Patient Case Study
The patient presents to OB-GYN complaining of not feeling well for last month, reports having night sweats, hot flashes, genitourinary symptoms. Patient weight is 230lb B/P 150/90 she has hypertension, and a history of ASCUS (atypical squamous cells of undetermined significance) five years ago and a family history of breast cancer. Pap smear normal, monthly menstrual cycles regular last LMP one month ago, mammograms up to date. Home medications Norvasc 10mg PO daily, HCTZ 25mg PO daily (Laurette, 2019e).
Diagnosis
Diagnosis of Menopause may be in the early stages of perimenopause. Menopause affects many women at some point in their lives occurring between the ages of 40-50 years old. Menopause is when the reproductive ability ends for women like the absence of menses over twelve consecutive months and is a natural response for aging women. Vasomotor Symptoms include hot flashes, night sweats, vaginal dryness, irregular menstrual bleeding, cognitive issues (Rosenthal & Burchum, 2021).
Treatment regimen
Hormone replacement therapy (HRT), I believe is the best treatment for this patient’s symptoms. According to Rosenthal and Burchum (2021), HRT is considered an effective treatment for women with menopause and perimenopause symptoms. Combinations of estrogen and progestin are used to treat certain symptoms of menopause. Hormone replacement therapy works by replacing estrogen hormone that is no longer being made by the body. Estrogen reduces feelings of warmth in the upper body and periods of sweating and heat (hot flashes), vaginal symptoms (itching, burning, and dryness) and difficulty with urination. Progestin is added to estrogen in hormone replacement therapy to reduce the risk of uterine cancer in women who still have their uterus. Based on the patient’s history and symptoms. I would start this patient on a combination of progestin and estrogen PO daily < 5 years a combination fixed-dose, estrogen lowest effective dose short-term therapy and then reassess at regular intervals. Estrogen low dose will help reduce symptoms of hot flashes and night sweats and replace the loss of estrogen due to menopause (Rosenthal & Burchum, 2021). Progestin will be given in combination with estrogen because the patient has not had a hysterectomy. Progestin is present to counterbalance estrogen-mediated stimulation of the endometrium, which can lead to endometrial hyperplasia and cancer (Rosenthal & Burchum, 2021). Patients should be educated of the risk related to HRT and measure if the risk outweighs the benefits of the relief from her symptoms (Fistonic et al., 2015).
Patient Education Strategy
The patient history of hypertension has to be considered and if her uterus is still intact, family history of breast cancer, when educating patient about HRT, because HRT is known to help in reducing cardiovascular disease it is vital that HRT is not used for managing hypertension (Berdah, 2017). The patient must continue to monitor blood pressure, assessment for fluid retention, including weight. Take HRT medication same time daily exactly as prescribed. The patient has to be educated to continue prescribed medication related to hypertension. Education on compliance with her antihypertensive medication and healthy heart diet is vital in maintaining her cardiovascular health. Physical activity, a healthy diet, and stress management can also reduce menopausal symptoms. Educate patients on the risk of HRT due to history of family history of breast cancer, and the importance of remaining compliant with mammograms for early detection and preventive measures (Berdah, 2017). Educate patients on side effects to look out for, Women who take HRT reports improved quality of life, report improved sleep, libido restoration, improved cognition, and enhanced mood.
References
Berdah, J. (2017). [What a healthy lifestyle stands for at the menopause: the role of the gynecologist]. Gynecologie, Obstetric & Fertility, 35(9), 785–790. https://doi-org.ezp.waldenulibrary.org/10.1016/j.gyobfe.2007.06.009
Fistonic, I., Franic, D., Popic, J., Fistonic, N., & Maletic, A. (2015). Adherence with hormone replacement therapy in menopause. Climacteric, 13(6), 570–577. https://doi-org.ezp.waldenulibrary.org/10.3109/13697130903491018
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier
