Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.
What evidence-based information will you provide to Ms. Martin regarding her concerns of HRT? Discuss the advantages and risks associated with HRT.
Hormone replacement therapy (HRT) is the administration of synthetic estrogen and progesterone to replace depleting levels of hormones in menopausal women (Martin & Barbieri, 2018). HRT play an important role in the management of hot flashes, vaginal atrophy, and, the mood lability that many women experience during the menopausal transition. The most recent clinical practice guideline published by the Endocrine Society presents the approach HRT treatment is based on calculating a woman’s baseline cardiovascular and breast cancer risks before therapy starts. Like most other guidelines, the Endocrine Society suggests that HRT is only used for the management of menopausal symptoms, but not for the prevention of osteoporosis, dementia and/or cardiovascular disease. The optimum time to start hormone replacement therapy is before 60 years of age or within the first 10 years after menopause. Use the lowest possible dosage of HRT for the shortest possible time to achieve symptom alleviation. HRT includes estrogen therapy alone and combined estrogen and progestin therapy. Estrogen therapy alone is reserved for patients who does not have uterus and combine estrogen progestin therapy for women who has a uterus. The benefits of HRT in menopausal women are to relieve vasomotor symptoms of hot flashes, night sweat, vaginal dryness, to reduce urogenital symptoms such as urinary frequency, dyspareunia and urgency, to prevent bone loss and to reduce the risk of colon cancer (Fait, 2019). The risks of HRT include weight gain, endometrial hyperplasia, endometrial cancer, ovarian cancer breast cancer, heart attack, stroke, DVT, and gallbladder diseases (Fait,2019).
What are your recommendations for Ms. Martin? Will you recommend continuing or discontinuing HRT and why?
The use of HRT should be a personalized decision with discussion regarding the balance of potential risks and benefits as individualized to that woman’s health circumstances (Newsome, 2016). I would perform a thorough history in physical especially a gynecological and sexual history and take into consideration the important factors including her age, health history, family medical history, type and timing of menopause, impact of symptoms on quality of life, and her personal preferences. I would provide Ms. Martin all available up to date evidence-based information regarding HRT including the benefits, risks, contraindication, of continuing, lowering, tapering and/or discontinuing the therapy. I would also counsel her in detail alternative nonhormonal options including lifestyle modifications, herbal supplements, mind-body techniques, and nonhormonal prescriptions. I would work and weigh the possible risks and benefits with her to find the best realistic plan for her based on the clinical findings and her individual needs.
What alternative treatments for menopausal symptoms will you discuss with Ms. Martin?
· Pharmacological therapy:
- Low doses of antidepressant SSRIs for mood swings and depression (Newsome, 2016).
- For vaginal dryness: Low-dose vaginal estrogen cream, tablet, or ring which are absorbed very small into the bloodstream, so the chance of health problems is much lower than with estrogen pills.
- Water- or silicone-based vaginal lubricants before sex to reduce discomfort.
· Non-pharmacological therapy: exercising daily, increasing fluid intake, dinking cool drinks, avoiding spicy food, coffee and alcohol, plenty of sleep, and stress management such as relaxation, breathing techniques, yoga, and tai chi (Newsome, 2016).
Discuss the recommended screening tests, using the latest evidence based guidelines that Ms. Martin should have.
Ms. Martin’s last mammogram was 2 years ago, and last pap-smear was 5 years ago. Based on the latest evidence guidelines of the American College of Obstetricians and Gynecologists, she should have cervical cytology, mammography, diabetes, lipid profile, TSH, colonoscopy, bone mineral density and genetic testing. Also, she should be screened for nutrition, abuse/neglect, sexual practices, STD s, tuberculosis skin testing and urinary and fecal incontinence (The American College of Obstetricians and Gynecologist, 2017).
What health promotion, maintenance, and prevention education would be important to provide to Ms. Martin?
The importance education I would provide to Ms. Martin:
- Nutrition—Eating a healthy balanced diet with adequate calcium and vitamin D help maintain to help her stay healthy and strong bones (The American College of Obstetricians and Gynecologist, 2017)
- Exercise—regular exercise decreases bone loss and improves wellbeing. Weight-bearing exercise, such as walking, exercise band, or handheld weights can help strengthens muscles and keep bones strong. With her age, balance training such as yoga and Tai chi is highly recommended to avoid fall which may lead to broken bones.
- Routine health care— includes annual physical exam, test, well women exam, dental checkups and eye exams. Routine health care visits can help detect problems early and prevent further chronic and complicated disease (ACOG, 2017).
The American College of Obstetricians and Gynecologist [ACOG]. (2017). Laboratory and other tests. Retrieved from https://www.acog.org/About-ACOG/ACOG-Departments/AnnualWomens-Health-Care/Well-Woman-Recommendations/Laboratory-Testing-Ages-40-64-Years
The American College of Obstetricians and Gynecologist [ACOG]. (2017). The menopause years. Retrieved from https://www.acog.org/Patients/FAQs/The-Menopause-Years#hormone
Fait, T. (2019). Menopause hormone therapy: Latest developments and clinical practice. Drugs in Context 1(8). doi: 10.7573/dic.212551
Newsome, L. (2016). Best practice for HRT: Unpicking the evidence. British Journal of General Practice 66(653). doi: 10.3399/bjgp16X687097