Case Diana

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1Case: DianaDiana 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 yearsago (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 FindingsBP: 155/80, P: 99, RR: 18, T: 98.4°F._Weight: 206 lbs., Height: 66 in, BMI: 33.2 kg/m2(obesity).=Abdomen: Soft, non-tender, no masses.=GU: Normal vaginal mucosa, no cervical motion

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2tenderness, uterus 8-week size, no adnexal masses.ZExtremities: 1+ bilateral edema.Diagnostic Tests, Procedures, Laboratory Work□CBC: To evaluate for anemia due to heavy menstrualbleeding (El Demerdash et al., 2024).□TSEI: To rule out thyroid dysfunction as a reason forirregular cycles.□Pelvic Ultrasound: To assess for fibroids, polyps, orendometrial hyperplasia (Stachowicz et al., 2021).□Pap Smear: Due to prolonged time since lastscreening.□HbAlc: Because of a family history of diabetes andobesity.Differential DiagnosesDiana's clinical presentation produces several differentialdiagnoses. In light of her age (48 years) and history ofirregular menses, perimenopause is strongly likely. Fibroidsof the uterus are also likely, in light of her heavy menstrualflow and mother's history of fibroids. Endometrial

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3hyperplasia would also need to be considered as adifferential, given her obesity and irregular bleeding whichincrease her risk for hyperplasia (Chou et al., 2024). Finally,hypothyroidism could, at least in part, explain weight gainand irregular menstrual cycles, so thyroid function needs tobe evaluated. Further testing and evaluation will be neededto further refine the underlying diagnosis for her symptoms.Medications, Treatments or Other InterventionsNSAIDs (e.g, ibuprofen) should be recommend for Diana fordysmenorrhea and heavy menstrual bleeding, as their effecton decreasing pain and blood loss is well documented(Rodriguez et al., 2019). Hormonal therapy can also be aconsideration such as oral contraceptive therapies (OCPs) orprogesterone to minimize her irregular cycles (Chandel etal., 2024). It is very important to change her lifestyle throughweight loss and regular activity in managing her obesity andmetabolic risk factors, as even a little weight loss wouldimprove menstrual irregularities and overall well-being

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