Short case study

Amira rafaat, 37 year-old patient, married for 12 years, P1+0,house wife, with no
special habits of medical importance.

s
She complains of heavy menstrual bleeding associated with lower abdominal pain
Her condition started 6 months ago, with acute onset and progressive course.
Menorrhagia continued for 12 days with increasing amount (5pads/day), with presence
Subjective of small blood clots. The pain started 2 months ago, dull aching in the lower abdomen
radiating to low back associated with recurrent attacks of fever and increases with
menses.
-She had no previous blood transfusions and didn’t complain of anemia. She performed
appendectomy only
-her menarche was at age of 15, she had regular cycles with normal amount 3 pads/day
and normal duration 3-5 days.
-No history of contraception methods.
-Family history show no similar condition or any chronic diseases
-Review on other system showing no abnormalities
Examination:
On speculum examination: hyperemic cervix.
On bimanual examination: cervical motion tenderness and enlarged uterus 14 weeks.

o
Investigations:

HSG was previously done showing patent tubes.

objective Pregnancy test was negative.
US showed 2 uterine interstitial fibroids in the posterior wall 6.8 cm.

.uterine fibroids

A
assesment
 ♦: Plan of Managment ,
:Conservative approach-1

P
Observation with periodic follow up every 6 months
: Medical Treatment -2
plan
control symptoms as AUB and pain by
NSAIDs and anti fibrinolytics( tranexamic acid ):reduce •
menstrual flow and treat pelvic pain
Cyclic Progestins:control mild bleeding and induce regular •
endometrial shedding
GnRH agonists: temporary reduction in size and vascularity (it is •
preffered to be used before myomectomy )
: Surgical Treatment -3
Myomectomy ( surgical removal of leiomyomata alone ) -1
Hystrectomy (surgical removal of uterus together with -2
leiomyomata, best management if no fertility needed )