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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.
“I am not getting relief from my endometriosis pain with Tylenol and I would like to see what other options I have.”
Kelly Lancaster is a 26-year-old woman who was diagnosed with endometriosis 1 year ago by a previous healthcare provider based on a history of dysmenorrhea, intermittent pain with defecation, and past history of dyspareunia. She presents to the nurse practitioner today to establish care and evaluate continued endometriosis-related pain despite treatment with acetaminophen which she has been using when the pain is most severe during her menstrual period. During these times, the acetaminophen reduces her pain from a 6 on a 10-point scale to a 5.
S/P deep vein thrombosis at age 20 after ankle surgery; treated for 6 months with warfarin; no coagulopathy identified; no recurrence
Seasonal allergic rhinitis
Mother (aged 60 years) has a history of endometriosis, no other health conditions; father (aged 62 years) has hypertension; one male sibling (aged 30 years) has asthma.
Patient is an information technology specialist. She has no children. 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 five times a week and teaches a yoga class 2 nights per week.
Acetaminophen 1000 mg PO four times daily for menstrual pain
Fluticasone propionate 50 mcg nasal spray: 1 spray in each nostril once daily during allergy season
Multivitamin one tablet PO daily
Ibuprofen (hives, anaphylaxis)
(+) For moderate pain in pelvic region, (–) for constipation, menstrual periods occur at regular intervals of 28 days
BP 108/72 mm Hg, P 65 bpm, RR 15, T 37°C; Wt 60 kg, Ht 5′6″; patient has maintained same weight for the last 5 years