Diagnostic features present in the patient are

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Running Head: Case Study
Case Study Analysis
Name of the Student
Name of the University
Authors Note

1CASE STUDY ANALYSIS
Case Study 1
Response 1
Diagnostic features present in the patient are;
 Pain during menstruation
 Chronic pelvic pain and severe lower backache
 Heavy and dark blood clots in first two days of periods
 Throbbing and proximal headache
 Neck pain and vomiting
 Painful defecation and intercourse
 Increasing fatigue
 Low blood pressure and heart rate
The questions which should be asked for identifying conditions of the patient are;
 How frequent have you missed your menstruation cycle?
 On a scale of 0 to 10, grade your menstruation pain during the cycle? (If 10 is the
worst pain and 0 is the state of pain free)
 Do you eat enough food on the days of periods?
 In the last three months, have you intaken any kind of painkiller?
 What is your normal body weight? Have you felt a sudden increase and decrease in
your body weight?
Response 2
Dysmenorrhea
This medical condition causes menstrual cramps due to uterine contractions. Primary
dysmenorrhea causes only the common menstrual cramps and pain during the cycle
whereas secondary conditions causes different abnormalities of reproductive organs
(Zuckerman et al., 2018).
Signs and symptoms
 Painful periods and weakness
 Pain in lower back
 Throbbing and cramps at the onset of the period
 Nausea and vomiting

2CASE STUDY ANALYSIS
 Headaches
Rationale
Ms Roberts is having pelvic pain and lower back pain along with throbbing. She
usually feels extreme pain on the onset of period. Pain continues first two days of period.
Therefore, the patient may suffer from dysmenorrhoea. She also feels tiredness and
headaches which are similar additional symptoms of dysmenorrhoea (Matthewman et al.,
2018).
Menstrual migraine and visual aura
Migraine and visual aura mean recurring headache which strikes within a specific
interval of time. This condition will make the patient feel sensory disturbances such as flash
of light, spots at the eyesight and changes of vision (Todd, Lagman-Bartolome & Lay, 2018).
Signs and symptoms
 Nausea and vomiting
 Sensitivity to light and sounds
 Pain behind one eye and one ear
 Temporary loss of vision
Rationale
In this case study, Ms Roberts faces paroxysmal headache and visual aura with headache
and vomiting during her menstrual cycle specially. Therefore, it can be said that the patient
might suffer from menstrual migraine.
Endometriosis
Sometimes tissues or similar structures like tissues are lined within and outside of
uterus and cause abnormalities such as irritation and pain; this condition is known as
endometriosis (Wardle, 2017).
Signs and symptoms
 Painful periods and menstrual cramps
 Painful intercourse and defecation

3CASE STUDY ANALYSIS
 Excessive bleeding during period
 Infertility (Soliman et al., 2017)
Rationale
The patient feels extreme pain in lower abdomen and pelvic area while her period is
going on. Pain during intercourse and bowel movements is very prominent in Ms Roberts.
During menstruation cycle, she has excessive and heavy bleeding. She is trying to conceive
for several years which can be a sign of infertility. The above discussed symptoms indicate
that the patient is suffering from endometriosis.
Response to Question 3
Endometriosis causes pelvic inflammatory disease, haemorrhage in corpus leuteum,
myomass, cancer in cervix and vagina (appendix , table 1). In this case study, infection in
upper part of female reproductive system and pain in lower abdomen, heavy vaginal
discharge and pain during intercourse are the symptoms in the patient (Alberico et al.,2018
). Abnormal bleeding due to cyst rupturing can affect the healthy tissues of uterus and leads
to removal of uterus due to surgery (Coxon, Horne & Vincent, 2018).
Myomass can cause heavy menstrual bleeding, lower back pain and pelvic pain
(appendix ,table 1). In this case study, Ms Roberts’ period lasts for more than one week and
pain during menstrual cycle. Change in bowel movement and frequent urination with weight
loss and urge for overeating are the symptoms of malignancy in ovary (Foth et al., 2017).
Endometriosis, fibroids and pelvic congestion are the result of dysmenorrhea. Pain is
present before and after the occurrence of period (appendix ,table 1). Chronic pelvic pain
and fatigue with sensation in pelvic region are the symptoms of dysmenorrhoea (Soliman et
al., 2017).
Menstrual migraine and visual aura are caused by fluctuation of hormones,
abnormalities of blood pressure and hormonal replacement therapy (appendix ,table 1).
Blurred vision and fatigue with headache and nausea are the symptoms of menstrual
migraine. Patient has abnormal periods and throbbing with headache. Patient is suffering
from visual aura and fatigue. The patient has fatigue, nausea and headache (Zuckerman et
al., 2018).
Response 4

