A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and she presented to her gynecologist for her annual gyn examination and to discuss her symptoms. She has a history of ASCUS (atypical squamous cells of undetermined significance) about 5 years ago on her pap, other than that, Pap smears have been normal. Home medications are Norvasc 10mg daily and HCTZ 25mg daily. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago.
The patient is presenting with marked symptoms for perimenopause. Perimenopause is the transitional period between productive and nonproductive years, a transition lasting 2 to 8 years. Perimenopause to each woman age of onset and time span is different. Some women start experiencing these symptoms a little early, while others start in their 40’s. Perimenopause is that period in a phase of a woman’s life during which she starts experiencing some estrogen imbalance, leading up to the final cessation of her menstrual cycle. Change in the hormonal occur during this time including erratically higher estradiol levels, decreased progesterone levels, and a disturbed ovarian-pituitary-hypothalamic feedback relationship with higher LH levels (McCance & Huether, 2019, p747).
The patient is experiencing the genitourinary symptoms that can include urethral tone decline along with muscle tone throughout the pelvic area leading to urinary frequency/urgency, urinary tract infections, and incontinence may occur (Huether & McCance, 2019, p750). Because of the decrease of estrogen levels, vasomotor systems present as hot flashes, sweating (night sweats) due to peripheral blood vessels dilating, other symptoms that can ensue are palpitations, dizziness, headaches, and increase the risk for cancers of the breast, uterus, and ovaries (Huether & McCance, 2019).
The transition time in the perimenopause phase also varies from one woman to another. Some women go through this period briefly, while some last several years before they finally achieve menopause. Women are still having menstrual cycles during this time and can get pregnant. The menopause-like symptoms start manifesting during the perimenopause phase because the ovaries are slowly regressive in the amount of estrogen it produces. This patient needs to be made aware that perimenopause to menopause modification is a midlife neuroendocrine switch ceremony unique to each woman that occurs on the background of aging biology.
Based on the symptoms the patient is exhibiting, it may be beneficial to start her on hormone replacement therapy (HRT). According to Akter and Shirin (2018), HRT is considered the most effective treatment for women who are suffering from perimenopausal and menopausal symptoms. HRT should be discussed thoroughly with patient and is individualized to each woman based on history and symptoms. The recommended HRT for the patient would be to start her on an estrogen and progestin combination daily. The estrogen would be prescribed for the treatment of her symptoms of hot flashes and night sweats. According to Rosenthal and Burchum (2018), low dose estrogen is given to replace the loss of estrogen from perimenopause and reduce the symptoms of hot flashes and night sweats. Progestin is giving in combination with estrogen because the patient still has her uterus. Progestin is needed to prevent endometrial cancer during menopause because it offsets the estrogen-mediated stimulation of the endometrium (Rosenthal & Burchum, 2018). The patient should be aware of the risk related to HRT and whether the risk outweighs the benefit of the relief of symptoms associated with menopause.
The patient has a history of hypertension which needs to be considered when educating the patient about HRT. According to Rosenthal and Burchum (2018), HRT can help with reducing cardiovascular disease (CD), but it is important that HRT is not used for that purpose and the patient continues to take prescribed medications related to CD. The patient takes medications for her hypertension and her current blood pressure is elevated. The education of continuing to take her antihypertensive medications and maintaining a healthy diet is important in maintaining her cardiovascular health. According to Ozcan (2019), healthy lifestyle behaviors such as physical activity, healthy diet, and stress management can reduce the menopausal symptoms. The patient
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