Menopause Essay Examples & Outline

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Menopause


Client Complains

The patient complains about hot flashes and nausea. She explains that the condition started few months ago. She has previously tried natural remedies, but it never worked out.

History of Present Illness

The patient had her last menstrual period one and a half years ago. She experienced irregular periods before they stopped completely. This shows that the patient is experiencing menopause symptoms.

Past Medical History

The patient has been previously diagnosed with Hyperlipidemia five years ago. Further, the patient was diagnosed with gastro-esophageal reflux disease (GERD) two years ago.

Family History

The patient’s mother died from injuries resulting from an accident. On the other hand, her father died of a presumed heart disease in his fifties. She has four sisters and she is the eldest. All of her sisters are alive and well. consequently, the family has no history of breast cancer.

Social history

The patient is married with three adult children who are in good health. She is a part-time bank teller. She walks on her treadmill daily and she watches her grandchildren after school during the week. The patient denies substance abuse, but she admits that she used to smoke two and a half packs of cigarettes per day. However, this was when she was aged fifteen up to forty-five. She drinks alcohol occasionally and ten to twelve diet cokes per day. The patient has tried following a strict low-salt and low-cholesterol diet, but she confessed it has been difficult. Moreover, she has increased her intake of calcium-containing food up to three-four times a day because she does not like taking so many tums.

Physical Assessments Findings

Vital Signs: BP: 130/85 mmHg; P: 85; RR: 16; T : 98.8 oF; Wt : 130 lb ; Ht : 5'8"
GU/Rect: Pelvic exam with pain and mucosal atrophy
Neuro: Within normal limits (WNL)
Cardiovascular: WNL
Skin: Dry and itchy
Lab Tests Findings
Tests Observed Values
Glucose (Glu) 110 mg/dL
Total Cholesterol (TC) 240 mg/dL
High density lipids (HDL) 37 mg/dL
Triglycerides (TRG) 250 mg/dL
Low density lipids (LDL) 160 mg/dL
Thyroid stimulating hormone (TSH) 3.49uIU/mL
Follicle stimulating hormone (FSH) 38 mIU/mL
Luteinizing hormone (LH) 38 mIU/mL
Estradiol level 15 pg/mL

Other tests:
Pap smear and mammogram normal

Negative pregnancy test

Dual energy X-ray absorptiometry (DEXA) scan of lumbar spine and right femoral neck shows slight osteopenia (T scores of minus 1.6, and minus 2.4 respectfully)
Current Medications
Acetaminophen 325 mg 1–2 po qd prn for joint pain after exercise
Prilosec 20 mg bid

Review of Symptoms

Genitourinary/Rectal (GU/Rect): Case of dryness, itching, urinary frequency, and dribbling after voiding; Gravida 3, Para 3, Menarche at age 14. Last menstrual period (LMP) 1 1/2 years ago; sexually active but experiencing dyspareunia

Mental Status: Case of insomnia, increased fatigue, and feeling somewhat depressed

Advanced Practice Nursing Intervention

Women experience various symptoms while they reach menopause. For instance, one can experience hot flashes, genital skin, insomnia, loss of sexual zeal and vaginal changes. Menopause occurs naturally due to old age and failure in ovulation. Normal menopause occurs between forty five and fifty years. However, there are cases of premature menopause where it happens before forty years.

Menopause is considered as a natural event and it is clear that every woman will have to go through it someday. However, medical intervention is necessary where the post menopause symptoms go on for few years after the last period. Most of these patients experience hot flushes, sweats and other symptoms such as fatigue, headaches, lack of sleep, loss of sex drive and depression (Finkler, 2012).

Long-term changes after menopause include hair and skin changes. After menopause, most women tend to lose their level of skin collagen. This leads to dry, thin and itchy skin. Further, they experience genital area changes such as vaginal changes, vulva changes and increased frequency of urination. Moreover, females experience signs of osteoporosis after menopause. Osteoporosis is a condition where the bones become less strong and less dense. Thus, this condition may cause the bones to fracture easily. Consequently, post-menstrual risks include the increase in the risk of developing cardiovascular disease (Clouse & Sherif, 2010).