4CASE STUDY ANALYSIS
Pathophysiology of endometriosis: Endometriosis is occurred due to transportation of
cells to the uterine cavity and implanted at ectopic sites. Retrogressive flow of menstrual
tissues in fallopian tubes and intra-abdominal sites (Coxon, Horne, & Vincent, 2018).
Exact pathological mechanism of this condition is rare, the endometrial cells are
transported to the pelvic organs and they start to seed and grow. The growth will hamper
normal menstruation and defecation. As a result, pain can be felt during menstruation and
defecation and intercourse (Coxon, Horne & Vincent, 2018).
Response 5
Investigatory tests for endometriosis are:
 Pelvic exam
 Ultrasound
 Magnetic resonance imaging (MRI)
 Laparoscopy
Magnetic resonance imaging (MRI)
Magnetic resonance imaging will help to identify deep endometriosis by assessing
pelvis. MRI is important in identifying the range of deep penetrating endometriosis,
specifically while laparoscopic inspection is restricted by adhesions. MRI may help to detect
surgical methods for patients with endometriosis for deep infiltrating endometriosis and other
unfamiliar sites of appearance (Bazot et al., 2017).
Laparoscopy:
The peritoneal implants, peritoneal windows, endometriomas, and deep infiltrating nodules
of endometriosis can be observed during laparoscopy. The surgeon will form a minor
incision nearby the patient’s lower abdomen and fill the abdomen with gas for a better look at
the internal organs of the patient (De Cicco et al., 2017).
Response 6
Two pharmacological intervention for the patient are:
NSASID: Non-steroidal Anti-Inflammatory Drugs such as Ibuprofen (400 mg) and Naproxen
(500 mg) should be administered 5-7 days prior to menstruation cycle to block the
endometriosis related prostaglandin which leads to pain and swelling (Bedaiwy, Allaire &
Alfaraj, 2017).

5CASE STUDY ANALYSIS
Combined oestrogen and progestin contraceptives are helpful in controlling the secretion of
gonadotropin hormones, stop cell proliferation and enhance apoptosis in ectopic
endometrium (Casper, 2017).
The non-pharmacological interventions are;
`Physical exercises such as Kegal exercise or the pelvic floor exercises should be
suggested to the patient under the supervision of physiotherapist. Proper posturing during
sleeping and sitting should be taught to the patient (Matthewman et al., 2018).
Weight management is helpful intervention in the endometriosis. Nutrition based and
vitamin rich food such green leaf, beans, fortified grains, broccoli, nuts, and seeds. The
inflammation of endometriosis can be controlled by increasing nutritional habit (Owiredu et
al., 2019).

