The women’s health clinic had visits by patients representing a wide range of medical conditions and concerns. My week provided me with the opportunity to collaborate with female patients of all age groups on various themes such as reproductive health, gynecological disorders, and general well-being. The roller-coaster of events I faced throughout the week made me a better prospective practitioner.
Challenges and Successes
This week, one of the challenges that I faced was patients who had a variety of complex gynecological symptoms which were difficult to diagnose immediately. Clinical presentation in some of the patients was typical of typical cases. Others, however, had an abnormal presentation or were even asymptomatic, totally complicating the diagnosis and management of the diseases. Nonetheless, the accurate recognition of these varied presentations and successful management with interdisciplinary collaboration improved the quality of care I delivered and validated the need for individualized care plans.
As an example, one of my patients was complaining of abdominal pain and cramps, unexplained bleeding, and menstrual irregularities. Excluding the possible causes and creating an appropriate treatment plan was quite challenging. Nevertheless, the issue was resolved when I did a comprehensive assessment and finally made a diagnosis by ordering some particular tests.
Patient Assessment
The patient was a 28-year-old, sexually active, nulliparous woman with the below presentations:
Signs and Symptoms
Moderate intensity pain in the lower right quadrant of the abdomen, typical abnormal bleeding that is heavy between menstrual periods, intervals of increased drowsiness and fatigue, and menstrual periods that vary in length from 25 days to 40 days.
Assessment and Test Results
Palpation of the right lower quadrant showed mild tenderness, and the pelvic ultrasound demonstrated a 4 cm ovarian cyst with complicated irregular borders and septations.
The hemoglobin and hematocrit levels in the CBC were normal. The estradiol, progesterone, and FSH levels were all in the normal range, and slightly elevated levels of tumor marker CA-125 were detected.
Plan of Care
Further testing was suggested based on the patient’s symptoms and signs. The following strategy was developed in light of the ovarian cyst and abnormal bleeding:
The patient was advised to keep a menstrual diary, which would note the length of her cycle, the pattern of her bleeding and any symptoms accompanying the menstruation, enabling an informative assessment in the future (Hara et al., 2021). Follow-Up Ultrasound: A follow-up pelvic ultrasound was scheduled for four weeks to assess the ovarian cyst and determine if it had increased in size or changed in appearance (Hara et al., 2021). The elevated levels of the tumor marker CA-125 led to referral for evaluation by a gynecologic oncologist.
Possible Differential Diagnoses and Rationale
Functional Ovarian Cyst: The age of the patient and the ultrasound results of a complicated ovarian cyst prompted the inclusion of this diagnosis into the differential diagnosis (Wolfman et al., 2020). However, the high marker of CA-125 gives a cause for concern regarding malignancy. Ovarian Cancer: Cancer worries arose from an ovarian cyst and a high CA-125 marker, making a specialist consultation necessary. Endometriosis: Menstrual irregularities, pelvic pain, and abnormal bleeding can all be manifestations of endometriosis (Farkas et al., 2023). Nevertheless, this does not fully explain the ovarian cyst or the high CA-125 marker.
Health Promotion Intervention
Treating the patient’s general condition rather than only their acute complaints is critical. Explaining the need to prevent and manage health issues through a proper diet, along with pap tests, mammograms for females, and regular physical activities, is essential. Hormonal Balance: Patients should be informed of hormonal balance that reduces the risk of ovarian cysts. It is crucial to describe the advantages of hormonal contraceptives in the normalization of menstrual cycles and preventing ovarian cyst formation, mainly in women with irregular menstrual cycles and hormonal disorders (Farkas et al., 2023).
Lessons
The clinical experience proved to me the necessity to carry out detailed examinations, especially when patients come with various symptoms that are difficult to diagnose. Precision diagnoses demand meticulous patient history taking, comprehensive physical examination, and appropriate diagnostic tests. Management of cases also greatly depends on an interdisciplinary approach and stimulates specialists’ referral. Patient-centered Care: Individually adjusting patients’ treatment plans will contribute to patient empowerment and improve therapy adherence.
Plan of Care Supported by Current Guidelines
The National Comprehensive Cancer Network (NCCN) advises of the need for screening and early detection of ovarian cancer to guide the management of this patient (Wolfman et al., 2020). The recommendations emphasize that tumor markers such as CA-125 should be used, and symptoms and risk factors should be analyzed to identify ovarian cancer. In addition, NCCN recommendations advise seeking a gynecologic oncologist when managing complex ovarian cysts and elevated tumor marker levels.
References
Farkas, A. H., Abumusa, H., & Rossiter, B. (2023). Structural gynecological disease: Fibroids, endometriosis, ovarian cysts. Medical Clinics, 107(2), 317-328. https://doi.org/10.1016/j.mcna.2022.10.010.
Hara, T., Mimura, K., Endo, M., Fujii, M., Matsuyama, T., Yagi, K., & Kimura, T. (2021). Diagnosis, management, and therapy of fetal ovarian cysts detected by prenatal ultrasonography: A report of 36 cases and literature review. Diagnostics, 11(12), 2224. https://doi.org/10.3390/diagnostics11122224.
Wolfman, W., Thurston, J., Yeung, G., & Glanc, P. (2020). Guideline No. 404: Initial investigation and management of benign ovarian masses. Journal of Obstetrics and Gynecology Canada, 42(8), 1040–1050. https://doi.org/10.1016/j.jogc.2020.01.014.
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