Diagnosing and Managing Gynecologic Conditions

Diagnosis 

From the case provided, the primary diagnosis is uterine fibroids. The second diagnosis is that it could be an ovarian tumor. This is because the mass has been determined to be 4cm large; it is palpable and non-tender. The third diagnosis is leiomyosarcoma (LMS) and endometrial polyps. It is also possible that the patient is pregnant since she is active sexually. Ideally, pregnancy can form in the wall of the uterus (Bibbins-Domingo et al., 2017). Intrauterine pregnancy develops in that manner, and they look like masses and are non-tender (Stewart et al., 2017).  

Uterine fibroids are categorized depending on the position: subserosal, intramural, and submucosal (Bibbins-Domingo et al., 2017). The signs and treatment alternatives are influenced by the size of the mass, the location, and the number. 

Symptoms of uterine fibroids 

Abnormal bleeding, commonly uterine fibroids, causes’ excess menstrual flow. 

Pressure in the pelvic region 

Bowel dysfunction 

Frequent urination 

Lower back pain 

Management 

Management of fibroids ranges from no treatment to surgery. If fibroids are not causing excess bleeding or any discomfort, treatment may not be necessary. 

Treatment  

Patients with excess menstrual flow and fibroids are advised to take hormonal medications to reduce bleeding and control the menstrual cycle (Taheri et al., 2019). Lupron is also used to stop bleeding and shrink fibroids. Lupron blocks the production of estrogen (Stewart et al., 2017). However, Lupron causes bone loss in the long run and causes the patient to have hot flashes. Lupron is recommended when fibroids are more than 10 cm before surgery (De La Cruz & Buchanan, 2017). 

Recommended Dosage 

7.5mg per month 

22.5mg in 3 months 

30mg in 4 months 

45mg 6 in months 

           The use of Intrauterine Devices (IUD) is also recommended. Although IUDs are usually used to prevent pregnancy, the hormones released by the device reduces bleeding caused by the fibroids (Stewart et al., 2017). Other hormonal birth controls such as the pills, rings, and implants reduce bleeding, pain during menstruation, cramps, and are essential for women who are anemic (De La Cruz & Buchanan, 2017). Additionally, women advised taking food supplements that contain iron and vitamins, which assist the body in using the available iron effectively. 

Differential diagnosis 

Leiomyosarcoma (LMS) 

Ovarian tumors 

Endometrial polyps 

Endometrial polyps 

The endometrial polyps are small growths that come from the tissues lining the uterus. The size range from small to a big golf ball.  

Causes of Endometrial polyps 

Change in the levels of hormones. Every time the levels of estrogen rise and fall, it causes the lining of the uterus to become thick, then shed off during the period.  

Symptoms of Endometrial polyps 

Heavy and irregular periods 

Vaginal bleeding between periods 

Leiomyosarcoma (LMS) 

This is a type of rare cancer that begins as smooth muscles that lines organs such as the abdomen, bladder, and the intestines (Bibbins-Domingo et al., 2017). The muscles are spontaneous, meaning it cannot be controlled. For instance, they make the stomach to contract to digest food (Bibbins-Domingo et al., 2017). 

Causes  

Gene changes  

Exposure to chemicals such as dioxins and vinyl chloride 

Symptoms  

Frequent urination  

Pain 

Vaginal discharge  

Diagnosis  

Computed tomography (CT) 

Magnetic resonance imaging (MRI) 

Ultrasound 

Ovarian tumors 

  Abnormal growth of a mass of tissue in ovaries of a woman and can be benign or malignant. 

Signs 

Pain in the abdomen 

Frequent urination 

Painful cramps 

Vomiting 

Diagnosis 

Pap test 

Treatment 

Surgery to remove the tumor 

Patient education  

Fibroids refers to a mass of muscles that develop in the uterus of a woman (De La Cruz & Buchanan, 2017). It is bear-shaped and is found between the bladder and the rectum. Fibroids present in various sizes -small to large. Education should also be done on ovarian tumors, leiomyosarcoma (LMS), and endometrial polyps.  

References

De La Cruz, M. S. D., & Buchanan, E. M. (2017). Uterine fibroids: diagnosis and

treatment.  American family physician ,  95 (2), 100-107.

Bibbins-Domingo, K., Grossman, D. C., Curry, S. J., Barry, M. J., Davidson, K. W.,

Doubeni, C. A., ... & Kurth, A. E. (2017). Screening for gynecologic conditions with pelvic examination: US Preventive Services Task Force recommendation statement.  Jama ,  317 (9), 947-953. 

Stewart, E. A., Laughlin-Tommaso, S. K., Catherino, W. H., Lalitkumar, S., Gupta, D., &

Vollenhoven, B. (2017). Uterine fibroids.  Nature reviews Disease primers ,  2 (1), 1-18. 

Taheri, M., Galo, L., Potts, C., Sakhel, K., & Quinn, S. D. (2019). Nonresective treatments

for uterine fibroids: a systematic review of uterine and fibroid volume reductions.  International Journal of Hyperthermia ,  36 (1), 295-301.