Table of Contents
Common Questions
Chat with CodyMD
Cody's Chat with Patient
Cody's AI Summary
Top 3 AI Diagnosis List
Review by Dr Albert DiPiero
Dr. DiPiero Video Guide to this Case Study
Resource Center
Testimonials
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Case Study
Meet your host
Albert DiPiero, MD MPH FACP
I am a co-founder and the Chief Medical Officer at CodyMD and your host for this edition of Cody Grand Rounds. I have been a practicing physician and faculty member at medical schools for over 26 years.
About The AI Doctor Case Study
CodyMD is a partnership between Human Doctors and AI Doctors. Cody is an AI Doctor who helps thousands of people every day. At each Cody Grand Rounds, I select a real case and review it with Cody, the AI Doctor.
Each case is based on a real patient but has been modified to maintain privacy and to emphasize certain teaching points.
Common Questions
What could cause heavy periods with clots for 3 days?
How are uterine fibroids detected?
What are common symptoms of endometriosis?
How is hormonal imbalance diagnosed?
What treatments are available for heavy menstrual bleeding?
How can an IUD affect menstrual bleeding?
What lifestyle changes can help manage heavy periods?
Chat with CodyMD
Click the button below to initiate a conversation with CodyMD, your AI Doctor.
Cody's Chat with Patient
Below is a conversation transcript between the patient and our AI Doctor CodyMd.
Cody, the AI Doctor
Hi there, I understand you are concerned about your heavy menstrual periods. Is that correct?
Patient
Yes, that's correct.
Cody, the AI Doctor
Let's talk about your concerns regarding heavy periods. First, how old are you?
Patient
40 years old.
Cody, the AI Doctor
Got it. Can you describe the characteristics of your heavy periods? For example, how long do they last, how often do they occur, and do you experience any clots or changes in color?
Patient
They last 9 days, heavy clots for 3 days, pain in lower abdomen for 5 days. They are just bloody. No other color.
Cody, the AI Doctor
Heavy periods that last for more than 7 days, accompanied by large clots and abdominal pain, can be indicative of conditions such as fibroids or endometriosis. When did you first start experiencing heavy periods? For example, did it begin 2 years ago or more recently?
Patient
6 months ago
Cody, the AI Doctor
Hmm. Any chance you are pregnant?
Patient
No. I have an IUD and I also did a home pregnancy test several times and it is negative.
Cody, the AI Doctor
Ok, I understand. Have you been diagnosed with any medical conditions that could affect your menstrual cycle? For example, conditions like polycystic ovary syndrome (PCOS), thyroid disorders, or anemia?
Patient
No not that I know of.
Cody, the AI Doctor
Alright, noted. How have your heavy periods changed over the past few months? For example, are they getting worse, getting better, staying the same, or do they vary from month to month?
Patient
Seems to be getting worse.
Cody, the AI Doctor
It's important to note that worsening heavy periods, also known as menorrhagia, can be caused by various factors such as hormonal imbalances, fibroids, or other underlying health conditions. Can you describe how your heavy periods started? For example, did they begin suddenly, or have they been gradually getting heavier over time?
Patient
They came on rather suddenly. I don't know why.
Cody, the AI Doctor
Hmm. On a scale of 1 to 10, how would you rate the severity of your heavy periods, where 1 is no problem and 10 is very severe? For example, if you feel that your daily activities are significantly affected, you might rate it higher.
Patient
7
Cody, the AI Doctor
A rating of 7 indicates that your heavy periods are quite bothersome and may be impacting your daily life. Have you noticed any specific activities or lifestyle changes that seem to make your heavy periods better or worse? For example, does exercise, stress, or changes in your diet have any effect?
Patient
No everything else is stable.
Cody's AI Summary
- 40 years old woman suffering from heavy periods that last for 9 days, with heavy clots for 3 days and abdominal pain for 5 days.
- You first started experiencing heavy periods 6 months ago.
- You have not been diagnosed with any medical conditions that could affect your menstrual cycle, and your heavy periods seem to be getting worse over time.
- You rate the severity of your heavy periods as a 7 out of 10.
- You have not noticed any specific activities or lifestyle changes that affect your heavy periods.
Top 3 AI Diagnosis List
Based on the information and conversations with Cody, we have prepared a top 3 AI Diagnosis List.
1. Uterine Fibroids(40 % probability)
Noncancerous growths in the uterus that can cause heavy bleeding and pain.
2. Endometriosis(30 % probability)
A condition where tissue similar to the lining inside the uterus grows outside of it, leading to pain and heavy periods.
