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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

“I am not getting relief from my endometriosis pain with Tylenol and I would like to see what other options I have.”

HPI

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.

PMH

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

G0P0A0

FH

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.

SH

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.

Meds

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

All

Ibuprofen (hives, anaphylaxis)

ROS

(+) For moderate pain in pelvic region, (–) for constipation, menstrual periods occur at regular intervals of 28 days

PE

Gen

WDWN woman in NAD

VS

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

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