mesopause case study
Indeed, the menopause transition is widely linked to a range of common signs and symptoms that may contribute to increased complications and reduced quality of life for the affected women. and Rees (2019) indicated that whilst vasomotor symptoms (night sweats and hot flashes) are highly prevalent among a significant portion of women approaching menopause, a set of other symptoms including sleep difficulties, dyspareunia/vaginal dryness, cognitive complaints, urinary complaints, palpitations, irregular menstrual bleeding, and severe mood changes may also be reported in among women aged 50 years and above. Jin (2022) noted that at least 2 million women enter the menopause phase in the United States each year, and this may be attributed to a number of risk factors including physical inactivity, smoking, obesity, hypercholesterolemia, history of surgery, and osteoporosis, exposure to radiation or chemotherapy. Similarly, Kovacs (2020) insisted the greater need for conducting health considerations for all menopausal women to response to issues such as alcohol use, smoking cession, cancer screening and prevention, cardiovascular risk assessment and management, bone health, and severity. Jin (2022) established that a combination on pharmacological treatments (such as estrogen and progestogene therapy, Alpha-2 agonists, beta-blockers, gabapentin, Selective Noradrenaline Reuptake Inhibitors (SNRIs) and Selective Serotonin Reuptake Inhibitors (SSRIs), and dehydroepiandrosterone) and non-pharmacological interventions (such as lifestyle measures, dietary modifications, lubricants for vaginal dryness).
Research has also shown that a myriad of complementary therapies (such as botanicals, phytoestrogens e.g. soy and red clover, evening primrose oil, and black cohosh) may also be used to improve therapeutic response amidst the need to consider some of the unwanted effects associated with these complimentary therapies and the lack of sufficient scientific evidence regarding their safety and efficacy (Kovacs, 2020; Bahri et al., 2019). The provision of individualized care to women affected by menopause can prove instrumental in enabling them to attain improvements in quality of life, and reduction in the severity and frequency of core symptoms of the menopause.
Bahri, N., Sajjadi, M., & Sadeghmoghadam, L. (2019). The relationship between management strategies for menopausal symptoms and women’s decision making styles during menopausal transition. Menopausal Review, 18(3), 174-179. https://doi.org/10.5114/pm.2019.90378
Jin, J. (2022). Treatment of menopause symptoms with hormone therapy. JAMA, 327(17), 1716. https://doi.org/10.1001/jama.2022.5105
Kovacs, G. (2020). Clinical features of the menopause/Postmenopause. Managing the Menopause, 12-18. https://doi.org/10.1017/9781108869102.003
Marshall, S., & Rees, M. (2019). Managing menopause and post-reproductive health: Beyond hormones and medicines. Postmenopausal Diseases and Disorders, 439-465. https://doi.org/10.1007/978-3-030-13936-0_29
This patient is presenting with hot flashes, night sweats and genitourinary symptoms. Given her presentation and her age, it is very likely that this woman is experiencing symptoms of menopause. 95% of women enter menopause between the age of 45-55 (Rosenthal and Burchum, 2021). Furthermore, 70% of women experience vasomotor symptoms including hot flashes and night sweats, as well as genitourinary symptoms, including urinary incontinence, urinary frequency and dryness (Rosenthal and Burchum, 2021).
There are many different treatment options for improving menopause symptoms. Options include hormone therapy, vaginal estrogen, SSRIs/SNRIs, Gabapentin and Clonidine (NIH, 2021). Estrogen remains the most effective treatment option for both vasomotor symptoms and genitourinary symptoms (Paciuc, 2020). Because this patient has hypertensions (and possibly CHD), has a family history of breast cancer, and has a history of ASCUS on her pap smear, she would be considered a high-risk individual and hormone therapy would not be recommended (Rosenthal and Burchum, 2021). Therefore, I would recommend starting her on low-dose Escitalopram to treat her vasomotor symptoms. Escitalopram is an effective non hormonal therapy for the treatment of hot flashes and other vasomotor symptoms (Dobkin et al., 2009). I would also start her on a topical estrogen for her genitourinary symptoms (Rosenthal and Burchum, 2021).
An education strategy I would use would be to educate this patient on the possible side effects of Escitalopram, such as nausea, sleepiness, dizziness, trouble sleeping and serotonin syndrome (Perez, 2017). I would also educate her on the importance of maintaining a healthy diet/lifestyle as she is overweight and hypertensive, despite taking multiple hypertension medications. Proven interventions that have been found to lower blood pressure include following a DASH diet, as well as incorporating aerobic exercise, isometric training and resistance training into her weekly routine (Fu et al., 2020).
Defronzo Dobkin, R., Menza, M., Allen, L. A., Marin, H., Bienfait, K. L., Tiu, J., & Howarth, J. (2009). Escitalopram reduces hot flashes in nondepressed menopausal women: A pilot study. Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists, 21(2), 70–76. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2683354/#:~:text=The%20results%20of%20this%20study
Fu, J., Liu, Y., Zhang, L., Zhou, L., Li, D., Quan, H., Zhu, L., Hu, F., Li, X., Meng, S., Yan, R., Zhao, S., Onwuka, J. U., Yang, B., Sun, D., & Zhao, Y. (2020). Nonpharmacologic Interventions for Reducing Blood Pressure in Adults With Prehypertension to Established Hypertension. Journal of the American Heart Association, 9(19). https://doi.org/10.1161/jaha.120.016804
NIH. (2021). What are the treatments for other symptoms of menopause? Https://Www.nichd.nih.gov/. https://www.nichd.nih.gov/health/topics/menopause/conditioninfo/treatments
Paciuc, J. (2020). Hormone Therapy in Menopause. Advances in Experimental Medicine and Biology, 1242, 89–120. https://doi.org/10.1007/978-3-030-38474-6_6
Perez, A. (2017, May 17). Escitalopram: Side effects, dosage, uses, and more. Www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/escitalopram-oral-tablet
Rosenthal, L., & Burchum, J. (2021). Lehne’s pharmacotherapeutics for advanced practice providers. (2nd ed.). Saunders