Discussion Response Paper
Discussion Response Paper
The menopause transition is when the body gradually reduces the production of hormones like estrogen, progesterone, and follicle-stimulating hormone to mark the journey toward the last menstrual period or menopause (Nappi, R. E., & Simoncini, T. 2021). The onset of menopause transition is about 45 to 55years and can last for a variable amount of time. During this period, the ovary function gradually decreases the production of estrogen and follicle-stimulating hormones, hence the changes in the menstrual cycle, vaginal dryness, urinary symptoms, hot flashes, sweating, mood swings, sleep disturbances, and weight gain. Estrogen hormone is stored in body adipose tissue, when in excessive production in the youthful years. Despite the cessation of its production in the ovaries, the body’s fat tissue releases the stored estrogen, hence the regular menstrual cycle in this patient. Estrogen hormone maintains the skin’s dermal fibroblasts, melanocytes, hair follicles, and sebaceous glands. Discussion Response Paper
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Effects Of Menopause Transition
A decrease in estrogen hormone causes decreased production of sebum that moisturizes skin and mucus membranes (Kim, et al, 2021). Thus, the patient presents with hot flushes, night sweats, and vaginal dryness. It slows down the process of metabolism increasing the risk for obesity and diabetes mellitus. The patient is at risk of breast cancer because she has a positive family history of cancer. Estrogen post menopause relatively increases the risk of breast cancer. This patient is obese and may release the stored estrogen in the body fats, thus causing cancer (Houghton, et al, 2021). The menopause transition symptoms are best treated by estrogen replacement therapy, posing a greater risk for breast cancer.
The patient has pre-existing hypertension that is poorly controlled at 150/90mmHg. The patient is on Norvasc, a calcium channel blocker, and HCTZ, a thiazide diuretic. The blood pressure is still high due to obesity, physical inactivity, and advancing age. Menopause predisposes obese patients to cardiovascular diseases due to the excessive accumulation of lipoproteins that cause atherosclerosis. I would add an enalapril 10mg angiotensin-converting enzyme inhibitor among the hypertensive drugs because it has cardio-protective properties. I would give aspirin to reduce cardiovascular diseases and stroke. The best patient education strategy is a physical interview with the show of diagrams explaining the possible complications, lifestyle modification, and self-medication.
A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and she presented to her gynecologist for her annual gyn examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap, other than that, Pap smears have been normal. Home medications are Norvasc 10mg qd and HCTZ 25mg qd. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago.
Initial post: Kimberly Stotts
This discussion aims to provide a treatment regimen including pharmacotherapeutics and an education strategy that would be recommended to assist the patient with the management of their health needs in the following cases study:
A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until one month ago, and she presented to her gynecologist for her annual GYN examination and to discuss her symptoms. She has a history of ASCUS about five years ago on her pap. Other than that, Pap smears have been normal. Home medications are Norvasc 10mg qd and HCTZ 25mg qd. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago.
The patient in the scenario is presenting with perimenopausal symptoms. Perimenopause is a transition period in which physiological changes begin, indicating transition toward the end of menstrual cycles (Delamater & Santoro, 2018). This transition may last for approximately four years. According to Delamater & Santoro (2018), due to changing hormone levels, women may present with varying symptoms which create complex clinical management situations for the advanced practice nurse. The provider must understand the physiological decline in ovarian functioning to help manage treatment for women during this time.
Loss of estrogen levels contributes to menopause and the symptoms of menopause (Rosenthal & Burchum, 2021). According to Rosenthal & Burchum (2021), most women begin menopause between the ages of 45 and 55. The woman in the scenario is 46 putting her in the age range for the beginning of menopausal symptoms. The decrease in estrogen has many effects, and women may experience vasomotor symptoms, sleep disturbance, bone loss, and urogenital atrophy (Rosenthal & Burchum, 2021).
Vasomotor symptoms such as hot flashes and night sweats are common and characterized by the sudden onset of sweating and skin flushing (Rosenthal & Burchum, 2021). Patients may awaken in the night, drenched in sweat.