3. Hormonal Imbalance(15 % probability)
An imbalance in hormones that can lead to irregular and heavy menstrual bleeding.
Review by Dr Albert DiPiero
Dr. Albert DiPiero
Upon reviewing the patient's history and differential diagnosis, I agree with the differentials listed by Cody, our AI Doctor. Let me provide more analysis for you.
1. Uterine Fibroids(35% probability)
The sudden onset and worsening nature of the menstrual symptoms make fibroids a strong contender. A pelvic ultrasound would be an initial step for confirmation.
2. Endometriosis(25% probability)
Typically causes menstrual pain and heavy periods. The sudden worsening makes it less likely but still worth considering. A diagnostic laparoscopy could help in confirming this suspicion.
3. Hormonal Imbalance(20% probability)
This is a common cause of heavy menstrual bleeding and should be ruled out. Detailed hormone profiling is advised.
4. Other possible considerations
Adenomyosis at 15% probability. Similar to endometriosis but involves the uterine muscle. MRI can be useful in diagnosing this condition. Polycystic Ovary Syndrome (PCOS) at 5% probability. Though less likely due to the sudden onset, it can sometimes present with heavy irregular bleeding. Blood workup for hormone levels and ultrasound could help in ruling this out.
Next Steps for Evaluation
Physical Examination: A thorough pelvic examination to check for any abnormalities, tenderness, or masses.
Pelvic Ultrasound: To evaluate for fibroids, endometrial thickness, and overall uterine morphology.
Hormone Profile: Blood tests to measure various hormone levels.
Follicle-Stimulating Hormone (FSH): To evaluate ovarian function.
Luteinizing Hormone (LH): To understand reproductive system functioning.
Estradiol: To assess the levels of estrogen.
Thyroid Function Tests: To rule out thyroid disorders which can impact menstrual bleeding.
Progesterone: To check for luteal phase abnormalities which can affect menstrual bleeding.
Endometrial Biopsy: If indicated, especially if the patient has risk factors for endometrial hyperplasia or cancer.
Diagnostic Laparoscopy: If endometriosis is strongly suspected and other noninvasive tests do not yield conclusive results.
Potential Treatment Modalities
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): For pain management and to reduce menstrual bleeding.
Hormonal Treatments:
Oral Contraceptives: Can help regulate menstrual cycles and reduce bleeding.
Levonorgestrel-Releasing IUD: Especially helpful in reducing menstrual blood loss.
Progesterone Therapy: For balancing estrogen levels and controlling bleeding.
Antifibrinolytic Agents: Such as tranexamic acid, which can reduce menstrual bleeding by inhibiting the breakdown of blood clots.
Iron Supplements: If the patient is anemic due to heavy blood loss.
Surgical Options:
Myomectomy: For removing fibroids while preserving the uterus.
Endometrial Ablation: For reducing menstrual bleeding by destroying the endometrial lining.
Hysterectomy: As a last resort, mainly for those who do not respond to other treatments and do not wish to preserve fertility.
Lifestyle Modifications
Diet:
Include iron-rich foods (lean meats, leafy greens, beans, fortified cereals).
Combine with vitamin C-rich foods (citrus fruits, peppers, strawberries).
Maintain good hydration and a balanced diet.
Engage in regular physical activity like brisk walking, swimming, and yoga.
Incorporate stress-reducing exercises such as yoga or meditation.
Consider ginger and cinnamon, but consult with a healthcare provider first.
Maintain a healthy weight to balance hormones.
Aim for 7-9 hours of sleep per night.
Track your cycle to recognize patterns and discuss symptoms with your healthcare provider.
Practice mindfulness and relaxation techniques like deep breathing, meditation, and gentle yoga.
Limit caffeine and alcohol.
Quit smoking, if applicable.
Conclusion:
The patient's symptoms are suspicious for uterine fibroids or endometriosis, each requiring further evaluation for confirmation. I recommend starting with a pelvic ultrasound and hormone profile. The next steps would involve more specialized evaluations by a gynecologist. Appropriate treatment, once the diagnosis is confirmed, will lead to improved quality of life.
Dr. DiPiero Video Guide to this Case Study
Resource Center
Testimonials
CodyMD is a very precise and accessible app. My consultation with CodymMD is commendable and I highly recommend it for others to try CodyMD especially for assessment and consultation purposes.
TrustPilot Review
Dr Cody spot on, better than most Human Drs. Also far more pleasant. Try him, he could better help you understand your issues. He will give you good info for your Drs visit as well.
TrustPilot Review
It gave me the best response possible and suggested simple self care treatment options which I'm in favor with. It has a to the point interface and brief answer for better understanding.
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