Treatments For Menopausal Symptoms

Treatments For Menopausal Symptoms

Ms. Martin is a 55-year-old woman who has been on HRT for 4 years. HRT was prescribed because Ms. Martin was experiencing vasomotor symptoms associated with menopause. Her last mammogram was 2 years ago and last pap was 5 years ago. Ms. Martin made an appointment with her nurse practitioner to discuss discontinuing HRT after hearing and reading news reports about the dangers associated with the medication. Treatments For Menopausal Symptoms Except for the HRT, Ms. Martin is taking no medication other than a daily vitamin. She had a tubal ligation after the birth of her third child but has had no other surgeries or history of any medical conditions. Her father had cardiovascular disease and died of a myocardial infarction at 77 years of age. Her mother was diagnosed with breast cancer at 81 years of age. Ms. Martin does not smoke and rarely drinks alcohol. She likes to work in her garden but is not involved in a formal exercise program. She has gained about 10 pounds since menopause.

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What evidence-based information will you provide to Ms. Martin regarding her concerns of HRT? Discuss the advantages and risks associated with HRT.

Many women going through menopause are placed on hormone replacement therapy to help with the symptoms experienced. Most women were first given HRT to help with hot flashes and any sort of vaginal discomfort common with menopause. However, research has shown that along with the advantages to HRT, there are many disadvantages as well that should be considered when determining whether or not this is an appropriate treatment for the patient.

The advantages of using hormone replacement therapy for treatment of women going through menopause includes the reduction of hot flashes, especially in women with moderate to severe hot flashes. It can also help to prevent osteoporosis, preventing bone loss and fractures. Additionally, in women who experience premature menopause, have had their ovaries removed, or have ovarian insufficiency, HRT has been proven to prevent certain health conditions related to the patient’s decrease in estrogen. Risks of hormone replacement therapy include the increased risk of developing blood clots, especially in the legs, which can in turn cause a pulmonary embolism. Additionally, the patient is at greater risk for a stroke. Women who have not had a hysterectomy or her ovaries removed need to take HRT with both estrogen and progesterone, or else there is potential for an increased risk of breast cancer, especially if therapy is prolonged past 5 years Treatments For Menopausal Symptoms.

What are your recommendations for Ms. Martin? Will you recommend continuing or discontinuing HRT and why?

For Ms. Martin, I would recommend the cessation of HRT. First off, she is 55 years old. The average age of menopause for most women is the early 50’s, but can happen anywhere between a woman’s 40s and 50s. That being said, we do not know Ms. Martin’s last menstrual period, but postmenopause symptoms typically only last between 4-5 years. She is likely reaching a point where this therapy is no longer necessary. Additionally, Ms. Martin is at risk for negative factors associated with HRT due to her familial history of myocardial infarction with cardiovascular disease. This places her at greater risk for developing blood clots which can be extremely dangerous. Her mother also has a diagnosis of breast cancer, making her at greater risk for developing this as well. HRT is known to increase a patient’s risk for breast cancer as well (Liu, J. Y., Chen, T. J., & Hwang, S. J. (2016).

What alternative treatments for menopausal symptoms will you discuss with Ms. Martin?

Alternative treatments that can be recommended for Ms. Martin could involve a regimen of supplementations. Vitamin D helps to regulate and balance hormones, which can help with menopausal symptoms that may be experienced. Black cohosh is another plant supplement that is often used for helping vasomotor symptoms. Other therapies and treatments that can also be discussed include acupuncture and yoga for regulation of symptoms (Pirotta, Ee, Teede, Chondros, French, Myers, & Xue, 2014)Treatments For Menopausal Symptoms.

Discuss the recommended screening tests, using the latest evidence based guidelines that Ms. Martin should have.

For women 55 and over, it is recommended that women get a mammogram done every two years or so. It has been two years since Ms. Martin’s last mammogram, therefore I would recommend scheduling the patient for this examination. It would also be wise to order Ms. Martin a pap examination as well, as women between the ages of 30-65 should get a pap done every 5 years, and her last exam was 5 years ago. We could order a pt/ptt with INR on this patient to assess the clotting status of her blood in order to determine if she is at risk for developing a blood clot. A CBC and fibrinogen test can also be ordered.

What health promotion, maintenance, and prevention education would be important to provide to Ms. Martin?

It would be important to educate Ms. Martin on the rationale behind cessation of HRT and how this could affect her after stopping the therapy. She should know that she is at greater risk for developing breast cancer and should continue with mammography screenings every 5 years. It is usually recommended that the patient gradually wean off HRT rather than stopping all at once. It can be discussed with the patient to slowly dose herself off the medication.

