Possible diagnosis
Since the mass was found in the walls of the uterus, there is a possible number diagnoses. Additionally, what should be considered is the palpable mass and the fact that it was non-tender. From this examination, there are several possible elements to put into consideration. Pelvic mass can occur at any age. Women with pelvic mass present with distended by a cystic or solid mass and occurs at any age.
The most likely and the primary diagnosis is uterine fibroids. The second diagnosis is that it could be a benign tumor. This is because the mass has been determined to be 4cm large; it is palpable and non-tender. The third thing to note is that the patient is active sexually and has three children. This could mean that the patient is pregnant. Ideally, pregnancy can form in the wall of the uterus (Guirguis-Blake, Henderson, Perdue & Whitlock, 2017); this can be one way to diagnose the problem. Intrauterine pregnancy develops in that manner, and they look like masses and are non-tender. However, this does not provide a clear explanation of why the patient had been experiencing bleeding between menstrual periods.
Uterine fibroids are categorized depending on the position: subserosal, intramural, and submucosal (Guirguis-Blake et al., 2017). The signs and treatment alternatives are influenced by the size of the mass, the location, and the number. The main symptom of uterine fibroids is abnormal bleeding, commonly uterine fibroids excess menstrual flow. Other common signs include pressure in the pelvic region, bowel dysfunction, frequent urination, lower back pain, constipation, and dyspareunia (De La Cruz & Buchanan, 2017). Management of fibroids may range from no treatment to surgery. If fibroids are not causing excess bleeding or any discomfort, treatment may not be necessary. Fibroids should be evaluated periodically to assess the signs and to observe the size of the uterus with examinations of the abdomen and the pelvic.
Differential diagnosis
Uterine bleeding
Prolonged pelvic inflammatory infection.
Endometriosis
Endometrial polyps
Uterine sarcoma
Ovarian abscess
Ovarian lump
Pelvic mass
Pregnancy
Treatment
Patients with excess menstrual flow and fibroids are advised to take hormonal medications to reduce bleeding and control the menstrual cycle (Baird, Schectman & Park, 2019). Lupron is also used to stop bleeding and shrink fibroids. It blocks the production of estrogen. However, it causes bone loss in the long run and causes the patient to have hot flashes. Lupron is usually recommended in particular cases such as when the patient has heavy bleeding or is anemic, and would require a blood transfusion during operation. Lupron is also recommended when fibroids are more than 10 cm before surgery (De La Cruz & Buchanan, 2017). The recommended dosage is that a patient should take 37.5mg per month, 22.5mg in 3 months, 30mg in 4 months, and 45mg 6 in months (Schuiling & Likis, 2016).
The use of Intrauterine Devices (IUD) is also recommended. Although IUDs are usually used to prevent pregnancy, the hormones released by the device can reduce bleeding caused by the fibroids. Other hormonal birth controls such as the pills, rings, shots, and implants reduce bleeding, pain during menstruation, cramps and are essential for women who are anemic (De La Cruz & Buchanan, 2017). Additionally, women who have anemia are advised to take food supplements that contain iron and vitamins, and multivitamins which assist the body in using the available iron effectively. It is the best option to combat anemia.
Patient education
Education range from explaining the meaning of fibroids, types of fibroids, causes, who are most affected, what happens with fibroids, and treatment. Fibroids refers to a mass of muscles that develop in the uterus of a woman (De La Cruz & Buchanan, 2017). It is bear-shaped and is found between the bladder and the rectum. Fibroids present in various sizes -small to large. Fibroids can stay the same for a long time, or it may grow with time.
Baird, D., Schectman, J., & Park, N. C. (2019). Uterine Fibroids?.
De La Cruz, M. S. D., & Buchanan, E. M. (2017). Uterine fibroids: diagnosis and treatment. American family physician, 95(2), 100-107.
Guirguis-Blake, J. M., Henderson, J. T., Perdue, L. A., & Whitlock, E. P. (2017). Screening for Gynecologic Conditions With Pelvic Examination.
Schuiling, K. D., & Likis, F. E. (2016). Women’s gynecologic health. Jones & Bartlett Learning.