Postmenopausal Symptoms and Osteoporosis Analysis - Case Study Example

Home Work Case Study: Postmenopausal Symptoms & Osteoporosis Case: A 51 year-old woman who is year postmenopausal presents for a routine physical check up. She complains of mild hot flashes and vaginal dryness and also asks what she can do to prevent osteoporosis. Response To reduce anxiety, educate the client that hot flashes and vaginal dryness are just some of the common manifestations of postmenopausal symptoms and menopause is a normal part of every woman’s life and not an illness.. According to Thibodeau, G.A. and Patton, K.T. (Anatomy & Physiology, 2003, p. 961), Menopause decreases sex hormones, especially estrogen, with advancing age and this account for the common symptoms such as cessation of menstruation, hot flashes, and vaginal dryness. In Reader’s Digest’s Guide to Medical Cures & Treatments (1998, p. 290), hot flashes, accompanied by reddish blush and sweating followed by chills, is the result as the body adjusts to its new hormone levels but flashes subside, and most end by age 60. While vaginal dryness is caused by the thinning of the outer layer of the mucous membrane that lines the vagina, these changes can lead to painful intercourse, persistent vaginitis, and increase incidence of bladder infections. Furthermore, the decrease in estrogen levels associated with menopause may also contribute to osteoporosis because of loss of bone mass. According to North American Menopause Society (NAMS, June 2006), osteoporosis and risks of fractures can be prevented by slowing/stopping bone loss, maintaining its strength, and minimizing/eliminating risk factors for fractures. These can be achieved through having a balanced diet, adequate calcium and vitamin D intake, adequate exercise, smoking cessation, avoidance of excessive alcohol intake, and fall prevention. It is important to consider though that as a primary care provider, we should evaluate the client properly by gathering information from baseline data to detailed description of the signs and symptoms that she feels; thorough physical cephalo-caudal examination for proper evaluation and diagnosis; obtain the client’s full health history for her presenting symptoms may direct the focus of the physician to the climacteric (menopause), but the possibility of another undiagnosed health problem should be considered. For health teachings to lessen the discomfort of postmenopausal symptoms and reduce the risk of complications, have a regular exercise for strength training (such as 15-20 minute brisk walk), emphasize diet with ample fresh fruits and vegetables for vitamin C, beta carotene, and other antioxidants that protect against cell damage from oxygen metabolism. Screening Tests Since menopause is not an illness but a part of every woman’s life, symptoms like hot flashes and vaginal dryness do not usually require diagnostic tests other than a pelvic examination and pap smear to find infections and abnormal cervical cells that can turn into cancer cells. According to Dr. Laurie Barclay and Dr. Charles Vega (Treatment for Postmenopausal Women Reviewed, September 2, 2008), beginning at 40 years old, the woman should be screened for breast cancer every 1 or 2 years while the required screening test for women starting from 50 years old is the colorectal cancer screening test also every 1 or 2 years. Women younger than 65 years who have a cervix and are sexually active should be routinely screened for cervical cancer with a Papanicolaou test. For postmenopausal women showing risk factors for osteoporotic fractures, bone mineral screening test should begin earlier than 65 years old (the age supposedly recommended for this type of screening test). Treatment for Hot Flashes Since hot flashes in postmenopausal women normally subside, utilizing first the various safe ways of alternative treatment like herbal teas, ginseng and cohosh extracts/capsules are recommended. Wear layers of lightweight clothing that can be shed quickly as the need arises. Take a cool shower before going to bed, work and sleep (using only a sheet or light blanket) in a cool environment. Abstain from nicotine, alcohol and caffeine for these can aggravate hot flashes. If hot flashes symptoms remain untreated and discomfort is not alleviated after utilizing alternative treatments, seek doctor’s advice for the medication treatment. Medications traditionally used to treat hot flashes are either oral or transdermal forms of estrogen. These