From the Guidelines
For this 42-year-old woman with sudden weight gain, fatigue, and heavy menses, additional assessments should include a pelvic ultrasound or MRI to evaluate for uterine fibroids, as well as a complete blood count to assess for anemia related to heavy menstrual bleeding, as suggested by the most recent guidelines 1. Given her symptoms of heavy and prolonged uterine bleeding, a thorough physical examination, including an abdominal examination, speculum examination, and bimanual pelvic evaluation, is essential to characterize the location, shape, and mobility of any potential fibroids. Additional workup may include:
- Pregnancy testing to rule out pregnancy as a cause of her symptoms
- Hemoglobin levels to evaluate the severity of anemia
- Endometrial biopsy if features of her presentation raise concern for other causes of heavy menstrual bleeding, such as endometrial hyperplasia or cancer
- Assessment of her reproductive history, including age of menarche, regularity of menses, and history of difficulty getting pregnant, to evaluate for any underlying reproductive disorders
- Screening for thyroid dysfunction, as her family history of thyroid problems and symptoms of fatigue and weight gain may suggest hypothyroidism, with a comprehensive thyroid panel (TSH, free T3, free T4, and thyroid antibodies) 1
- Evaluation of her mental health, given her history of depression, to assess for any exacerbation of symptoms due to potential underlying medical conditions. These assessments are crucial because they can help identify the underlying cause of her symptoms, whether it be uterine fibroids, thyroid dysfunction, or another condition, and allow for timely and appropriate management to improve her quality of life and prevent complications.
From the Research
Additional Assessments for Patient Examination
The patient's symptoms of sudden and unexpected weight gain, fatigue, and heavy menses for the past 3 months require a comprehensive assessment. The following additional assessments should be included in the patient examination:
- Vital signs assessment, including calculation of Body Mass Index (BMI) as a vital sign 2
- A complete physical examination to obtain valid information concerning the patient's health, including evaluation of individual organ systems 3
- Assessment of the patient's condition, including how they are responding to medical treatment and whether the patient is deteriorating 4
- General health checks to identify and prevent disease, including screening for chronic diseases such as depression and hypertension 5
- Evaluation of the patient's medical history, including their history of allergies, Guillain-Barré syndrome, depression, and difficulty getting pregnant
- Review of the patient's family medical history, including their maternal grandmother's history of thyroid problems
Key Principles of Vital Signs Assessment
The assessment of vital signs is critical for safe, high-quality care 4. The following key principles should be considered:
- Vital signs data provide valuable insight into the patient's condition
- Abnormal vital signs have been associated with poor clinical outcomes
- Factors contributing to neglected vital signs assessment include nurses' knowledge, clinical judgement, culture, tradition, and workloads
General Health Checks in Adult Primary Care
General health checks are commonly performed in adult primary care to identify and prevent disease 5. The following points should be considered:
- General health checks are not associated with decreased mortality, cardiovascular events, or cardiovascular disease incidence
- General health checks are associated with increased detection of chronic diseases, moderate improvements in controlling risk factors, and increased clinical preventive service uptake
- Primary care teams may reasonably offer general health checks, especially for groups at high risk of overdue preventive services, uncontrolled risk factors, low self-rated health, or poor connection or inadequate access to primary care 5