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Patient case
Uterine Fibroids.

Uterine Fibroids.

Patient details
Patient details.
Mrs. AK Age: 38 Location: Kumasi, Ghana Presenting Complaints Mrs. AK presents to the clinic with complaints of heavy menstrual bleeding and pelvic pain, which have progressively worsened over the past year.
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Medical History

Mrs. AK reports that her menstrual periods have always been regular, but over the past year, her bleeding has become much heavier, often lasting more than seven days. She also experiences severe cramping and a constant dull pain in her lower abdomen. Additionally, she has noticed an increase in the frequency of urination and occasional constipation. She has had three successful pregnancies in the past, with her last childbirth occurring five years ago. There is a family history of fibroids, as her mother also suffered from them.

Social History

Mrs. AK works as a market trader and lives in a busy urban area of Kumasi. Her diet mainly consists of local staples, and she has a physically demanding job that keeps her active. She does not smoke and drinks alcohol occasionally. Mrs. AK is concerned about her fertility, as she and her husband are considering having another child.

Examination Findings

On examination, Mrs. AK appears generally healthy but is visibly uncomfortable due to pelvic pain. A bimanual pelvic examination reveals an enlarged, irregularly shaped uterus. No other abnormalities are noted.

Investigations

A transvaginal ultrasound shows multiple fibroids within the uterine wall, the largest measuring 6 cm in diameter. Blood tests indicate mild anaemia, likely due to chronic heavy menstrual bleeding.

Diagnosis

Symptomatic uterine fibroids, causing menorrhagia (heavy menstrual bleeding), pelvic pain, and mild anaemia.

Management Plan
  1. Medical Management:

   - Prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief.

   - Offer hormonal therapy, such as a gonadotropin-releasing hormone (GnRH) agonist, to reduce the size of the fibroids and manage bleeding.

   - Iron supplements to address anaemia.

  1. Surgical Options:

   - Discuss the possibility of a myomectomy (surgical removal of fibroids) if medical management is ineffective or if Mrs. AK wishes to preserve her fertility.

   - In the case of severe symptoms unresponsive to other treatments, consider a hysterectomy, particularly if childbearing is no longer desired.

  1. Follow-Up:

   - Monitor symptoms and the size of the fibroids with regular ultrasounds.

   - Reassess anaemia and adjust treatment as necessary.

   - Referral to a fertility specialist if Mrs. AK wishes to pursue pregnancy.

Discussion
Discussion

With appropriate treatment, Mrs. AK’s symptoms can be effectively managed, and her quality of life can improve. Fertility preservation through myomectomy offers a viable option for future pregnancy, though ongoing monitoring and management will be essential.

Questions
1. What is the primary symptom that prompted Mrs. AK to seek medical attention?

   (A). Weight loss  

  (B). Heavy menstrual bleeding and pelvic pain  

   (C). Severe headaches  

   (D). Difficulty breathing  

2. What was revealed by the transvaginal ultrasound in Mrs. AK’s case?

   (A). A single large ovarian cyst  

   (B). An enlarged uterus with multiple fibroids  

   (C). A normal uterus with no abnormalities  

   (D). Endometrial hyperplasia  

3. What treatment was suggested to manage Mrs. AK’s anaemia?  

   (A). Blood transfusion  

   (B). Iron supplements  

   (C). Vitamin D supplements  

   (D). No treatment needed  

4. What surgical option was discussed with Mrs. AK for preserving her fertility?

   (A). Hysterectomy  

   (B). Tubal ligation  

   (C). Myomectomy  

   (D). Oophorectomy  

Reveal answers

Answers

  1. (B). Heavy menstrual bleeding and pelvic pain
  2. (B). An enlarged uterus with multiple fibroids
  3. (B). Iron supplements
  4. (C). Myomectomy