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Introduction
Patients with concerns about gynecologic health may present to the office not understanding the cause of their problems. The condition of one’s reproductive system depends on a variety of factors, including one’s lifestyle. In the case study, a young female athlete presents to the office with a complaint of ceased menses. Her participation in sports, young age, and decreasing weight suggest such differential diagnoses as functional hypothalamic amenorrhea (FHA), polycystic ovary syndrome (PCOS), and pregnancy. The following analysis will discuss the primary and differential diagnoses as well as treatment and patient education.
Differential Diagnosis
The first potential diagnosis is functional hypothalamic amenorrhea (FHA), a common type of secondary amenorrhea. The combination of excessive exercise, stress, and weight loss leads to the reduction in the release of gonadotropin-releasing hormone (GnRH) and amenorrhea. It is a problem that is diagnosed by elimination – the patient’s history and anatomy have to be analyzed to exclude any pathologies (Gordon et al., 2017). Then, the patient’s psychological stressors need to be measured to determine the root cause. FHA is a part of the “female athlete triad” – three conditions for which women actively participating in sports are at risk (Kelly & Hecht, 2016). To support this diagnosis, such tests as the GnRH stimulation test are central to the assessment.
The second possible condition is polycystic ovary syndrome (PCOS), a disorder that may develop in all women of reproductive age. It is commonly associated with irregular periods, high levels of androgen, and the development of cysts on ovaries (Schuiling & Likis, 2017). A pelvic exam and blood tests (including androgen levels) can eliminate this diagnosis (Tharpe, Farley, & Jordan, 2017). The patient does not report having any other symptoms, and her weight is decreasing, which is uncommon for PCOS, thus making this diagnosis less viable.
Finally, pregnancy has to be excluded in the beginning as a potential differential diagnosis. The case does not present any information about the patient’s sexual activity. A conversation with the patient and a pregnancy test will help one to see whether she could be pregnant (Tharpe et al., 2017). After dismissing on confirming the pregnancy, one can move onto other diagnoses. It may also be helpful to discuss safe sexual practices with the patient during this talk.
Treatment, Management, and Patient Education
The primary diagnosis of FHA is considered for treatment in this case. The first approach to this condition is a lifestyle change as FHA is influenced by sports, diet, and stress. Thus, the patient should reduce her physical activity and consult a nutritionist to increase her caloric intake and gain the lost weight (Gordon et al., 2017). Some psychological support has to be recommended to help the patient deal with stress (Gordon et al., 2017). If these lifestyle changes were ineffective for several months, then the patient may undergo short-term hormone therapy with cyclic oral progestin (Gordon et al., 2017). However, first-line treatment is not pharmaceutical since the reduction of stressors can return menses to their regular schedule.
Patient education has to include such topics as sexual activity, exercise, and nutrition. It is vital to consult the patient on any questions about overexertion and proper dieting and remind her that sufficient calorie intake is necessary to support her growing body. Moreover, the nurse should talk about safe sex and contraceptive methods. Finally, a conversation about possible stress factors can contribute to the patient’s understanding of the roots of her concerns.
Conclusion
The fourth case demonstrates how one’s behavior and activity can contribute to gynecological issues. The primary diagnosis is FHA, with PCOS and pregnancy, among other possible conditions. Young female athletes are at high risk of hormonal imbalance induced by stress, dieting, and exercising. By addressing these factors, the patient is also likely to resolve her health concerns. Here, pharmacological therapy should not be attempted without assessing the patient’s lifestyle.
References
Gordon, C. M., Ackerman, K. E., Berga, S. L., Kaplan, J. R., Mastorakos, G., Misra, M., Warren, M. P. (2017). Functional hypothalamic amenorrhea: An endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(5), 1413-1439.
Kelly, A. K. W., & Hecht, S. (2016). The female athlete triad. Pediatrics, 138(2), e20160922.
Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA: Jones and Bartlett Publishers.
Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.
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