For this paper I choose the topic related to heavy and prolonged menstruation.
Being a medical resident (endocrinologist) and working daily with patients with
hormonal imbalances, I was impressed by a case of a woman of childbearing age, with
no significant personal or family history, who went fom being regular but prolonged
and very heavy menstruation, with abdominal pain and cramps that had affected her
day by day life to extremely irregular. She was on an IUD Betleem those times. Her
period is now all over the place. Sometimes it vomes every 35 ish days, Other times it
comes every 6_8 weeks or basically just when it feels like it. When she gets it the flow
is not At all normal or consistent At all.
Her Blood analyzes showed very low iron, undetectable ferittin and her hemoglobin
was also low. Concerning her hormones, only a Low serum progesterone it was
revealed. Her estradiol, testosteron and corisol was in normal range.
As symptoms she associated horrible mood swings for 99% of the month, dizziness
and she was very weak all day long. She is very stressed and this symptoms really
changed her life because she is feeling stick constantly that she has no idea why.
The physical exam showed no signs of hyperandrogenism and investigations to
determine a possible cause of PCOS didn t confirmed, as well as the thyroid function
who was in range . I mention that the patient had a vaginal ultrasound and did not
detect the appearance of polycistic ovaries that can be present in PCOS.
At discharge they recommended to her only birth control pills and iron supplements.
For such a case in which her life was in danger I considered the administration of
contraceptives correct and necessary concernig her massive blood loss but not as the
only method of treatment.
I mention that no method of lifestyle change was specified considering that the patient
had a disorderly lifestyle in terms of food but also her sleep and stress was So
affected by having a very stresful job- she is a nurse that works day and night. What I
found insuficient was the investigation of possible adjacent symptoms, premenstrual
syndrome with irritability, firm, painful breasts that were neglected.
I consider it very important to look for the cause and a much more detailed anamnesis
regarding the case presented because at a young age we can neglect a very important
diagnosis such as endometriosis and the birth control pills cannot resolve her problem,
only the symptoms for a Short period of time.
The problem in our hospitals is that we don’t Look for the root cause of the disease,
we only Look to Find a diagnostic for every patient.
That s why I consider that is very important to Take longer consultations, to have
patience with everyone Because a deeper anamnesis Could lead to precious
information.
Only treating symptoms is not a good choice and usually that it s not going to long
term results. A Healthy, nutrient diet, a good, restfull sleep and an active life ,
reducing stress should be the main concerns and also indications for one patient.
Then with good tests recommandation we should try to Find the cause of their
problems.