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

Perimenopausal stage in a women's reproductive life begins several years before menopause, when the ovaries began to produce less estrogen. One has to undergo many ailments during this stage like hot flashes, dry vagina, mood swings. In order to manage these ailments, hormonal treatment of estrogen and progestrone is given.

Benefits of hormonal therapy:

1. Its easily assessible and cost effective: Even in rural areas these medications are easily available in primary health centers. Thus helps to manage the sign and symptoms of menopause.
2. Helps to prevent osteoporosis: In women who undergoes menopause,due to the changes in estrogen production in body,they tend to have a low reserve of calcium. Thereby decreasing their bone density and prone for osteoporosis. Hormonal therapy helps to manage this condition.

Risks of hormonal therapy:

1. Chances of breast cancer:
2. Risks of developing hyperlipidemia, cardiovascular and liver problems

Long term use of hormonal therapy have been found to cause various cardiovascular issues, breast cancer, other forms of cancer like uterine cancer, vein thrombosis.

B) A risk is a chance of a harm to occur, but not that the harm will occur. Women experiencing these symptoms of perimenopausal stage prefer to be treated rather than to tolerate them because of the fear of the risk. There are minimal dosage of drugs available that can help in managing these symptoms with less chances of risk factors to develop. Choice of the treatment depends on women's decision- her age, risk, assessibility to treatment, her preferences, cost of the product and manymore.

C) Alternative therapy for hormones:

• Black cohosh: medicinal herb to be taken 6-8 weeks have shown decrease in the ailments of menopause.
• Vitamin E: women taken vitaminE 400IU per day have shown significant reduction in hot flashes and vaginal dryness. It can also be supplimented through foods like avacados, seed oils, green leafy vegetables, whole grains,wheat germ.
• Omega 3 fatty acid: The symptoms of omega 3 fatty acid is similar to menopause stage like vaginal dryness, depression, aching joints. Use of omega 3 helps to relieve these symptoms and acts has lubricating effect reducing vaginal dryness. It also reduce the risk of breast cancer.
• Phytoestrogenic Foods: These acts on the oestrogen receptors. Phytooestrogenic foods include soya foods like miso,tempeh and tofu, lentils,garlic linseeds, fennel and celery.
• Vitamin D and Vitamin B helps to manage osteoporosis, panic attcks, depression. Vitamin B produces neurotransmitter and manage stress. Vitamin D helps in calcium absorption.

These alternatives are natural with low risk of developing side effects. Its readily available and assessilble.As its natural in nature, women can easily be dependent on them for long term management.

D) According to the QSEN, patient has the full right to participate in his/her treatment regimen and their preferences values and needs should be respected. Based on the above notion, the patients should be explained all the available treatment modules i.e both hormonal and natural remedies to manage the ailments of perimenopausal stage. Their concerns regarding their condition should be answer with respect. The decision for choice of treatment should be valued by the caregiver.