The doctor will need to find the cause.

• Your doctor may order some tests, such as blood work or an examination of your internal organs.

If you have a bleeding problem between periods, your doctor will ask you about your medical history and examine you physically. They may also order some tests like an ultrasound to check for any problems with ovulation (the release of eggs from an ovary). If there is no obvious reason for bleeding during this period of time, they’ll likely suggest taking birth control pills or other medications that can help regulate periods so they are less painful and more predictable than menstrual cycles alone would be.

It may be one of several things.

• It may be one of several things.

• The most common cause of abnormal bleeding during your period is a hormonal imbalance caused by an irregular menstrual cycle or by pregnancy. In this case, you should see your doctor as soon as possible so that they can rule out other causes for the abnormal bleeding that you’re experiencing and help you get back on track with your normal cycle.

It will require a pelvic exam and some testing.

If you have bleeding between your menstrual periods, it will require a pelvic exam and some testing. Your doctor may order one or more of the following tests:

• A Pap test (a type of cervical cancer screening)

• An ultrasound to check for abnormal cells in your cervix or uterus

• Tests that check for infection and inflammation in the area where most women bleed (the ovaries) and/or elsewhere in their bodies

Many times, this kind of bleeding can be treated easily with hormones.

Many times, this kind of bleeding can be treated easily with hormones. Hormone therapy is often the first treatment for women who are having heavy menstrual bleeding. It may be combined with a procedure such as dilation and curettage (D&C), so that the uterus is removed and its contents examined.

Hormone therapy may also be given in pill form or shot form; hormone replacement therapy (HRT) involves taking hormones like estrogen and progesterone by mouth every day, usually together with other medications that help control symptoms like hot flashes and pain during sex. Creams or patches containing progesterone can also be used for short periods of time but tend not to have long-term effects on health unless they’re applied continuously over long periods of time (more than a few days).

Sometimes surgery is needed.

Sometimes surgery is needed. The doctor will need to find the cause of your bleeding, which may be one of several things:

• you have an infection that needs treatment

• there’s a physical problem with your uterus or ovaries that needs treating with hormones or other medicine

• there’s a problem with your fallopian tubes (the tubes connecting you to your ovaries) and they’re not working properly

Bleeding in between periods requires a visit to your doctor to determine the cause

If you are bleeding in between periods, it is important to see your doctor. Your doctor can determine the cause of the bleeding and help you treat it.

If this is a sign of an underlying problem that needs to be treated, then additional testing may be needed. This could include blood tests or an ultrasound or MRI scan. It could also mean surgery might be necessary to remove excess tissue or cure a condition such as fibroid tumor (fibroids).

Conclusion

If you have any questions, please ask your doctor.