Explain the impacts of Managing Menopause.

A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and she presented to her gynecologist for her annual gyn-examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap, other than that, Pap smears have been normal. