Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least two of these prompts:
- Do you agree with your peers’ assessment?
- Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
- Share your thoughts on how you support their opinion and explain why.
- Present new references that support your opinions.
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with citations and references in APA format.
1- Daisy Smith
Construct the patient’s subjective data in a SOAP Note format.
The Subjective data is she is G1 P1 and averages 6 or more hot flashes per day and is frequently awakened by night sweats and vasospasms for 8 months, and no menstrual periods for 1 year. She feels that her symptoms make it difficult for her to concentrate and cause her to be irritable, affecting her ability to do her job and negatively impacting the quality of her relationships. She is sexually active and experiencing a decrease in libido and is thinking about getting a divorce.
She does not routinely exercise and has smoked 1 pack of cigarettes per day for 20 years. Although she takes a multivitamin/mineral tablet each day, SP is uncertain about the doses of calcium and vitamin D provided by this supplement. Her mother and a maternal aunt had osteoporosis, and her mother sustained a hip fracture. SP has no family or personal history of breast cancer and has not had a breast biopsy.
SP is uncertain about hormone therapy because of the negative things she has heard via the news and her friends. She is concerned about the possibility of developing breast cancer even though she has no personal or family history of this disease. She is also concerned about the possible risk of developing Alzheimer’s disease. She does not voice any concerns about bone health.
How would you diagnose and treat vaginal atrophy?
Vaginal atrophy would be diagnosed by complaints of vaginal dryness, burning, or itching. The patient would also complain of dyspareunia, a yellow vaginal discharge, spotting or bleeding during sex, or vulvar itching around the external genitalia, she could be treated with estrogen cream to manage her symptoms (Cleveland Clinic, 2023).
Discuss general treatment of menopause and osteoporosis with hormones.
As the woman transitions through menopause, her body will start to produce estrone which is a weak form of estrogen that is normally found in menopausal women. Estrogen normally produced by the ovaries will decrease related to elevated FSH and ovarian atrophy. Thus, women can be determined to be in menopause after 12 months of amenorrhea. Until that time, patients may experience vasomotor symptoms (hot flashes) (Alexander, 2017). Moreover, low estrogen levels will also consequently affect the bones leading to osteoporosis and women who are older than 50 years old are more likely to suffer a fracture secondary to osteoporosis (Carcio and Secor, 2019). Therefore, estrogen therapy may be beneficial to the patient to assist with managing hot flashes as well as improve bone density in this patient (Carcio and Secor, 2019). I would place this patient on an estradiol patch because she has a history of smoking and according to Alexander, et al., (2017), estrogen patches have a lower risk of cardiovascular issues as well as stroke than the oral form of the estrogen therapy hormone would. Moreover, her mother and her grandmother had a history of osteoporosis, so placing her on the patch may work better for her because she will be able to get a smaller dose compared to oral dosing which is again better for her due to her history of smoking and it may also help with additional estrogen distribution to her bones to improve her bone density. I would discuss compounding and saliva testing with her but based on bioidentical (natural hormones) information provided by Alexander, et al., (2017), I would be reluctant to place her on the compound drugs because they are not FDA regulated, have a history of false claims of being safer than pharmaceutical meds approved by the FDA, and even though doses can be tailored toward what the patient’s body needs based on lab testing, I would counsel her on those as far as an option however, discourage use of them.
How would you counsel this client?
I would inform this patient that she is experiencing signs of menopause. Her diagnosis would be conclusive because she has not had a period in 12 months, and I would advise her that she would need to take vitamin D supplements of at least 600-1000 U/d and that she should also incorporate a daily calcium intake of 1200- 1500 mg/ day to assist with maintaining her bone health. (Alexander, et al., 2017). I would also counsel her on the side effects associated with taking estrogen therapy such as depression, mood changes, dry eyes, elevated blood pressure, abdominal bloating, and cramping with flatulence. She would also be informed of the risk of breast cancer, stroke, cardiovascular disease, and clotting. (Alexander, et al., 2017).
HPI: A 53-year-old female patient presents with a chief complaint of ” she feels that her symptoms make it difficult for her to concentrate and cause her to be irritable, affecting her ability to do her job and negatively impacting the quality of her relationships.” She also stated that “She is concerned about the possibility of developing breast cancer even though she has no personal or family history of this disease. She is also concerned about the possible risk of developing Alzheimer’s disease. She does not voice any concern about bone health.” She is a G1P1 who has not had any menstruation for 1 year. She is currently suffering from 6 or more hot flashes per day.
Medications: Calcium and Vitamin D, uncertain of doses
Social History: 1 PPD Cigarette smoking for 20 years, she does not exercise regularly.