6CASE STUDY ANALYSIS
References
Alberico, D., Somigliana, E., Bracco, B., Dhouha, D., Roberto, A., Mosconi, P., ... &
Vercellini, P. (2018). Potential benefits of pregnancy on endometriosis
symptoms. European Journal of Obstetrics & Gynecology and Reproductive
Biology, 230, 182-187. https://doi.org/10.1016/j.ejogrb.2018.08.576
Bazot, M., Bharwani, N., Huchon, C., Kinkel, K., Cunha, T. M., Guerra, A., ... & Thomassin-
Naggara, I. (2017). European society of urogenital radiology (ESUR) guidelines: MR
imaging of pelvic endometriosis. European radiology, 27(7), 2765-2775.
https://doi.org/10.1007/s00330-016-4673-z
Bedaiwy, M. A., Allaire, C., & Alfaraj, S. (2017). Long-term medical management of
endometriosis with dienogest and with a gonadotropin-releasing hormone agonist
and add-back hormone therapy. Fertility and sterility, 107(3), 537-548.
https://doi.org/10.1016/j.fertnstert.2016.12.024
Casper, R. F. (2017). Progestin-only pills may be a better first-line treatment for
endometriosis than combined estrogen-progestin contraceptive pills. Fertility and
sterility, 107(3), 533-536. https://doi.org/10.1016/j.fertnstert.2017.01.003
Coxon, L., Horne, A. W., & Vincent, K. (2018). Pathophysiology of endometriosis-associated
pain: a review of pelvic and central nervous system mechanisms. Best Practice &
Research Clinical Obstetrics & Gynaecology, 51, 53-67.
https://doi.org/10.1016/j.bpobgyn.2018.01.014
De Cicco, S., Tagliaferri, V., Selvaggi, L., Romualdi, D., Di Florio, C., Immediata, V., ... &
Guido, M. (2017). Expectant management may reduce overtreatment in women
affected by unexplained infertility confirmed by diagnostic laparoscopy. Archives of
gynecology and obstetrics, 295(2), 427-433. https://doi.org/10.1007/s00404-016-
4246-z
Foth, D., Röhl, F. W., Friedrich, C., Tylkoski, H., Rabe, T., Römer, T., ... & Ahrendt, H. J.
(2017). Symptoms of uterine myomas: data of an epidemiological study in
Germany. Archives of gynecology and obstetrics, 295(2), 415-426.
https://doi.org/10.1007/s00404-016-4239-y
Matthewman, G., Lee, A., Kaur, J. G., & Daley, A. J. (2018). Physical activity for primary
dysmenorrhea: a systematic review and meta-analysis of randomized controlled

7CASE STUDY ANALYSIS
trials. American journal of obstetrics and gynecology, 219(3), 255-e1.
https://doi.org/10.1016/j.ajog.2018.04.001
Owiredu, W. K., Ofori, P. N., Turpin, C. A., Obirikorang, C., Acheampong, E., Anto, E. O., ...
& Adu, E. A. (2019). Weight management merits attention in women with infertility: a
cross-sectional study on the association of anthropometric indices with hormonal
imbalance in a Ghanaian population. BMC research notes, 12(1), 545.
https://doi.org/10.1186/s13104-019-4593-5
Soliman, A. M., Coyne, K. S., Zaiser, E., Castelli-Haley, J., & Fuldeore, M. J. (2017). The
burden of endometriosis symptoms on health-related quality of life in women in the
United States: a cross-sectional study. Journal of Psychosomatic Obstetrics &
Gynecology, 38(4), 238-248. https://doi.org/10.1080/0167482X.2017.1289512
Todd, C., Lagman-Bartolome, A. M., & Lay, C. (2018). Women and migraine: the role of
hormones. Current neurology and neuroscience reports, 18(7), 42.
https://doi.org/10.1007/s11910-018-0845-3
Zuckerman, R. M., Silton, R. L., Tu, F. F., Eng, J. S., & Hellman, K. M. (2018). Somatic
symptoms in women with dysmenorrhea and noncyclic pelvic pain. Archives of
women's mental health, 21(5), 533-541. https://doi.org/10.1007/s00737-018-0823-4

