NSG 6430 Hormone Replacement Therapy
Evidence-Based Information And The Advantages And Disadvantages Associated With Hrt
The mean age that women reach is about 51 years. About 95% of women across the world reach menopause between the ages of 45 years old to 55 years. Most women reach menopause naturally while others go through surgical interventions. Nonetheless, all the women in menopause will experience its side effects due to reduced estrogen levels in their body. Research shows that studies concerning cancer and hormonal balance have reached a different level. For instance, it has been proven that the estrogen that women are taking nowadays is considered to be “bio-identical” to what the ovaries produce naturally, and thus approved by the FDA (Lobo, 2017). However, hormonal replacement therapy is associated with risks of developing breast cancer, which is low (Brinton et al., 2018). Nevertheless, hormone replacement therapy is also associated with several advantages such as the reduced risk of heart disease or stroke, prevention of bone loss, and reduced menopausal symptoms guaranteeing these women better sleep and improved quality of life.
Recommendations on whether to Continue Or Discontinue Ms. Martin on HRT
Ms. Martine should discontinue hormone replacement therapy. However, for her to continue with the therapy, the regiment should be a combination of both estrogen and progestin. Women with an intact uterus, just like Ms. Martin. need progestin as part of the HRT to protect the endometrium of her uterus from malignancy or hyperplasia (Sullivan et al., 2018). Additionally, the patient has been on hormone replacement therapy for about four years, while the recommended duration is a maximum of 5 years. Consequently, the patient has a family history of breast cancer, which puts her at significant risk if she goes on with the therapy. Previous studies show that some women usually experience the vasomotor symptoms of menopause for 7.4 years on average, while it might persist in others for even more than ten years. For such women, it is recommended that they use nonhormonal therapy before restarting on hormonal-based therapy.
Alternative Treatments for Menopausal Symptoms
Several treatment options are available for the menopausal symptoms experienced by Ms. Martin. For instance, cognitive behavioral therapy inclusive of hypnosis has shown beneficial outcomes in the management of disturbed sleep and hot flashes. Consequently, the mind-body approach can be used to reduce stress among other menopausal symptoms. For obese or overweight women, eating a healthy diet full of soy-based products and frequent exercise can help reduce the symptoms (Lobo, 2017). Soy-based foods are beneficial in reducing hot flashes. Soy contains high concentrations of daidzein, which transform to equol in the intestine. Equol is responsible for duplicating the effect of estrogen in the body upon binging to the estrogen receptors. Lastly, pharmacological agents which are non-hormonal such as selective serotonin reuptake inhibitors have been approved by the FDA to be used in the management of hot flashes (Lobo, 2017).
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Recommended Screening Tests for Ms. Martin
The recommended screening tests for women between the age of 40 to 64 years, in addition to Ms. Martin case study, are as follows (Symer et al., 2018):
- Blood pressure screening after every two years if the reading is less than 120/80 or every year when the systolic blood pressure is between 120 to 139 mm Hg and diastolic between 80 to 89mm Hg.
- Mammogram yearly, in addition to a clinical breast exam.
- A Pap test plus HPV tests (co-testing) after every five years for cervical cancer screening.
- Colorectal cancer screening by flexible sigmoidoscopy every five years and colonoscopy after every ten years (Symer et al., 2018). The patients can also undergo a double contrast barium enema after every five years. Other tests for cancer include fecal occult blood test yearly, fecal immunochemical tests yearly, or stool DNA Tests.
- Diabetes Mellitus at least after every three years mainly for adults with a sustainable blood pressure of 135/80 mm Hg and no symptoms of diabetes (Symer et al., 2018).
- Lipid disorder teste at least after every five years for all women above 45 years who are a high risk of coronary artery disease.
- Overweight and obesity by frequently checking BMI.
- Other routine examinations such as osteoporosis, vision, and hearing.
Health Promotion, Maintenance, and Prevention Education Important to Ms. Martin
The body, mind, and soul are supported by an appropriate health promotion, and preventive and maintenance education. I would encourage the client to adopt a healthy diet, exercise frequently and get enough sleep, which reduce the risks of developing cardiovascular diseases, stroke, osteoporosis, and diabetes mellitus (Utian & Schiff, 2018). She should also take adequate amounts of food rich in vitamin D and calcium. Her weight should be monitored closely in addition to her avoiding taking alcohol or any other drug of abuse. Lastly, the client needs to be aware of the fact that menopause causes vaginal irritations and dryness; hence the use of vaginal lubricants are necessary for maintaining comfort.
Brinton, L. A., Brogan, D. R., Coates, R. J., Swanson, C. A., Potischman, N., & Stanford, J. L. (January 01, 2018). Breast cancer risk among women under 55 years of age by joint effects of usage of oral contraceptives and hormone replacement therapy. Menopause (New York, N.y.), 25(11), 1195-1200.
Lobo, R. A. (January 01, 2017). Hormone-replacement therapy: current thinking. Nature Reviews Endocrinology, 13( 4), 220-231.
Sullivan, J. M., Shala, B. A., Miller, L. A., Lerner, J. L., & McBrayer, J. D. (January 01, 2018). Progestin enhances vasoconstrictor responses in postmenopausal women receiving estrogen replacement therapy. Menopause (New York, N.y.), 25(11), 1180-1186.
Symer, M. M., Wong, N. Z., Abelson, J. S., Milsom, J. W., & Yeo, H. L. (January 01, 2018). Hormone Replacement Therapy and Colorectal Cancer Incidence and Mortality in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Clinical Colorectal Cancer, 17, 2.
Utian, W. H., & Schiff, I. (January 01, 2018). NAMS-Gallup survey on women’s knowledge, information sources, and attitudes to menopause and hormone replacement therapy. Menopause (New York, N.y.), 25(11), 1172-1179.