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Gynaecology - Case Study Example

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This is a case study analysis and discussion on a patient who started to have complaints of heavy and painful menstrual bleeding two years ago. To start with the bleeding was lesser than it is now. From both subjective and objective measures, the extent of bleeding has increased progressively in quantity over time…
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Download file to see previous pages (NICE, 2007). Prevalence of HMB is 4-9 % (Harlow and Campbell, 2004). It has been estimated that one in twenty women seeks medical attention for HMB (NICE, 2007). By definition, thus, it is prolonged or heavy cyclic menstruation. Objectively, menses lasting longer than 7 days or exceeding 80 mL of blood loss qualify HMB (Shapley et al., 2007).
The graph above represents the annual rates of heavy menstrual bleeding in different age groups and shows its prevalence in virtually all age groups with the highest incidence in age group 45-49. As indicated in Bonnar and Sheppard (1996), the causes of heavy menstrual bleeding have been tabulated below.
This patient came to a Women's Health Clinic via the Choose and Book system. Choose and Book system is a national electronic referral service introduced in England in the summer of 2004. This system gives patients a choice of place, date and time for their first outpatient appointment in a hospital or a clinic (de Kare-Silver, 2005). The Women's Health Clinic is run by female practitioners with a special interest in Gynaecology. This clinic was set up in 2002 to assist male general practitioners in this area, whose female patients suffer from gynaecological conditions. About 61% of female patients registered with GPs in this area are of South Asian origin (Webb, 2004), and over a third of women have no access to a female GP within their practice. These ladies prefer to come to the Women's Health Clinic for their initial management.
Before attending this consultation, the patient had an ultrasound done. The General Practitioner wanted to rule out any structural pathology that could contribute to her HMB. Ultrasonography report confirmed the presence of small-sized fibroids. Although information regarding the endometrium was possible to be obtained from the ultrasonogram, unfortunately the sonologist did not comment on the endometrial regularity and thickness, which are important for differentiating the causes of HMB. She had a one-centimetre submucous and two small intramural fibroids. Although sub-mucous fibroids are associated with HMB (RCGP, 2005), it is still possible that in this patient, HMB was not solely due to fibroids. Royal College of Obstetricians and Gynaecologists (RCOG) suggest initial treatment with oral Tranexamic acid and Mefenamic acid for regular painful HMB if contraception is not required for at least three months (Grant et al., 2000). National Institute of Clinical Excellence suggests IUS as first line of treatment if ...Download file to see next pagesRead More
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