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22/08/2022
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 about 5 years ago on her pap, other than that, Pap smears have been normal. Home medications are Norvasc 10mg qd and HCTZ 25mg qd. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago.
An efficient treatment strategy will be developed using the patient’s family history of breast cancer, obesity, and atypical squamous cells of unknown significance (ASCUS). A woman’s risk of having breast cancer is increased if she has close relatives who have the disease. Compared to women who maintain a healthy weight, overweight and obese women are more likely to get breast cancer. The most frequent abnormal pap test result is ASCUS, but the evidence is not definitive that this increases the risk of invasive cancer diseases. As a result, women with ASCUS who receive regular care are at low risk of developing invasive cancer (Tai et al., 2018).
A diagnosis of perimenopause is reasonable given the patient’s age and complaints of hot flashes, nocturnal sweats, and genitourinary symptoms. According to Santoro (2016), perimenopause is a transitory period marked by significant hormonal and reproductive changes that surround the final years of reproductive life. Since the patient is still having regular periods but exhibiting vasomotor symptoms (VSM) like hot flashes and night sweats along with genitourinary symptoms, it is likely that she is in the early stages of menopause. Beginning in the mid-40s, the transition can extend for up to 5-8 years before menstrual cycles finally stop (Roberts & Hickey, 2016).
Treatment Option
Hormone therapy is frequently used to treat vasomotor symptoms brought on by menopause (HT). According to Roberts and Hickey, hormone therapy ought to be avoided in this patient because she has a family history of breast cancer (2016). There are options available for treating menopause symptoms. The antidepressants Pristiq and Lexapro can significantly lessen the frequency and intensity of hot flashes, according to Rosenthal and Burchum (2021).
Additionally, the patient’s high blood pressure needs to be treated. I would initially encourage her to lose weight to treat her hypertension. It has been demonstrated that cutting back on carbohydrates and exercising more frequently can assist women in perimenopause lose weight (Santoro, 2016). If It would also be reasonable to increase her hydrochlorothiazide dosage to 50 mg at this time in order to aid in shedding extra water weight and bringing her blood pressure down.
Recommended Education Strategy
The diagnosis of perimenopause, dietary modifications, drugs, and blood pressure control would all be covered in the lessons. The patient would require explanations of the menstrual cycle, menopause, and, the reasons why HT cannot be used to treat her genitourinary symptoms and VSM because of her family history of breast cancer. By showing the patient how to count carbohydrates and choose healthier foods, you can help them lose weight and eventually get improved blood pressure readings. Teaching her how to take her blood pressure at home and when to call for potential dose modifications is also crucial.
References
Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86(2016), 53-58.
https://doi.org/10.1016/j.maturitas.2016.01.007
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice
nurses and physician assistants (2nd ed.). Elsevier.
Santoro, N. (2016). Perimenopause: From research to practice. Journal of Women’s Health, 25(4), 332-339.
https://doi.org/10.1089/jwh.2015.5556
Tai, Y. J., Chen, Y. Y., Hsu, H. C., Chiang, C. J., You, S. L., Chen, C. A., Cheng, W. F., & Taiwan Cervical Cancer Control Task Force (2018). Risks of cervical intraepithelial neoplasia grade 3 or invasive cancers in ASCUS women with different management: a population-based cohort study. Journal of gynecologic oncology, 29(4), e55.
https://doi.org/10.3802/jgo.2018.29.e55
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