Menopause: A Case Study

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A fifty-one-year-old woman, E.P., presents to the family practice clinic with complaints of amenorrhea and hot flashes multiple times during the day disrupting her sleep at least ten times per night. She is uncomfortable and fatigued. During the visit, a Pap smear and mammogram are completed and are negative. Her FSH is 32 international units/ml. E.P. is 5’8” and weighs 130 pounds. She has no significant medical history and family reveals her mother has osteoporosis. Family history is negative for breast cancer. She expresses her desire to explore hormone therapy (HT) as an option to manage her symptoms of menopause. The following paper will discuss specific goals of treatment for E.P.’s clinical presentation, best treatment option, …show more content…
Vaginal problems can develop early and encompass dryness, dyspareunia, and increased pH (Edmunds & Mayhew, 2014). Muscle tone in the pelvic region, as well as urethral tone, becomes diminished. This, combined with the increased pH and decreased vaginal secretions can lead to urinary tract infection as well as incontinence (Edmunds & Mayhew, 2014). Cardiovascular disease rises in postmenopausal women due to a disruption in cholesterol metabolism that had previously been provided by an estrogen-stimulated enzyme (Edmunds & Mayhew, 2014). This reduces the vascular pliability increasing the incidence of atherosclerosis (Edmunds & Mayhew, 2014). Breast tissue loses density with globular breast tissue supplanted by fat and connective tissue (Edmunds & Mayhew, 2014). Osteoporosis becomes a concern as bone mass decreases rapidly for several years after menopause before reducing to a slower rate (Edmunds & Mayhew, 2014). Estrogen and progesterone have multiple chemical and structural effects on the brain regarding memory, cognitive functions and thermoregulatory processes (Edmunds & Mayhew, 2014). Menopause can also cause dry skin, insomnia, paresthesia, constipation, mood changes, muscle and joint pain, and decreased quality of life (Edmunds & Mayhew, …show more content…
cannot tolerate the oral estrogen/progestogen regimen, it is available in a transdermal application, however, as it contains the same medication she may not tolerate it absorbed dermally either. Another option to consider is low-dose oral contraceptives (OC). While not FDA approved for the management of menopausal symptoms, they may be an alternative for E.P. provided she does not smoke, have an estrogen-dependent neoplasm, untreated hypertension, history of DVT, stroke, PE, or ischemic heart disease (Edmunds & Mayhew, 2014). Other contraindications to OC are abnormal genital bleeding, diabetic neuropathy, nephropathy, vascular disease, active viral hepatitis, cirrhosis, and liver tumors (Edmunds & Mayhew, 2014).
Health promotion recommendations include education regarding contraception as it is still possible to become pregnant during perimenopause (Edmunds & Mayhew, 2014). E.P. should also be counseled on lifestyle modifications that may help manage symptoms related to menopause such as decreasing caffeine intake, avoiding refined sugars and alcohol which can trigger hot flashes (Edmunds & Mayhew, 2014). Dietary modifications that may help
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