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Case Diana

Case study on perimenopausal abnormal uterine bleeding, diagnostics, treatment options, SDoH factors, and patient education for Diana, a 48-year-old woman with obesity and irregular menses.

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    1 Case: Diana Diana is a 48-year-old Hispanic woman (G4P1031) with irregular periods (variable interval, changing flow, dysmenorrhea), 30-pound weight gain over the last 10 years, and recent heavy, clotted 10-day menses. Last Pap smear 12 years ago (normal). No medical or surgical history of note other than gallstones and a past cholecystectomy. Family history of fibroids (mother) and diabetes (sister). Subjective Data □ Irregular periods (variable intervals, changing flow, dysmenorrhea relieved by ibuprofen). □ 30-pound weight gain over 10 years. □ Recent heavy, clotted 10-day menses. □ No current medications, allergies, or STI history. □ Last Pap smear 12 years ago (normal). □ Family history: fibroids (mother), diabetes (sister). Objective Findings BP: 155/80, P: 99, RR: 18, T: 98.4°F. _ Weight: 206 lbs., Height: 66 in, BMI: 33.2 kg/m 2 (obesity). = Abdomen: Soft, non-tender, no masses. = GU: Normal vaginal mucosa, no cervical motion

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    2 tenderness, uterus 8-week size, no adnexal masses. Z Extremities: 1+ bilateral edema. Diagnostic Tests, Procedures, Laboratory Work □ CBC: To evaluate for anemia due to heavy menstrual bleeding (El Demerdash et al., 2024). □ TSEI: To rule out thyroid dysfunction as a reason for irregular cycles. □ Pelvic Ultrasound: To assess for fibroids, polyps, or endometrial hyperplasia (Stachowicz et al., 2021). □ Pap Smear: Due to prolonged time since last screening. □ HbAlc: Because of a family history of diabetes and obesity. Differential Diagnoses Diana's clinical presentation produces several differential diagnoses. In light of her age (48 years) and history of irregular menses, perimenopause is strongly likely. Fibroids of the uterus are also likely, in light of her heavy menstrual flow and mother's history of fibroids. Endometrial

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    3 hyperplasia would also need to be considered as a differential, given her obesity and irregular bleeding which increase her risk for hyperplasia (Chou et al., 2024). Finally, hypothyroidism could, at least in part, explain weight gain and irregular menstrual cycles, so thyroid function needs to be evaluated. Further testing and evaluation will be needed to further refine the underlying diagnosis for her symptoms. Medications, Treatments or Other Interventions NSAIDs (e.g, ibuprofen) should be recommend for Diana for dysmenorrhea and heavy menstrual bleeding, as their effect on decreasing pain and blood loss is well documented (Rodriguez et al., 2019). Hormonal therapy can also be a consideration such as oral contraceptive therapies (OCPs) or progesterone to minimize her irregular cycles (Chandel et al., 2024). It is very important to change her lifestyle through weight loss and regular activity in managing her obesity and metabolic risk factors, as even a little weight loss would improve menstrual irregularities and overall well-being

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