The symptoms, such as flushing, night sweats, and genitourinary issues, indicate that the 46-year-old female patient is in the perimenopausal period. Based on the health needs assessment, there are several problems that should be properly managed by the healthcare provider. Firstly, vasomotor symptoms (VMS) treatment is vital since VMS are among the patient’s primary complaints and might cause physical discomfort and psychological distress. During the menopausal transitional period, VMS causes cutaneous vasodilation, or the increased blood flow from the body core to the skin of the face, neck, or chest (Aminimoghaddam & Abolghasem, 2018). Secondly, there is a concern about the presence of genitourinary symptoms resulting from the decrease in sex steroids. 50% of menopausal women experience genitourinary symptoms that rarely improve without proper treatment (Kagan et al., 2019). Finally, the patient suffers from hypertension (HTN) and demonstrates high blood pressure of 150/90, so her current medication should be adjusted via the introduction of an additional component to prevent menopause- or age-associated heart disease.
The appropriate treatment regimen should respond to the health concerns described above. VMS and the changes in vulvovaginal and urethral areas require pharmacologic treatment (hormonal replacement therapy) or adjunctive therapies (lubricants, moisturizers, laser therapy) to reduce vaginal dryness, irritation, insufficient lubrication, and pain (Kagan et al., 2019). However, the patient might be at risk of developing breast cancer because of family history, so hormonal replacement therapy (HRT) in the forms of estrogen/drospirenone (Angeliq) or conjugated estrogens/bazedoxifene (Duavee) should be recommended with caution. There are no guidelines on HRT for women who have a personal/family history of breast cancer. The Collaborative Group on Hormonal Factors in Breast Cancer (2019) suggests that the 5-year use of estrogen/progestin by 50-year-old women increases the 20-year breast cancer occurrence risk from 6.3% to 8.3%. Topical estradiol gels (Imvexxy), creams (Premarin), vaginal rings (Estring), and laser therapy are the first-line treatments to alleviate genitourinary symptoms, while HRT can only be introduced if severe VMS symptoms occur (Kagan et al., 2019). To treat high blood pressure and prevent cardiovascular disease, the maximum dose of 10mg amlodipine (Norvasc) qd might be replaced with the fixed-dose combination of amlodipine/atorvastatin (Caduet) administered as a 10 mg/10 mg pill qd.
Changes in dietary and exercise habits can improve the symptoms of perimenopause and HTN. Adequate levels of physical activity and the decreased intake of salt and alcohol can be recommended as these factors might reduce HTN and the likelihood of heart disease during menopause (Wenger et al., 2018). Patient education should focus on menopause as a natural part of a woman’s lifecycle, so the patient should be involved in the decision-making and encouraged to choose treatment according to personal preferences and needs. The clinician should educate the woman on the changes in her anatomy during the perimenopausal period. For instance, a gynecologic exam can help the provider to demonstrate the application of the recommended treatment options (Kagan et al., 2019). Additionally, before prescribing the lowest doses of estrogen/drospirenone (Angeliq) or conjugated estrogens/bazedoxifene (Duavee), the healthcare professional should discuss the potential harm and benefits of the treatment supported with current evidence. The patient should be informed about the HTN treatment regimen changes and the benefits of fixed-dose drugs for HTN and heart disease. The provider should emphasize the importance of treatment adherence and the need for regular blood pressure measurements to assess the effectiveness of the new medication strategy.
References
Amini Moghadam, S., & Abolghasem, N. (2019). A review of management of perimenopausal hot flashes. Journal of Obstetrics, Gynecology and Cancer Research, 4(1), 5–11. Web.
Collaborative Group on Hormonal Factors in Breast Cancer. (2019). Type and timing of menopausal hormone therapy and breast cancer risk: Individual participant meta-analysis of the worldwide epidemiological evidence. The Lancet, 394(10204), 1159–1168. Web.
Kagan, R., Kellogg-Spadt, S., & Parish, S. J. (2019). Practical treatment considerations in the management of genitourinary syndrome of menopause. Drugs & Aging, 36, 897–908. Web.
Wenger, N. K., Arnold, A., Merz, N. B., Cooper-DeHoff, R. M., Ferdinand, K. C., Fleg, J. L., Gulati, M., Isiadinso, I., Itchhaporia, D., Light-McGroary, K., Lindley, K. J., Mieres, J. H., Rosser, M. L., Saade, G. R., Walsh, M. N., & Pepine, C. J. (2018). Hypertension across a woman’s life cycle. J Am Coll Cardiol, 71(16), 1797–1813.