Discussion #2

What evidence-based information will you provide to Ms. Martin regarding her concerns of HRT? Discuss the advantages and risks associated with HRT.

The evidence-based practice information I would provide for her is to inform her that hormone therapy is the use of natural or synthetic estrogen or a combined estrogen and progestin by the postmenopausal woman to alleviate the symptoms of lower amounts of natural estrogen. These symptoms include hot flashes, vaginal atrophy, accelerated skin aging, vaginal dryness, decreased muscle mass, sexual dysfunction and bone loss that women can experience during the menopausal transition. Symptoms of depression and low mood can be very common and often respond well to HRT. There is no clear evidence that antidepressants improve the low mood in menopausal women (Newson, 2016)Treatments For Menopausal Symptoms. Age and years since menopause are now known to be important variables affecting the benefit–risk profile of HRT. Benfits of HRT are symptoms of the menopause such as hot flushes, mood swings, night sweats, and reduced libido all improve. Other benefits of taking HRT include reduced risk of developing osteoporosis and reduced risk of bone breakage, lowered risk of colon cancer, lowered risk of diabetes, modest improvement in joint pains, and lower death rate for women who take hormone therapy in their 50s (Cleveland Clinic, 2019). Risks of HRT are an increased risk of endometrial cancer (only if a woman still has her uterus and is not taking a progestin along with estrogen), increased risk of blood clots and stroke. However, in women within 5 years of menopause there was no statistically significant increase in stroke risk. Also, studies suggest that using estrogen delivered from the skin via a patch/cream might further lessen the risk of blood clots. Increased chance of gallbladder/gallstone problems and increased risk of dementia if hormone therapy is started after a woman has been in menopause for 10 years.

What are your recommendations for Ms. Martin? Will you recommend continuing or discontinuing HRT and why?

My recommendations to her would encourage her to think about the information provided  so she can make a decision about her healthcare, that will give her a comforting quality of life. She is not at risk for adverse side effects of HRT and she does not have cardiovascular disease, but her mother has breast cancer. With her familial history of breast cancer I would recommend her take a lower dose of HRT for the shortest time possible. This would decrease her risk of developing breast cancer but it will help with the vasomotor symptoms she is experiencing.

What alternative treatments for menopausal symptoms will you discuss with Ms. Martin? Treatments For Menopausal Symptoms

Many women seek complementary and alternative medicine (CAM) for symptom management.  Black cohosh, evening primrose may help breast tenderness, Ginseng may help improve sleep, mood, and sense of well-being, and Kava may help relieve anxiety. Acupuncture may help some women with insomnia, mood swings, or hot flashes, paced breathing may provide relief of hot flashes when done for 20 minutes three times a day, and relaxation therapies including massage, meditation, and yoga may relieve stress, insomnia, and fatigue.

Discuss the recommended screening tests, using the latest evidence based guidelines that Ms. Martin should have.

Major guidelines concur that women at average risk of breast cancer benefit from screening mammography at least every other year from 50 to 74 years of age. Several effective options for colorectal cancer screening are recommended for women 50 to 75 years of age. Cervical cancer screening should occur at three- or five-year intervals depending on the test used, and can generally be discontinued after 65.  Screening for ovarian cancer is not recommended. Clinicians should consider screening for sexually transmitted infections in older women at high risk. Postmenopausal women should be routinely screened for depression, alcohol abuse, and intimate partner violence (Baill & Castigioni, 2017)Treatments For Menopausal Symptoms.

What health promotion, maintenance, and prevention education would be important to provide to Ms. Martin?

Postmenopausal women have a number of unique health-promotion and disease-prevention needs. Cardiovascular prevention – the prevalence of CVD increases rapidly at the onset of menopause and continues to increase through the post-menopausal period. Coronary heart disease – The complex effects of hormones on the cardiovascular system result in different presentations of coronary heart disease in women, with a higher incidence of angina, a lower burden of obstructive coronary artery disease. Stroke and atrial fib – unique risk factors for stroke in post-menopausal women include the use of hormone therapy and a higher prevalence of hypertension. Fall prevention – According to the USPSTF, effective fall prevention measures include daily intake of 600 to 800 IU of vitamin D, weight-bearing exercise, balance training three times per week, muscle strengthening twice per week, and 150 minutes per week of moderate-intensity or 75 minutes per week of vigorous-intensity aerobic physical activity. Postmenopausal women benefit from receiving vaccines.  They provide protection against herpes zoster, influenza, pneumococcus, and tetanus, diphtheria, and pertussis (Baill & Castigioni, 2017)Treatments For Menopausal Symptoms.

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