Description
Reply to Jackline
Discussion 1
This weeks clinical experience went well. There were no challenges faced. During my clinical rotation this week I saw a 39yr old female with fibroids and her last pap smear 3 years ago. PMH of anxiety and depression and fibroids. The patient stated that her pap smears were normal. The patient also reported that she has painful and heavy menstrual cycles. The possible differential diagnosis for this patient would be abnormal uterine bleed, endometriosis, and endometrial polyps.
I learned that fibroids are the growth of the uterus that often appears during childbearing years. They range in size from seedlings, and are undetectable by the human eye, to bulky masses that can distort and enlarge the uterus (Mayo Clinic, 2019). Women can have single or multiple fibroids. Sometimes fibroids can expand to the uterus that sometimes reaches the rib cage adding weight gain. Fibroids are usually discovered through a pelvic exam or ultrasound. Symptoms of fibroids include dysmenorrhea, menorrhea, pelvic pain, menstrual bleeding lasting more than a week. Fibroids are usually classified by their locations. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity, and subserosal fibroids project to the outside of the uterus. Causes of fibroids can be due to genetics, hormones such as progesterone and estrogen can promote the growth of fibroids. Also, extracellular matrix. Which is the material that makes the cells stick together. The extracellular matrix is increased in fibroids and makes them fibrous. It also stores growth factors and causes biological changes in the cells. The growth of fibroids varies. Some may grow rapidly or slowly or remain the same size. Some may shrink on their own or go through sprouts. Risk factors for fibroids include heredity, race, onset of menstruation at an early age, obesity, vitamin D deficiency. Having a diet high in red meats, and alcohol can increase the risks of fibroids. Complications of fibroids include anemia due to heavy menstrual bleeding and blood loss. Fibroids can raise the risk of certain pregnancy complications such as placenta abruption, fetal growth restriction, and preterm delivery. The treatment for fibroids depends on the symptoms. Women may have no symptoms and not need treatment for fibroids. Those with significant symptoms may need medical or surgical treatment. Treatment includes NSAIDs, iron and vitamins, hormonal birth control, antifibrinolytics such as Lysteda to help slow menstrual bleeding, progesterone receptor modulators, gonadotropin-releasing hormones analogs. Myomectomy can also be done to remove the fibroids which can help reduce bleeding and related symptoms. Endometrial ablation can also help with the destruction of the lining of the uterus which can help decrease heavy blood flow caused by the fibroids (Up to date, 2021). This can be beneficial for me as an advanced practice nurse because knowing the symptoms and what are fibroids can help me determine a diagnosis for patients who present with this problem. It also gives me a clear understanding of what are fibroids, what types, risk factors, and complications, and whether or not the patient needs treatment.
References
UpToDate. (n.d.). https://www.uptodate.com/contents/uterine-fibroids-beyond-the-basics (Links to an external site.)
Uterine fibroids – Symptoms and causes. (2019, December 10). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288 (Links to an external site.)