Treatments Of Menopausal Symptoms Discussion
Perimenopause is a natural transition period that occurs in the years leading up to menopause, which is defined as the cessation of menstrual cycles for 12 consecutive months, according to Rees et al. (2022). During perimenopause, women experience a range of physical and psychological symptoms as hormone levels fluctuate and eventually decline. The most common symptoms are vasomotor symptoms, such as hot flashes and night sweats, which affect up to 80% of women in perimenopause (Rees et al., 2022). Hot flashes are characterized by a sudden feeling of warmth that spreads over the upper body, often accompanied by sweating and rapid heartbeat. Night sweats are hot flashes that occur during sleep, leading to disrupted sleep patterns and daytime fatigue. These symptoms are caused by changes in the hypothalamic-pituitary-gonadal axis, which regulates reproductive
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hormones, as well as alterations in neurotransmitter and neuropeptide signaling (Kandasamy et al., 2019)Treatments Of Menopausal Symptoms Discussion. Genitourinary symptoms are also common during perimenopause and can affect up to 50% off and are caused by declining levels of estrogen, which lead to thinning and atrophy of the vaginal tissue, decreased lubrication, and an increase in vaginal pH. These changes can cause discomfort, pain during intercourse, and an increased risk of urinary tract infections and vaginal infections.
The use of medications such as amlodipine and hydrochlorothiazide can also mimic and contribute to the development of perimenopausal symptoms (Walton et al., 2021). Amlodipine is a calcium channel blocker that can cause vasodilation and flushing, which may exacerbate hot flashes. Hydrochlorothiazide is a diuretic that can cause dehydration, which may contribute to vaginal dryness and irritation; therefore, since the patient is hypertensive, alternative medications to control hypertension ought to be considered.
Treatment options for perimenopausal symptoms include hormonal and non-hormonal therapies. Hormonal therapies such as estrogen and progesterone replacement have been shown to alleviate vasomotor and genitourinary symptoms effectively. However, they are not appropriate for all women and can carry risks such as an increased risk of breast cancer and blood clots. Non-hormonal therapies such as selective serotonin reuptake inhibitors (SSRIs) and gabapentin can also effectively alleviate vasomotor symptoms. Additionally, hormonal therapy effectively alleviates vasomotor and genitourinary symptoms and prevents osteoporosis post-menopause (Paciuc, 2020)Treatments Of Menopausal Symptoms Discussion. However, HT should be used with caution due to its potential risks, including an increased risk of breast cancer. The patient already has a high risk for breast cancer due to her family history, especially if it is a first-degree relative. HT should be utilized with the lowest effective dose and for the shortest duration possible. Therefore, the nurse should educate the patient about the risks associated with HT, carefully weigh the potential benefits and risks before initiating therapy, and regularly assess the patient for the need to continue HT therapy once initiated and monitor for any adverse effects. It is also important to note that vasomotor symptoms can decline over time, even without treatment, though it may take years. Non-hormonal therapies, such as SSRIs and gabapentin, are alternative treatment options for perimenopausal symptoms (Jan & Rosie, 2023). These therapies can effectively alleviate vasomotor symptoms and may be a safer option for patients with a high risk of breast cancer.
Non-pharmacologic management of vasomotor symptoms is an important first-line approach to managing menopausal symptoms as it carries minimal risks and can improve the patient’s quality of life. According to a systematic review by Baker et al. (2021), behavioral modifications, such as cooling techniques, can reduce the frequency and intensity of hot flashes. Additionally, regular exercise has been shown to improve vasomotor symptoms, mood, and sleep quality in postmenopausal women (Baker et al., 2021). SSRIs, SNRIs, gabapentin, and clonidine are pharmacologic options for managing vasomotor symptoms. SSRIs and SNRIs act by inhibiting serotonin and norepinephrine reuptake, respectively, and have been shown to reduce the frequency and severity of hot flashes. However, they can cause adverse effects such as weight gain, nausea, and sexual dysfunction (Menown & Tello, 2021). Gabapentin, an anticonvulsant, has also been shown to be effective in reducing the frequency and severity of hot flashes, with fewer adverse effects compared to SSRIs and SNRIs (Veisi et al., 2021)Treatments Of Menopausal Symptoms Discussion. Clonidine, an alpha-2 adrenergic agonist, is another option for managing vasomotor symptoms, but it may cause side effects such as dry mouth, dizziness, and sedation.
