a brief description of your patient’s health needs from the patient case study you assigned. Be specific.
Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response.
Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.
CASE STUDY 2
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.
patient’s health needs from the patient case study
This patient per the scenario above is certainly experiencing (hot flushing, night sweats, and genitourinary syndrome) symptoms most compatible with the perimenopausal phase most women in her age must go through. These symptoms as reported suggest the phase surrounding the concluding years of a woman’s procreative life. This patient needs to be made aware that perimenopause to menopause modification is a midlife neuroendocrine switch ceremony unique to each woman that occurs on the background of aging biology. Mosconi et al. (2017) in their article opined that while the outcome of this transition is reproductive senescence, the related symptoms are largely neurological in nature. In other words, the interference in estrogen-regulated systems (thermoregulation, sleep, circadian rhythms, sensory processing, depression, and cognitive impairment) other than menstrual and reproductive system creates major issues for the woman.
Perimenopause is that period in a phase of a woman’s life during which she starts experiencing some estrogen imbalance, leading up to the final cessation of her menstrual cycle. Perimenopause begins several years before menopause. Menopause is a condition where a woman’s monthly period stops. It is the time when the ovaries slowly begin to produce less early. It usually starts in a woman’s 40s but can start in her 30s or even earlier “The average length of perimenopause is 4 years, but for some women this stage may last only a few months or continue for 10 years” (Johnson, 2020). these symptoms as reported suggest the phase surrounding the concluding years of a woman’s procreative life. This patient needs to be made aware that perimenopause to menopause modification is a midlife neuroendocrine switch ceremony unique to each woman that occurs on the background of aging biology. Some of the symptoms include vasomotor symptoms, vaginal dryness, sexual dysfunction, mood, urinary symptoms, and sleep disturbances. “Vasomotor symptoms (VMS); “hot flashes” or “night sweats” are normal during the menopause transition and affect 80% of women” (Roberts & Hickey, 2016).
There are several treatment options which include hormone therapy, non-hormonal treatment, vaginal estrogen therapy, Selective ER modulators (SERMs), and anti-depressant (SSRIs) .
Moderate dose estrogen-containing hormone treatment estrogen. (MHT) is the best treatment for VMS and furthermore improves vaginal dryness. “Menopausal HT, formerly known as hormone replacement therapy (HRT), consists of low doses of estrogen (with or without a progestin) taken to compensate for the loss of estrogen that occurs during menopause” (Rosenthal & Burchum, 2018, Pg 527). MHT could be treated with estrogen alone, or with a progestin. Progestin is not recommended for ladies who have experienced hysterectomy. However, the patient has a history of breast cancer, so it would be recommended that she takes a low dose Serotonin non receptor inhibitor (SNRI) like Paroxetine.
Selective ER modulators (SERMs). ospemifene 60mg orally is the only SERM approved by the US Food and Drug Administration (FDA) for the treatment of moderate to severe dyspareunia. Ospemifene is an oral non-estrogen drug with an estrogen agonistic effect on vaginal epithelial tissue (Kim et al., 2015).
Non-hormonal treatment. GSM genitourinary syndrome of menopause can be treated with over-the-counter vaginal Hyaluronic Acid-based moisturizers or lubricants (water-, silicone-, or oil- based). According to this article (Kim et al., 2015), American Menopause Society stated that the first-line treatment for women with vulvovaginal or GSM symptoms includes non-hormonal lubricants during intercourse and regular use of long- acting vaginal moisturizers.
Vaginal Estrogen Therapy: This type of treatment has been shown to provide women with symptomatic relief of urogenital symptoms associated with perimenopause and menopause (American College of Obstetricians and Gynecologists, 2016).
Desvenlafaxine – SNRI and escitalopram – SSRI is found effective in the treatment of perimenopausal symptoms. Pauline et al (2019), in this article, found a large randomized double-blind trial which compared the SNRI desvenlafaxine and the SSRI escitalopram among postmenopausal women, no significant difference in efficacy was seen after 8 weeks of acute phase treatment nor after 6 months of continuation phase treatment.
Since the patient has a family history of breast cancer and has HTN, she is at increased risk of harm whit therapy. Stress reduction therapy and psychological counseling may benefit women with nonorganic causes of vaginal dryness. (Gandhi at el., 2016). Wear a very light shirt under your clothing, so you can remove a layer when you become too hot. Use a fan in your little space and for sleeping
She would be educated of the importance of taking her blood pressure medications as prescribed, maintaining a low sodium diet, and exercising often. The patient would also be educated of the importance of early breast screenings. Some of the side effects of Paroxetine are nausea, sweating, somnolence, tremor, and fatigue. These symptoms diminish overtime.
Johnson, T. (2020). Perimenopause: Symptoms, Treatments, weight Gain, and More.
Roberts, H., & Hickey, M. (2016). Managing the Menopause: An update. Maturitas, 86(2016), 53-
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier
American College of Obstetricians and Gynecologists. (2016). The Use of Vaginal Estrogen in Women with a History of Estrogen-Dependent Breast Cancer. Retrieved from https://www.acog.org/Clinical-Guidance- and-Publications/Committee-Opinions/Committee-on-Gynecologic- Practice/The-Use-of-Vaginal-Estrogen-in-Women-With-a-History-of- Estrogen-Dependent-Breast-Cancer?IsMobileSet=false
Kim et al. (2015). The Recent Review of the Genitourinary Syndrome of Menopause. Journal of menopausal medicine, 21(2), 65–71. doi:10.6118/jmm.2015.21.2.65
Martin, K & Barbieri, R. (2019). Treatment of menopausal symptoms with hormone therapy. Retrieved from https://www.uptodate.com/contents/treatment-of-menopausal- symptoms-with-hormone-therapy
Mosconi et al. (2017) Perimenopause and Emergence of an Alzheimer’s Bioenergetic Phenotype in Brain and Periphery. PLOS ONE 12(10): e0185926. https://doi.org/10.1371/journal.pone.0185926
Pauline et al. (2019). Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations. Journal of Women’s Health, 28:2, 117-134. https://doi.org/10.1089/jwh.2018.27099.mensocrec