Gyn sickcall - Fibroids, fibroids and more fibroids

Twas the name of the day for me, twas more than I could handle!

3 clients, same history . Client A: 38 y/o AA female with history of fibroids with symptoms (pelvic fullness, intense pain, and menometrorrhagia). S/P Tubal ligation x 16 years ago. Motrin and heat packs for relief – little good. Do a pelvic exam, bimanual exam, check for recent pap, if none present, do one. Maybe/maybe not order U/S now, assess CBC for anemia (palms of hand, skin, cap refill, oral mucosa and subconjunctival mucosa). Client B: 26 y/o WF, AD, nulliparous and celibate (virgin), asymptomatic, with significant family history (mother and aunts hysterectomy age 34 d/t recurrent fibroids), Client C: 45 y/o WF symptomatic abnormal uterine bleeding x 6 months, metromenorrhagia, microcytic anemia, history of tubal ligation >6 years with worsening symptoms after. NO RECENT CERVICAL/VAGINAL EXAM/PAP WITHIN LAST 2 YEARS, but there was a recent U/S order and result showing >12cm mass on the uterus. Whoever ordered the U/S did not do an exam.

For the asymptomatic pt we offered her 2 options: try a COC to try to suppress/ control the ovaries hormonal production (nuvaring) or wait another 3 months to revisit U/S to assess growth, if she did not want to start the BC measures. For the other 2 patients, treatment were similar. We scheduled them for endometrial biopsy, possible date for hysterectomy (assessed anesthesia and intubation status – sleep apnea, obesity, asthma, response to anesthesia etc) and my preceptor talked to them about starting Lupron till the date of surgery as a temp quick fix measure with f/u.


With these patients, I learnt that some providers tend to shy away from doing pelvic exam on the patients for whatever reason. Doesn’t do them much good, especially the ones that say, but I had one 2 years ago and “they” said I was fine, I think or I am not ready for one today, can I reschedule! Or I am only here to review the results of my U/S and Labs. We heard all these “reasons” today. So he says to me: Never be afraid to “get in there” and “do it.” You are not doing them any good! Eventually, it going to be done, but it may be too late! If it is a vaginal complaint, look at the vagina (inside not outside)!

Do the RECTOVAGINAL EXAM!