Family History: Mother is living and has a history of osteoporosis and a hip fracture. Maternal Aunt has a history of osteoporosis. She denies a family history of breast cancer or ever having a breast biopsy.
How would you diagnose and treat vaginal atrophy?
The healthcare provider can diagnose vaginal atrophy based on the symptoms the patient is having and a pelvic exam to visualize the general appearance of the vagina.
Classic signs of atrophy during a pelvic exam include A shortened or narrowed vagina, dryness, redness and swelling, loss of stretch in the skin, whitish discoloration to the vagina, sparsity of pubic hair, a bulge in the back wall of the vagina, vulvar skin conditions (dermatoses), vulvar lesions and/or vulvar patch redness (erythema), a bladder that has sagged into the vagina, urethral lesions, and minor cuts (lacerations) near the vaginal opening.
The vast majority of the time, a trained clinician can easily diagnose atrophic with a careful physical exam. Occasionally laboratory tests are required to differentiate vaginal atrophy from other conditions such as: Pap test, urine sample, ultrasound, serum hormone testing, vaginal pH, and some microscopy testing could be helpful. It is important to work with the patient to decide which plan is most effective based on your symptoms and the severity of them. It is important to consider the quality of life for the patient as well. This patient is sexually active, so this atrophy is definitely affecting her life. Estrogen therapy is usually the most effective.
Some treatments are meant to treat the symptoms of atrophy. Others address the loss of estrogen, specifically, which will also act to relieve symptoms. Lubricants and moisturizers to add moisture and to loosen the vagina can treat dryness. This improves comfort during sex. The moisturizers won’t completely restore the health of the vagina. Dilators are devices to widen (dilate) the vagina to enable you to go back to having sex. Hormone therapy not only improves symptoms of vaginal atrophy the best but also brings back the health of the skin by restoring the normal acid balance of the vagina, thickening the skin maintaining natural moisture, and improving bacterial balance. Over-the-counter repHresh vaginal gel can also be used to help restore normal vaginal pH. For women who are only having vaginal atrophy symptoms, there are several options that allow estrogen to be delivered only to the vagina. Vaginal low-dose estrogen therapy (local therapy). These formulations are meant to treat only vaginal symptoms, as they are not being absorbed by the rest of the body. They are available in the form of a cream (two types, estradiol or conjugated estrogens), a vaginal pill/suppository, or a ring that is left in the vagina for three months. After three months, the old ring is removed and a new one is inserted (Naumova & Castelo-Branco, 2018)
Discuss the general treatment of menopause and osteoporosis with hormones.
Osteoporosis often results from hormonal fluctuations in women’s bodies during the menopause period. Hormone replacement therapy (HRT) – consisting of estrogen, progesterone, or their combination – was once the most widely prescribed treatment for osteoporosis and other menopausal symptoms. While quick and highly effective, HRT has been found to increase the risk of serious side effects and put women’s health at risk, as shown in the studies below. For this reason, its use is reserved for women with high fracture risks. However, HRT comes with side effects. Any treatment that changes the body’s natural composition is likely to produce some side effects. HRT is no different. Known side effects of using hormone replacement therapy for an extended period of time include an increased risk of heart disease and certain types of cancer, stroke, and blood clots. Despite being able to effectively treat hormone imbalances and relieve many symptoms of menopause, HRT can pose serious health risks. Additionally, recent studies have found that HRT only provides mild protection against osteoporosis during menopause (Stevenson, 2022)
How would you counsel this patient?
The provider should offer menopause counseling so patients can manage symptoms and feel more comfortable in their changing bodies by: Assessing patients’ expressions of negative feelings, self-worth, anxiety, and general complaints about their present status in life. Encourage the expression of feelings in a nonjudgmental environment. Inform the patient that feelings and symptoms caused by a decrease in hormone secretion are not unusual. Suggest referral to counseling for chronic anxiety or depression if the patient does not improve.
Include a discussion of bioidentical hormones and compounding with saliva testing, Be sure to discuss what subjective/objective data you need before you prescribe.
Saliva Testing provides a more accurate measurement of most hormones. This will measure only active hormone levels unlike serum tests, which reflect inactive levels. Measuring inactive hormone levels is not useful in assessing function or balance. When testing the sex hormones through saliva, it is also important to assess adrenal status (DHEA and diurnal cortisol) (Huang et al., 2023)
Bioidentical hormones are artificial hormones that are similar to the hormones produced by the human body. They are used as treatment for people whose own hormones are low or unbalanced. Some people benefit from bioidentical hormones, but there are risks to treatment. Some risks include overdosing the patient on hormones.
Subjective/Objective Date needed in order to prescribe hormones.
History of blood clotting disorder, heart or cardiovascular disease, breast cancer, or stroke.
