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NU 631 â€“ Unit 13 Discussion â€“ Menopausal Transition

With the above information, construct the patientâ€™s subjective data in a SOAP Note format.

CC: Eight-month history of vasomotor symptoms

HPI: Pt is a 53-year-old, G1 P1, female who presents to the clinic with complaints of an 8-month history of vasomotor symptoms. Pt reports an average of 6 or more hot flashes per day and is frequently awakened by night sweats. She states that her symptoms make it difficult for her to concentrate and cause her to be irritable, affecting her ability to do her job and negatively impacting the quality of her relationships. Pt is sexually active with her last menstrual period a year ago. Pt reports a decrease of libido and is thinking about getting a divorce. Pt added that she is uncertain about hormone therapy because of the negative things she has heard via the news and her friends. She is concerned about the possibility of developing breast cancer even though she has no personal or family history of this disease. She is also concerned about the possible risk of developing Alzheimer’s disease. She does not voice any concern about bone health.

PMH: Amenorrhea (1 year ago), Obstetric history: G1 P1 (date and mode of delivery unknown)

Medications: Daily multivitamin/mineral tablet

SH: She does not routinely exercise and has smoked 1 pack of cigarettes per day for 20 years. Sexually active with a decrease in libido and is thinking about getting a divorce.

FH: Mother (Osteoporosis, H/O fracture to hip), Maternal Aunt (Osteoporosis), No family history of breast cancer

ROS:

GYN: Pt reports dysmenorrhea x 1-year, decreased libido

ENDO: Pt reports approximately 6 hot flashes per day and frequent night sweats

PSYCH: Pt reports difficulty concentrating and irritability that are affecting her relationships and ability to work

How would you diagnose and treat vaginal atrophy?

As a provider, the first thing to understand about vaginal atrophy is that it is largely under-treated because most patients will not report it and/or the provider does not recognize it (Tiwari et al., 2023). Because we know that this is an expected condition with menopause, I would ask my patients specifically during their visit if they have experienced any vaginal discomfort, dryness, pain during sex, etc. I would also pay attention to how they respond to my exam and the speculum. Additionally, we know that the vaginal pH is altered during this time, so use of a vaginal atrophy screening combistick is something currently being studied for used in assessing the pH and the vaginal maturation index (Tiwari et al., 2023). However, in order to properly examine and identify vaginal atrophy, a speculum examination and colposcopy are performed, where we would find thin, pale, easily traumatized petechial hemorrhages and atrophic epithelium (Alexander et al., 2023).

Using nonhormonal vaginal lubricants before to sexual activity and regularly applying long-lasting vaginal moisturizers is the first-line treatment for vaginal atrophy. If these measures were not effective, then we would discuss using hormonal treatments, but not after reviewing the patientâ€™s risk factors, especially to breast cancer (Alexander et al., 2023).

Discuss general treatment of menopause and osteoporosis with hormones.

Menopause care, which is tailored to each patient, focuses on symptom control and lowering health risks. There are several methods employed: Self-management techniques include hormone therapy, nonhormonal prescription drugs, complementary and alternative medicine, and lifestyle modifications. Of these options, hormone replacement therapy continues to be the most effective at managing menopause and improving patientâ€™s quality of life. Because this patient has a uterus, she would require combination hormone therapy. Osteoporosis is also improved and/or prevented when we replace this lost estrogen, as lack of estrogen is the primary cause of its development in women (Alexander et al., 2023).

How would you counsel this client?

I would begin with empathizing and acknowledging the validity of the physical and emotional symptoms that she has presented today. From there, I would educate her on what is taking place in her body through menopause and all of the ways that we know to improve it. I would encourage her to not make any big life decisions, such as moving forward in a divorce, until we did some work on balancing her hormones, especially if she was previously happy in this relationship.

From here I would give the patient two options. First, I could place referrals for her with a nutritionist, an endocrinologist, and a functional medicine provider, as I believe that these specialties will give her the best education and work-up for her individual needs if she was interested in the holistic/alternative route. I would have her schedule a 3-month follow-up appointment with me to discuss her experience and progress with these providers and adjust the plan of care if desired. Second option would be to provide brief education on diet, exercise, benefits of smoking cessation, and supplements and then prescribe her to start hormone replacement therapy. I would not prescribe until I had ensured that she was up to date on pap smear and mammogram, however (Alexander et al., 2023).

Include a discussion of bio-Identical hormones and compounding with saliva testing. Be sure to discuss what subjective/objective data you need before you prescribe.

Bioidentical hormones are hormones derived from plants that are biochemically identical to or similar to hormones produced by the body or ovary. Typically, these formulations are offered as sublingual, oral, or injectable forms. Many women seek out these â€œnaturalâ€ hormones that are advertised as safer or that they come with less side effects, but that is not accurate. Additionally, these hormones are sourced from the same materials all of the other pharmaceutically manufactured hormones (Alexander et al., 2023).

Postmenopausal women frequently report experiencing a variety of oral discomforts, such as burning sensations, dry mouth, increased salivary viscosity, altered taste perception, and numerous mucosal illnesses include Sjogren’s syndrome, lichen planus, and benign mucosal pemphigoid. Testing saliva was frequently believed to help in menopausal diagnosis and treatment. However, it has been demonstrated that saliva testing is not accurate or necessary (Divya et al., 2024).

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