8CASE STUDY ANALYSIS
Appendix
Table 1
Main
condition
Causes Characteristics
of outcome of
the symptoms
Associated
Symptoms
Findings
Endometriosi
s
Pelvic
inflammatory
disease
Lower abdominal
pain , painful
intercourse(Coxo
n, Horne &
Vincent, 2018)
Infertility , chronic
pelvic pain
Infection in
upper part of
female
reproductive
system. Pain
in lower
abdomen ,
heavy
vaginal
discharge
and pain
during
intercourse.
Haemorrhag
e in corpus
leuteum
Cysts in ovary
cause pelvic pain
and abnormal
bleeding(Foth et
al.,2017) .
Ovarian torsion with
pain and rupturing of
the cysts causes
internal bleeding.
Abnormalities
during cyst
rupturing
can affect
the healthy
tissues of
uterus and
leads to
removal of
uterus due to
surgery.
Myomass 1. Heavy
menstrual
bleeding and
pelvic pain.
Constipation,
frequent urination
and difficulties in
urinary retention
(Foth et al., 2017).
Period lasts
for more than
one week
and pain
during

9CASE STUDY ANALYSIS
2.Lower back
pain
menstrual
cycle.
Malignancy
in ovary
Abnormal blotting
and discomfort in
pelvic area.
Change in bowel
movement and
frequent
urination.
Weight loss and urge
for overeating.
The pap
smear of the
patient is
negative.
Therefore the
patient has
no signs of
malignancy.
Cancer in
cervix and
vagina
Pelvic pain and
irritation during
intercourse can
be seen. The
patient has heavy
and clotted
discharge during
period.
Watery and foul
smelled discharge
with blood stain.
The pap
smear was
negative so
she is not
suffering from
cancer.
Dysmenorrhe
a
Endometriosi
s
Pain is present
before and after
the occurrence of
period.
Dyspareunia,
premenstrual spotting
and difficulties to
conceive.
Pelvic pain
and infertility.
Fibroids Sensation in
pelvic region and
dysmenorrhoea.
Enlargement of
abdomen, painful
periods and
constipation.
Ms Roberts
feels painful
periods, back
pain and
problem in
bowel
movement.

10CASE STUDY ANALYSIS
Pelvic
congestion
Pelvic pain during
menstrual phase
and chronic
pelvic pain and
fatigue.
Abnormal vaginal
discharge, backache
and
depression(Zuckerma
n et al., 2018)..
Dysmenorrhe
a and fatigue
are present
with back
pain.
Menstrual
migraine and
visual aura
Fluctuation
of hormones
Loss of appetite
and abnormal
menstruation can
be observed
(Todd, Lagman-
Bartolome & Lay,
2018).
Fatigue and
weakness with
severe headache.
Patient has
abnormal
periods and
throbbing
with
headache.
Blood
pressure
abnormalities
Blurred vision
and fatigue.
Dizziness, lack of
concentration and
nausea.
Patient is
suffering from
visual aura
and fatigue.
Hormonal
replacement
therapy
Headache and
nausea.
Bloating, changes in
mood and vaginal
bleeding (Zuckerman
et al., 2018)..
The patient
has fatigue,
nausea and
headache.
References
Coxon, L., Horne, A. W., & Vincent, K. (2018). Pathophysiology of endometriosis-associated
pain: a review of pelvic and central nervous system mechanisms. Best Practice &
Research Clinical Obstetrics & Gynaecology, 51, 53-67.
https://doi.org/10.1016/j.bpobgyn.2018.01.014
Foth, D., Röhl, F. W., Friedrich, C., Tylkoski, H., Rabe, T., Römer, T., ... & Ahrendt, H. J.
(2017). Symptoms of uterine myomas: data of an epidemiological study in
Germany. Archives of gynecology and obstetrics, 295(2), 415-426.
https://doi.org/10.1007/s00404-016-4239-y

11CASE STUDY ANALYSIS
Todd, C., Lagman-Bartolome, A. M., & Lay, C. (2018). Women and migraine: the role of
hormones. Current neurology and neuroscience reports, 18(7), 42.
https://doi.org/10.1007/s11910-018-0845-3
Zuckerman, R. M., Silton, R. L., Tu, F. F., Eng, J. S., & Hellman, K. M. (2018). Somatic
symptoms in women with dysmenorrhea and noncyclic pelvic pain. Archives of
women's mental health, 21(5), 533-541. https://doi.org/10.1007/s00737-018-0823-4