PCOS Diagnosis and Management

PID, Amenorrhea, and PCOS
An 18-year-old female presents to the clinic for evaluation of amenorrhea. She complains of having irregular menstruation cycles that started since menarche at age 13. While she lives with both parents, the patient expressed concerns regarding fertility as she engages in unprotected sex with her boyfriend regularly. She denies having any other health problems and stopped taking birth control pills more than a year ago. The patient suspects having a menstrual or reproductive disorder, which could be affecting her fertility. This situation is an example of a clinical issue involving menstruation and requires proper diagnosis and treatment plan. This paper discusses the diagnosis of her condition and provides a therapeutic plan incorporating pharmacological and non-pharmacological treatments based on evidence-based practice.
Diagnostic Testing and Possible Physical Exam Findings
The patient’s history of present illness meets the criteria for Polycystic Ovary Syndrome (PCOS), which is a common endocrine disorder in adolescent girls (Lanzo, Monge & Trent, 2015). PCOS has reproductive and metabolic implications for this population and is commonly detected during the evaluation of menstrual irregularity. The diagnosis of this condition requires consideration of clinical symptoms and laboratory evaluation or diagnostic testing. Clinical assessment for this condition begins with a comprehensive adolescent-based interview. During this assessment, the clinician examines the patient’s pubertal history, past medical history, menstrual history, and reproductive health history. For this patient, assessment of probable PCOS is essential since she has a history of amenorrhea. PCOS is the most common cause of amenorrhea among adolescent girls or women with androgen excess.
The first diagnostic test that should be carried out as part of laboratory evaluation is the measurement of human chorionic gonadotropin (hCG). This test is vital and should be the first aspect of laboratory assessment since it will help to rule out pregnancy. It is important to rule out pregnancy because many with this condition ovulate intermittently and could be pregnant. If pregnancy is ruled out, the patient should be assessed for thyroid dysfunction by measuring thyroid-stimulating hormone (TSH). This is an important component of diagnostic testing as it helps determine whether the amenorrhea is caused by hypothyroidism or hyperthyroidism.
The other probable diagnostic test for this patient is pelvic ultrasound, which is commonly ordered for patients suspected to have this condition. Pelvic ultrasound is a suitable diagnostic test since it will help determine whether the patient has classic ovarian morphology with several small cysts. Additionally, dehydroepiandroseterone-sulphate (DHEA-S) and free and total testosterone should be measured because elevated levels could indicate an ovarian or adrenal tumor (Lanzo, Monge & Trent, 2015).
One of the probable physical exam findings that could result in the diagnosis of PCOS is polycystic ovaries. The laboratory evaluation using pelvic ultrasound is likely to indicate polycystic ovaries in this patient. Secondly, the other tests are likely to show higher levels of testosterone in the patient, which is a sign of excess male hormones. This is likely to be the case even the patient’s blood test is normal. Additionally, the physical exam is likely to show higher levels of androgens or hyperandrogenism in the blood. Williams, Mortada & Porter (2016) contend that the diagnosis of PCOS requires at least two of the following physical exam findings: polycystic ovaries, hyperandrogenism, and ovulatory dysfunction. These findings can be accomplished with a physical examination, careful history, and laboratory testing. The patient’s history of presenting illness and current symptoms are likely to meet the criteria of at least two findings required for the diagnosis of PCOS. Consequently, the patient is increasingly likely to be diagnosed with and treated for this condition.
Differential Diagnoses
One of the possible differential diagnoses for this patient is pelvic inflammatory disease, which is an infection of the reproductive organs of a woman. Pelvic inflammatory disease (PID) is usually spread by sexual contact and is characterized by irregular periods. The patient could be diagnosed with this condition given her history of regular sexual intercourse with her boyfriend and irregular periods. Additionally, this diagnosis is possible if her physical examination findings indicate lower abdominal pain and vaginal discharge. The second differential diagnosis for the patient is thyroid dysfunction, which could result in menstrual irregularities. She could be diagnosed with this condition if the findings of her physical examination show hypothyroidism or hyperthyroidism but the absence of hyperandrogenism.
Therapeutic Plan
The therapeutic plan for the patient will focus on the treatment or management of PCOS, which is the most likely diagnosis. The ultimate objective of this plan is to enhance the clinical manifestations, high-related quality of life, and long-term health outcomes (Lanzo, Monge & Trent, 2015). In this regard, the short-term priority of the therapy is to lower ovarian androgen levels through hormonal suppression. Generally, controlling and managing the levels of androgen in the patient would help enhance menstrual regularity and address aesthetic issues relating to PCOS.
The management of this condition for the patient will involve the use of pharmacological and non-pharmacological interventions. Pharmacological interventions will focus on menstrual management by managing the condition’s endocrine characteristics. Additionally, pharmacological therapy will be required to induce a withdrawal bleed if the interval between her menses goes beyond two months (Lua, How & King, 2018). In this case, cyclical progesterone like Duphaston and an oral contraceptive pill will be administered. Anti-androgen medication like spironolactone, eflornithine for rapid control of facial hirsutism, and metformin to improve insulin sensitivity will also be administered. Hormonal contraceptives will also be prescribed to help in the treatment of acne associated with this condition. Non-pharmacological interventions will entail lifestyle changes that can help improve menstrual regularity. Some of the recommended interventions for this patient include weight loss and exercise, which will help enhance insulin resistance, improve body composition, and lessen hyperandrogenism.
As part of the therapeutic plan, the patient will receive education and counseling for the pharmacological and non-pharmacological interventions. Nutritional counseling will be provided to ensure the patient adopts a modified diet for weight loss and improved BMI. This counseling will be provided as part of dietary and exercise modifications for the patient. The patient will also receive education on the symptoms of androgen excess and potential side-effects of the prescribed medications. Client education will also focus on improving medication adherence and maintaining lifestyle changes to improve her condition.
In conclusion, Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in adolescent girls. The patient’s history of present illness and clinical presentation meets the current criteria for this condition. While this patient is likely to be diagnosed with PCOS, her differential diagnoses include pelvic inflammatory disease (PID) and thyroid dysfunction. Nonetheless, the therapeutic plan for the patient will focus on the treatment and management of PCOS, which is the most likely diagnosis. Pharmacological and non-pharmacological interventions will be used to help the patient manage the condition. She will receive nutritional counseling for the non-pharmacological and lifestyle changes as well as client education relating to the pharmacological interventions.
References
Lanzo, E., Monge, M. & Trent, M. (2015, September). Diagnosis and Management of Polycystic Ovary Syndrome in Adolescent Girl. Pediatric Annals, 44(9), e223-e230. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5659205/
Lua, A.C.Y., How, C.H. & King, T.F.J. (2018, November). Managing Polycystic Ovary Syndrome in Primary Care. Singaporean Medical Journal, 59(11), 567-571. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250763/
Williams, T., Mortada, R. & Porter, S. (2016, July 15). Diagnosis and Treatment of Polycystic Ovary Syndrome. American Family Physician, 94(2), 106-113. Retrieved from https://www.aafp.org/afp/2016/0715/p106.html