Practicum Experience, Essay Example

I have not had an opportunity to evaluate a patient with endometriosis, ovarian cysts, or amenorrhea during the last five weeks, therefore a case study was selected for examination from the University of Pennsylvania (University of Pennsylvania, n.d.). In this case, a 20-year old woman presented with a four year history of increasing lower abdominal pain with her menstrual cycle. The pain begins on the first day of the menstrual cycle and ends two to three days later. She also presents with lower back pain and nausea. Menarche occurred at the age of 13 and her menstrual cycle occurs every 28 days and last 5 days. Her physical and pelvic exam were normal and she is not currently taking any medications.

The patient is diagnosed with endometriosis due to the presence of the following symptoms: abdominal pain, lower back pain, and nausea. Her lower abdominal pain is classified as dysmenorrhea. To confirm this diagnosis, it is useful to perform a clinical test to determine whether PGF2? levels are elevated in the secretory endometrium. A pelvic examination would likely reveal the presence of tender nodular masses along thickened uterosacral ligaments, the posterior uterus, or the posterior cul-de-sac. The aim of the treatment plan is to reduce the pain associated with endometriosis to improve the patient’s quality of life (Fourquet et al., 2011). To treat these symptoms, the patient will be provided with NSAIDs, which have a prostaglandin synthetase inhibitor function (Giudice, 2010). It is recommended that the patient be provided with NSAIDs and instructed to return to a healthcare professional in approximately one month to determine if the treatment is effective.

Endometriosis, ovarian cysts, and amenorrhea all cause pelvic pain and it is therefore essential for healthcare professionals to understand the difference between treatment modalities and the implications of these differences when diagnosing and treating patients. As stated above, endometriosis is typically treated with NSAIDs and it is often recommended to treat pain symptoms rather than remove the source of the pain. In extreme cases, patients with endometriosis will be given hormone therapy or surgery. However, extreme treatment measures are typically avoided unless patients exhibit a clear need for them. Patients with ovarian cysts will typically be treated on the basis of the size of the cyst. Some healthcare professionals may not prescribe any treatment to first determine whether the cyst will dissipate on its own. If this is not the case, birth control pills and/or surgery will be recommended. Amenorrhea treatment often depends on the cause of this manifestation in patients. Some women will experience amenorrhea during pregnancy, breast-feeding, and menopause, which is considered to be normal and may not be treated. Primary amenorrhea treatment typically involves surgery. Secondary amenorrhea treatment includes birth control pills and other hormonal medications, medications to relieve the symptoms of PCOS such as clomiphene citrate (CC) therapy to stimulate the ovaries, and estrogen therapy replacement (ERT) (Chou et al., 2011). Secondary amenorrhea can also be treated with surgical options. These include treatment for uterine scarring using a hysteroscopic resection and the use of surgery to remove the pituitary tumor if medications are not effective for this purpose. It is essential to understand that while all three of these gynecological disorders are related, they have different causes and must therefore be treated differently. Treatment options should also be considered based on the severity of the disorder in all cases.

References

Chou SH. (2011). Leptin is an effective treatment for hypothalamic amenorrhea. 108(16): 6585–6590.

Fourquet J, Báez L, Figueroa M, Iriarte RI, Flores I. (2011). Quantification of the impact of endometriosis symptoms on health-related quality of life and work productivity. Fertility and Sterility. 96(1): 107-112.

Giudice LC. (2010). Endometriosis. N Engl J Med, 362:2389-2398.

University of Pennsylvania. (n.d.). Pelvic Pain – Dysmenorrhea and Endometriosis. Retrieved from http://www.uphs.upenn.edu/obgyn/education/documents/PelvicPainDysmenorrheaandEndometriosis.ppt