It is important to note that patients with a history of atypical squamous cells of undetermined significance (ASCUS) on a pap smear may need closer follow-up and surveillance. ASCUS is an abnormal result on a pap smear that indicates the presence of atypical cells that cannot be definitively classified as benign or pre-cancerous (Benoit et al., 2023). Patients with ASCUS require further testing and follow-up, such as colposcopy, to rule out the presence of pre-cancerous or cancerous cells. The patient in this case study should be informed of the significance of her ASCUS result and the need for regular pap smears and follow-up testing as indicated.
It is also important to manage the patient’s high blood pressure, as uncontrolled hypertension can lead to serious health consequences such as stroke, heart attack, and kidney disease. High blood pressure can worsen during perimenopause due to hormonal changes (Still et al., 2020). The nurse should review the patient’s medication regimen to ensure that they are adhering to their medication schedule and that their dosages are appropriate. If the patient’s blood pressure remains elevated despite lifestyle modifications and medication, the nurse must consider adding or adjusting antihypertensive medications. It is crucial to monitor the patient’s blood pressure regularly and adjust their medication regimen as necessary to maintain optimal blood pressure control. Additionally, the nurse should encourage the patient to make lifestyle modifications such as following a low-sodium diet, engaging in regular exercise, limiting alcohol intake, and quitting smoking to help manage their blood pressure. Treatments Of Menopausal Symptoms Discussion
References
Baker, F. C., de Zambotti, M., Chiappetta, L., & Nofzinger, E. A. (2021). Effects of forehead cooling and supportive care on menopause-related sleep difficulties, hot flashes, and menopausal symptoms: a pilot study. Behavioral Sleep Medicine, 19(5), 615–628. https://doi.org/10.1080/15402002.2020.1826484
Benoit, M. F., Facog, M. Y. W.-B. M., & Edwards, C. L. (2023). Gynecologic Oncology Handbook: An Evidence-Based Clinical Guide. Springer Publishing Company.
Jan, R., & Rosie, A. (2023). Non-hormonal treatments of menopausal symptoms. InnovAiT Education and Inspiration for General Practice, 16(3), 140–143. https://doi.org/10.1177/17557380231153677 Treatments Of Menopausal Symptoms Discussion
Kandasamy, M., Radhakrishnan, R. K., Poornimai Abirami, G. P., Roshan, S. A., Yesudhas, A., Balamuthu, K., Prahalathan, C., Shanmugaapriya, S., Moorthy, A., Essa, M. M., & Anusuyadevi, M. (2019). Possible existence of the hypothalamic-pituitary-hippocampal (HPH) axis: A reciprocal relationship between hippocampal specific neuroestradiol synthesis and neuroblastosis in ageing brains with special reference to menopause and neurocognitive disorders. Neurochemical Research, 44(8), 1781–1795. https://doi.org/10.1007/s11064-019-02833-1
Menown, S. J., & Tello, J. A. (2021). Neurokinin 3 receptor antagonists compared with Serotonin Norepinephrine Reuptake Inhibitors for non-hormonal treatment of menopausal hot flushes: A systematic qualitative review. Advances in Therapy, 38(10), 5025–5045. https://doi.org/10.1007/s12325-021-01900-w
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
Rees, M., Abernethy, K., Bachmann, G., Bretz, S., Ceausu, I., Durmusoglu, F., Erkkola, R., Fistonic, I., Gambacciani, M., Geukes, M., Goulis, D. G., Griffiths, A., Hamoda, H., Hardy, C., Hartley, C., Hirschberg, A. L., Kydd, A., Marshall, S., Meczekalski, B., … Lambrinoudaki, I. (2022). The essential menopause curriculum for healthcare professionals: A European Menopause and Andropause Society (EMAS) position statement. Maturitas, 158, 70–77. https://doi.org/10.1016/j.maturitas.2021.12.001
Still, C. H., Tahir, S., Yarandi, H. N., Hassan, M., & Gary, F. A. (2020). Association of psychosocial symptoms, blood pressure, and menopausal status in African-American women. Western Journal of Nursing Research, 42(10), 784–794. https://doi.org/10.1177/0193945919898477
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Veisi, F., Azadian, T., & Zangeneh, M. (2021). The comparison of paroxetine and gabapentin in the management of postmenopausal symptoms. GSC Biological and Pharmaceutical Sciences, 015(02), 040–048. https://doi.org/10.30574/gscbps.2021.15.2.0122
Walton, J. C., Walker, W. H., 2nd, Bumgarner, J. R., Meléndez-Fernández, O. H., Liu, J. A., Hughes, H. L., Kaper, A. L., & Nelson, R. J. (2021). Circadian variation in efficacy of medications. Clinical Pharmacology and Therapeutics, 109(6), 1457–1488. https://doi.org/10.1002/cpt.2073 Treatments Of Menopausal Symptoms Discussion
