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LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Identify the signs and symptoms associated with endometriosis.

  • Compare and contrast the benefits and risks associated with various hormonal medications used for the treatment of endometriosis-associated pelvic pain.

  • Determine a treatment approach for this case taking into account other health issues and potential health benefits.

  • Discuss possible side effects associated with treatment for endometriosis.

PATIENT PRESENTATION

Chief Complaint

“Although the pain associated with my menstrual period is better, the naproxen upsets my stomach, and I am still having pain in my lower abdomen at other times during the month.”

HPI

Lisbeth Anderson is a 30-year-old woman who was diagnosed with endometriosis 3 months ago based on a history of dysmenorrhea, intermittent pain with defecation, and past history of dyspareunia. She presents to the nurse practitioner today for evaluation and management of continued endometriosis-related pain despite treatment with naproxen.

PMH

  • S/P deep vein thrombosis 4 years ago after a flight to Southeast Asia; treated for 6 months with warfarin; no recurrence

  • G1P1A0; one healthy male child aged 2 years

FH

Mother (aged 57 years) has a history of endometriosis, no other health conditions; father (aged 58 years) has hypertension and elevated cholesterol; one female sibling (aged 25 years) is healthy

SH

Patient is a freelance photographer. She has one child. She is single; currently not sexually active. She does not smoke and consumes no more than two alcohol-containing beverages per week. She exercises 30 minutes most days of the week.

Meds

  • Naproxen 250 mg three times daily with food at first sign of menses for 5–7 days was begun at previous visit

  • Multivitamin one daily

All

NKDA

ROS

(+) For moderate pain in pelvic region, (–) for constipation, menstrual periods occur at regular intervals of 29 days

Physical Examination

Gen

WDWN female in NAD

VS

BP 115/70 mm Hg, P 65 bpm, RR 15, T 37°C; Wt 72 kg, Ht 5′11″; patient has maintained same weight prepregnancy and postpregnancy

Skin

No lesions

HEENT

WNL

Neck/Lymph Nodes

Supple, no bruits, no adenopathy, no thyromegaly

Lungs/Thorax

CTA bilaterally

Breasts

Supple; no masses

CV

...

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