medications decrease the frequency of hot flashes by about 80% to 90% according to Dr. M.C. Stoppler (Alternative Treatments for Hot Flashes in Menopause, 2008). Hormone replacement therapy (HRT) or postmenopausal hormone therapy (PHT) is a hormone therapy that either consists of estrogen alone or a combination of estrogen and progesterone but according to Dr. Stoppler, long-term studies discovered that combination hormone therapy had an increased risk of heart attack, stroke and breast cancer. Non-estrogen prescription medications can also provide relief from hot flashes and these are: (1) selective serotonin reuptake inhibitors or SSRI’s like venlafaxine (Effexor), paroxetine (Paxil) and flouxetine (Prozac); (2) Clonidine (Catapres), which normally acts to decrease blood pressure, also relieves hot flashes in some women; (3) Megestrol acetate (Megace) is a progesterone medication that can effectively relieve hot flashes but only for short-term use and not usually recommended as first-line hot flash drug; (4) Medroxyprogesterone acetate (Depoprovera) administered through injection can be use for long-term but with side effects of weight gain and bone loss; (5) Gabapentin (Neurontin) is a drug use to treat seizures but moderately effective in treating hot flashes with drowsiness side effect. Treatment for Vaginal Dryness According to Claire Adrews, author of Vaginal Dryness as a Menopause Symptom: Treatments and Relief (2006), vaginal dryness is easily and safely treated through the following self-care measures: (1) Up your water intake to ten 8 oz. glasses a day for natural hydration. This can be helpful in relieving vaginal dryness; (2) Vaginal lubricants may help relieve vaginal dryness, particularly during intercourse; (3) Supplements like Vitamin E, ginseng and soy products are believed to help improve vaginal moisture levels; (4) A low-fat, high-fiber, mostly vegetarian diet featuring soy products can help relieve vaginal dryness; and (5) Avoid douching as this can cause an imbalance in the chemical composition of the vagina as well as causing irritation. If vaginal dryness persists despite best efforts to alleviate discomfort through self-care, estrogen therapy may be in order (Andrews, 2006). In estrogen therapy take note of possible side effects or health risks in conjunction with medical history before starting treatment. Vaginal estrogen treatments are available in three different forms: (1) Estrogen cream, inserted directly into the vagina, generally 2 to 3 times per week. It is usually used at bedtime; (2) Estrogen rings, soft, flexible O-shaped rings that are inserted into the vagina. They stay in place for up to three months, releasing estrogen at appropriate levels continually; and (3) Estrogen tablets, placed directly into the vagina twice per week are another treatment option. Should creams, rings and tablets fail to relieve vaginal dryness, your doctor may suggest more comprehensive estrogen replacement therapy, particularly if you are experiencing other discomforting menopause symptoms. Discuss this possibility with your doctor in detail. ERT is not without risks, and women should make informed choices about all of the treatment options available for relief of various menopause symptoms. Works Cited: Andrews, C. (2006). Vaginal Dryness as a Menopause Symptom: Treatments and Relief. Copyright 2006 MenopauseReliefs.com link available at: < http://www.menopausereliefs.com/Vaginal-Dryness-as-a-Menopause-Symptom-Treatments-and-Relief.php > Barclay, L. and Vega, C. (September 2, 2008). Treatment for Postmenopausal Women Reviewed. Medscape Medical News copyright 2008. Link available online at: < http://www.medscape.com/viewarticle/579943 > North American Menopause Society (June 2006). Management of Osteoporosis in Postmenopausal Women. A service of the U.S. National Library of Medicine and the National Institutes of Health. An online article available at: Reader’s Digest (1998). Guide to Medical Cures & Treatments: Menopause. The Reader’s Digest Association, Inc., Pleasantville, New York/Montreal, U.S.A., p 290. Stoppler, M.C. (2008). Alternative Treatments for Hot Flashes in Menopause. An online article at MedicineNet.com with link at: < http://www.medicinenet.com/alternative_treatments_for_hot_flashes/article.htm > Thibodeau, G.A. and Patton, K.T. (2003). Anatomy & Physiology, 5th Edition. Copyright 2003 by Mosby, Inc., a division of Elsevier Science, Westline Industrial Drive, St. Louis, Missouri, p 961. Read More