In the clinical situation, the doctor will initially carry out various vital tests to diagnose the cause of the condition. One of the most common tests in this condition is the hormone blood tests. This is used to confirm that the patient is experiencing menopause. Further, the hormonal tests can provide useful information regarding the condition of the patient after menopause.

Menopause is considered as a natural occurrence and most patients go through it without medication. However, the short-term symptoms may become severe in some patients. Thus, hormone replacement therapy is provided to women who experienced increased menopause symptoms (Finkler, 2012).

Urine and Blood Levels

Urine and blood tests would be necessary to evaluate the level of LH, FSH and estradiol in menopause. The LH and FSH levels are used to examine menstrual irregularities. If the patient has poor ovarian cycle or past menopause, the level of LH is measured by administration of gonadotropin releasing hormone. Further, a pelvic exam would be necessary to measure the vaginal changes caused by reduction of the estrogen levels. Consequently, bone density tests should be carried to measure the level of osteoporosis.

Hormone replacement therapy

All hormone replacement hormones involve use of oestrogen hormone. Hormone replacement therapy mainly focuses on providing additional oestrogen that ovaries do not provide after menopause. Hormone therapy is available in numerous forms. For example, one can get the therapy in form of tablets, vaginal ring, skin patches, nasal spray and gels. This therapy offers a variety of brands for each of these forms. They all add oestrogen into the patient’s blood stream.

Nevertheless, the use of hormone replacement therapy has some dangers as well. For instance, the use of this therapy increases the risk of patients developing uterus cancer. Thus, oestrogen in this therapy is combined with progestogen hormone. This reduces the risk for one developing uterus cancer (Fogel & Woods, 2013).

Hormone replacement therapy is available in two types of combination therapy. Monthly cyclical hormone replacement therapy and three month cyclical hormone replacement therapy. Monthly cyclical hormone replacement therapy entails taking oestrogen daily and progestogen added after every fourteen days, for a 28 day treatment cycle. On the other hand, three months cycle entails taking oestrogen daily and progestogen after fourteen days for three weeks. However, if the patient has stopped experiencing her periods for a year or more, then she will be advised to take a daily combination of oestrogen and progestogen daily (Clouse & Sherif, 2010).

Vaginal symptoms

Vaginal symptoms caused by low levels of oestrogen include, atropic vaginitis and vaginal dryness. This often occurs in post-menstrual patients and it leads to pain experienced during sex. The condition is managed by hormone-replacement therapy and through application of non-hormonal lubricants and mosturisers.

Lifestyle changes

Postmenstrual patients usually experience osteoporosis, which put them in danger of losing bones or getting fracture easily. Thus, various lifestyle changes are necessary to increase the efficiency of their bones. Physicians advise women undergoing menopause to avoid smoking, get enough calcium, avoid caffeine, avoid alcohol, avoid spicy foods, get vitamin D, maintain healthy weight and exercising frequently. Further, these patients are advised to eat healthy foods that are low in fat and high in fiber.

Further, the patient should be referred to a dietician to improve the patient’s food choices. For instance, the patient needs to stop taking 12 cokes a day. Caffeine and sodas can increase the degree of hot flashes experienced by the patient.

Medical management

The patient should continue using medications prescribed in order to reduce the previously diagnosed conditions from reoccurring. Further, the patient should engage in a hormone replacement therapy where she would take both oetrogen and progestogen daily. This is because she stopped having periods more than a year ago. Further, her lipid profile should be watched closely since she was previously diagnosed with hyperlipidimia (Fogel & Woods, 2013).

Moreover, the medications should include vitamin supplements and antidepressants prescriptions. Antidepressants such as effexor, paxil and Prozac grabapentin help reduce hot flashes.

References

Finkler, K. (2012). Women in pain: Gender and morbidity in Mexico. Philadelphia: University of Pennsylvania Press.
Clouse, A. L., & Sherif, K. (2010). Women's health in clinical practice: A handbook for primary care. Totowa, N.J: Humana Press.
Fogel, C. I., & Woods, N. F. (2013). Women's health care in advanced practice nursing. New York: Springer Pub.