Question

As the RN working in a family health clinic, you are providing education to a peri-menopausal woman who is seeking your guidance related to hormone therapy for management of hot flashes, mood swings and night sweats.

Using information from evidence based findings found in current professional resources; respond to the following questions.

Initial Discussion Post:

Describe two (2) benefits and two (2) risks of hormone therapy?

Do the benefits of hormone therapy outweigh the risk? Provide rationale with evidence based data from the literature.

What is one potential alternative to hormone therapy for this patient? Provide rationale to explain how this alternative may be beneficial for this patient.  

Describe how you will incorporate the QSEN pre-licensure Patient Centered Care competency into assisting this patient to make an informed decision on the most appropriate plan of care for her.

Answer 1

Hormonal therapy.

BENEFITS :

Literally hundreds of clinical studies have provided evidence that systemic HT (estrogen with or without progestogen) effectively helps such conditions as hot flashes, vaginal dryness, night sweats, and bone loss. These benefits can lead to improved sleep, and sexual relations, and quality of life.

The primary indications for HT are hot flashes, night sweats, vaginal dryness, and prevention of osteoporosis.

RISKS:

In order to minimize serious health risks, HT is recommended at the lowest effective dose for the shortest time period. The real concern about hormone safety is with long-term use of systemic ET or EPT.

As a result of the Women’s Health Initiative (WHI) trial in 2002, the US Food & Drug Administration and Health Canada require all estrogen-containing prescription therapies to carry a “black box” warning in their prescribing information about the adverse risks of HT. A

Most of the risk of breast cancer is associated with EPT. Both ET and EPT have been associated with stroke and an increase in blood clots in the veins. These risks are higher in women over age 60.

For women with a uterus, progestogen must be prescribed along with estrogen to protect her against uterine cancer.

WEIGHING BENEFITS & RISKS:

There is no single way to ensure the best possible quality of life around menopause and beyond. Each woman is unique and must weigh her discomfort against her fear of treatment. Risk is defined as the possibility or chance of harm; it does not indicate that harm will occur. Generally, HT risks are lower in younger women than originally reported in all women ages 50 to 70 combined. It is now believed that women taking estrogen alone—women who have had their uterus removed by a hysterectomy—have a more favorable benefit-risk profile than those taking EPT. This is especially true for younger menopausal women (in their 50s or within 10 years of menopause) than for older women.

ALTERNATIVE FOR HORMONAL THERAPY:

Fortunately there are some alternative ways are available instead of hormonal therapy for menopausal women.  The most effective alternative to hormone therapy, however, doesn't come in a bottle in the form of treatment. It is lifestyle modification. Physicians say that preventing heart disease, osteoporosis and cancer often boils down to lifestyle, one that includes regular exercise and a healthy diet. A diet high in calciumalong with weight-bearing exercise bolsters bones. Avoiding high-fat foods and participating in regular aerobic exercise keeps the hearthealthy. There are other ways such as use of some herbals also proved the effectiveness . For example flax seeds, sounds and so on. It has many advantageous over hormonal therapy that it doesn't have any side effects .