As the symptoms of menopause can resemble some other conditions or states of the human body, it is suggested that the patient should take a pregnancy test to rule out pregnancy (Dunphy, Winland-Brown, Porter, & Thomas, 2015). Additionally, blood tests that will indicate the levels of follicle-stimulating hormone (FSH) and estrogen (estradiol), as well as thyroid-stimulating hormone (TSH), should be made to determine whether the patient is in perimenopause and to rule out hypothyroidism (Mayo Clinic, 2017).
To ease patient’s symptoms, aerobic exercise to relieve hot flashes and insomnia, limited alcohol and caffeine intake, and herbal therapies such as isoflavonoid phytoestrogens or black cohosh are recommended (Dunphy et al., 2015). Benefits of the hormone replacement therapy include relief in vasomotor symptoms, mood improvements, improvement of sexual function, decreased urinary frequency, prevention of osteoporosis (as a long-term effect), improvement in cognitive function, and reduction of cardiovascular risks (Panay, Hamoda, Arya, & Savvas, 2013). The disadvantages include a small increase in the risk of developing breast cancer and endometrial cancer (if no progesterone is taken), and an increased risk of venous thromboembolism (Panay et al., 2013).
Estrogen/progestogen therapy is recommended as the patient is a non-hysterectomized woman. According to Panay et al. (2013), women who did not undergo this procedure should be prescribed with the estrogen/progestogen therapy to avoid the development of hyperplasia and carcinoma. Alternative pharmacotherapeutics include the use of SSRIs, for example, paroxetine to mitigate the severity of vasomotor symptoms in women in menopause (Portman et al., 2014). Research also demonstrates that gabapentin (300 mg/day) is more effective than fluoxetine (20 mg/day) in treating vasomotor symptoms (Rahmanian, Mohseni, & Ghorbani, 2014).
Health promotion strategies can include drinking a glass of cold water during hot flashes, using relaxation techniques to control mood swings, avoiding caffeine and alcohol, and giving up smoking to decrease the risk of cardiovascular issues and cancer (Mayo Clinic, 2017). Physical activity can also help prevent cardiovascular diseases and avoid weight gain. Complementary therapies include the use of hop (Humulus lupulus) against vasomotor symptoms, fruit-oil of Vitex agnus-castus, yam, flaxseed meal or flaxseed extract, pine bark against other menopausal symptoms (Depypere & Comhaire, 2014). Additionally, hypnosis could be useful against insomnia (Mayo Clinic, 2017).
It is necessary to educate the patient about the possibility of pregnancy during perimenopause, and various birth control methods (such as barrier BC or oral contraceptives) should be discussed as well. The patient should be aware of the advantages and disadvantages of HRT and possible depression or other mood issues that can emerge during perimenopause or menopause. Problems with short-term memory can also develop, and the patient should not confuse it with other diseases, such as, for example, Alzheimer’s (only if the problems are not severe). If the patient does not experience relief in symptoms, has perimenopausal or postmenopausal bleeding, or has severe depression that is resistant to treatment, a referral to either a gynecologist or a mental health specialist is necessary (Dunphy et al., 2015).
This visit could be described as a level 2 EM visit since the help the patient needed is minor, and the bill for this visit would be approximately $40. Circle of Caring could be used to draw patient’s attention to the importance of art and spirituality in one’s life; various exercises such as yoga, massage, or meditation could help her cope with menopausal symptoms and improve psychological well-being.
Depypere, H. T., & Comhaire, F. H. (2014). Herbal preparations for the menopause: Beyond isoflavones and black cohosh. Maturitas, 77(2), 191-194.
Dunphy, L., Winland-Brown, J., Porter, B., Thomas, D. (2015). Primary care: The art and science of advanced practice nursing (4th ed.). Philadelphia, PA: F.A. Davis.
Mayo Clinic. (2017). Menopause. Web.
Panay, N., Hamoda, H., Arya, R., & Savvas, M. (2013). The 2013 British menopause society & women’s health concern recommendations on hormone replacement therapy. Menopause International, 19(2), 59-68.
Portman, D. J., Kaunitz, A. M., Kazempour, K., Mekonnen, H., Bhaskar, S., & Lippman, J. (2014). Effects of low-dose paroxetine 7.5 mg on weight and sexual function during treatment of vasomotor symptoms associated with menopause. Menopause, 21(10), 1082-1090.
Rahmanian, M., Mohseni, A., & Ghorbani, R. (2015). A crossover study comparing gabapentin and fluoxetine for the treatment of vasomotor symptoms among postmenopausal women. International Journal of Gynecology & Obstetrics, 131(1), 87-90.