According to Rosenthal & Burchum (2021), the highest estrogen receptors (ER) concentrations are found in the vagina and urethra, contributing to the maintenance of functional integrity. As estrogen levels decline, the vaginal epithelium and urethra undergo degenerative changes. Genitourinary symptoms such as incontinence and urinary frequency may occur as a result.
Estrogen is the most effective treatment for genitourinary symptoms (Rosenthal & Burchum, 2021). However, according to Rosenthal & Burchum (2021), it carries an increased risk for the development of breast cancer and cardiovascular thromboembolic events. Since the patient in the scenario has a family history of breast cancer, Estrace 1 gram applied topically weekly would be prescribed. The Estrace would be titrated up slowly to ensure the lowest dose that adequately controls the symptoms was maintained. Estrogen would be prescribed topically as the topical form is safer than oral due to lower blood levels with topical use (Rosenthal & Burchum, 2021). Due to minimal amounts of estrogen entering the bloodstream with topical use, low-dose estrogen is not thought to increase the risk of breast cancer or stroke (Santen & Loprinzi, 2022).
Lexapro 10 mg PO daily would be prescribed to treat the patient’s vasomotor symptoms due to the patient’s family history of breast cancer. According to Rosenthal & Burchum (2021), Lexapro has been shown to decrease the frequency and severity of vasomotor symptoms such as hot flashes. Lexapro is a selective serotonin reuptake inhibitor (SSRI). It may help lessen any cognitive symptoms such as depression and anxiety experienced during this transition period (Rosenthal & Burchum, 2021). SSRIs are generally well tolerated and do not cause hypotension or anticholinergic effects (Rosenthal & Burchum, 2021). Common side effects include nausea, headache, and weight gain. Lexapro can also help improve quality of life by improving sleep (Roberts & Hickey, 2016).
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The patient should be educated on strategies to help improve symptoms and quality of life that can be used in conjunction with pharmacologic approaches or on their own. There are over-the-counter vaginal lubricants that can be beneficial in helping manage genitourinary symptoms by hydrating and reducing dryness and dyspareunia (Aninye et al., 2021). According to Aninye et al. (2021), there is data that indicates physical activities such as yoga help improve peri and postmenopausal quality of life. Cognitive behavioral therapy can help decrease vasomotor symptoms and is an evidence-based approach to treating insomnia. Regular physical activity is a practical approach to reducing vasomotor symptoms as it increases beta-endorphin levels in the hypothalamus (Taebi et al., 2018) Discussion Response Paper
Hormonal changes experienced with menopause can bring about underlying conditions such as osteoporosis (Aninye et al., 2021). The advanced nurse practitioner must promote health and wellness and educate the patient to help during this transitional phase.
The patient continues to have regular monthly menstrual cycles. However, she presents with hot flashes, night sweats, and genitourinary symptoms that indicate perimenopause. A combination of topical Estrace and Lexapro would be utilized to help manage the presenting symptoms. By beginning with a low dose of each medication, the advanced practice nurse can evaluate the effectiveness and ensure symptoms are controlled with the lowest possible dosing. Careful management and education can help the patient to improve her quality of life.
Aninye, I. O., Laitner, M. H., Chinnappan, S., & Society for Women’s Health Research
Menopause Working Group (2021). Menopause preparedness: perspectives for patient,
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Delamater, L., & Santoro, N. (2018). Management of the Perimenopause. Clinical obstetrics and
gynecology, 61(3), 419–432. https://doi.org/10.1097/GRF.0000000000000389
Roberts, H., Hickey, M. (2016) Managing the menopause: An update. Maturitas, 86(2016), 53-
Rosenthal, L. & Burchum, J. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Santen, R., & Loprinzi, C. (2022, June). Patient education: Non-estrogen treatments for menopausal symptoms . UpToDate. Retrieved July 24, 2022, from https://www.uptodate.com/contents/non-estrogen-treatments-for-menopausal-symptoms-beyond-the-basics/print
Taebi, M., Abdolahian, S., Ozgoli, G., Ebadi, A., & Kariman, N. (2018). Strategies to improve
menopausal quality of life: A systematic review. Journal of education and health
promotion, 7, 93. https://doi.org/10.4103/jehp.jehp_137_17 Discussion Response Paper