case study

Posted: November 7th, 2023

The case study presents the case of an adult female, 46-years-old, complaining of not feeling good for over a month. The patient states she experiences hot flashes, genitourinary symptoms and night sweats. According to her medical information, she has a history with several complications, namely hypertension and ASCUS. The latter was diagnosed five years ago by a pap smear. The patient states subsequent ASCUS examinations have been clear. Family records show a history of breast cancer. The patient is up to date with her annual mammograms. Blood pressure is 150/90 and weight 230lbs. Home medications include HCTZ 25mg daily and Norvasc 10mg daily. The purpose of this report is to provide a diagnosis for the patient, including suitable treatment regime and education strategies for continued management.

Diagnosis

            The patient seems to be experiencing early stage menopause, otherwise known as perimenopause. According to Santoro et al. (2015), over ninety percent of women aged 45-55 years old experience menopause symptoms. The sweating at night and hot flashes are symptoms associated with menopause. The patient also states she is experiencing genitourinary symptoms, which normally includes vaginal dryness (Delameter & Santoro, 2018). During menopause, women’s oestrogen levels decrease resulting in the vaginal epithelium and urethra degenerating. The resultant implications include urge incontinence, urinary dryness and changes to urinary frequency (Santoro et al. 2015). The clinician’s goal is to identify suitable treatments that allow the patient to restore her quality of life.

Treatment Regimen

            The onset and severity of the patient’s symptoms suggests that she should start receiving Hormone Replacement Therapy (HRP). The treatment is cited as one of the most effective course of action when dealing with menopausal and perimenopausal women (Roberts & Hickey, 2016). It would be suitable to start the patient on oestrogen and progestin treatment on a daily basis. The objective is to return the patient’s oestrogen levels to near normal or normal to address the night sweats and hot flashes. According to Rosenthal and Burchum (2018), the patient should receive progestin since she still has her uterus. The medication is known to prevent the development of endometrial cancer. The provision of oestrogen will offset the natural stimulation of the endometrium, thus use of progestin (Rosenthal & Burchum, 2018). The vasomotor symptoms will reduce with the use of oestrogen and progestin.

            It is important to take note of the potential side effects when using the two drugs. HRP is not recommended for individuals with a history of breast cancer, cardiovascular complications or vaginal bleeding (Rosenthal & Burchum, 2018). The patient’s medical information highlight that she has a family history of breast cancer and a personal history of ASCUS. It would be good to consider alternative treatments, such as SSRI or SNRIs. The class of antidepressants are known to relieve vasomotor symptoms, though with less effectiveness compared to HRP (Rosenthal & Burchum, 2018). Oestrogen replacement remains the best option since it is more effective and the subject is not a high risk patient.

Patient Education Strategy

The patient needs to be taught on the need not to use HRP to treat her underlying hypertension. HRT is known to reduce the chances of cardiovascular complications (Rosenthal & Burchum, 2018). However, that is not the purpose of the medication in this case. The patient and family members should be trained to keep cautious that medication is terminated with the successful treatment of menopause. The management of hypertension should be lifestyle based, including physical exercise, stress control and healthy eating. Teaching stress management should be key since it affects both menopause and hypertension. Frequent interactions via telehealth technologies should facilitate the education process.

References

Delamater, L., & Santoro, N. (2018). Management of the Perimenopause. Clinical Obstetrics and Gynaecology, 61(3), 419–432. https://doi.org/10.1097/GRF.0000000000000389

Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86(2016), 53–58. https://doi.org/10.1016/j.maturitas.2016.01.007

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. Elsevier.

Santoro, N., Epperson, C. N., & Mathews, S. B. (2015). Menopausal symptoms and their management. Endocrinology and Metabolism Clinics of North America, 44(3), 497–515. https://doi.org/10.1016/j.ecl.2015.05.001