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INSTRUCTIONS FOR THE DOCTOR
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Please discuss with Jenny what you think may be causing the problem and how you plan to manage this situation.
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Scenario
Jenny Butterfield is a 35-year-old woman who has heavy periods. Her periods are regular but last up to 10 days. For the first three to four days she is leaking despite wearing both tampons and sanitary pads. She has to change protection every half an hour and takes time off work during her period because of this. The periods are not painful. She has no other gynaecological symptoms and she does not pass clots. She is separated from her husband.
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The following information is on her medical record:
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Past medical history
Two normal vaginal deliveries
Medication
Nil known
Allergies
Nil
Immunisations
Up-to-date
Pap smear
Normal this year
Family history
Mother died of pancreatic cancer, aged 53
Social history
Separated
Two children
Non-smoker
Clinical examination findings
Normal abdominal and pelvic examination.
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INSTRUCTIONS FOR THE PATIENT, JENNY BUTTERFIELD
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You are 35 years old and work as a receptionist. It is not easy to leave the reception desk to go to the toilet. Your last three periods have come on time but have been very heavy. The periods last up to 10 days. For the first three to four days you leak despite wearing both tampons and sanitary pads. You have to change protection every half an hour and because of this take time-off work during your periods. The periods are not painful. You have no other gynaecological symptoms and do not pass clots.
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You are separated from your husband. You will soon run out of sick leave and this worries you as you are bringing up two teenage children on your own.
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— You sometimes have a heavy dragging sensation in your lower abdomen
— You have felt much more tired than normal. The other day you’d forgotten to put out the bins and made a mad dash in your pyjamas, your heart was pounding out of its chest, you were short of breath and nearly fainted. You assumed you’ve just become really unfit. You are reluctant to attend your normal gym classes because of the flooding
— Your weight is stable and you don’t particularly feel the heat or the cold
— Your bowel habit has not changed.
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Please make sure you ask the doctor to outline your options for treatment.
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The following information is on your medical record:
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Past medical history
Two normal vaginal deliveries
Medication
Nil known
Allergies
Nil
Immunisations
Up-to-date
Pap smear
Normal this year
Family history
Mother died of pancreatic cancer, aged 53
Social history
Separated
Two children
Non-smoker
Clinical examination findings
Normal abdominal and pelvic examination.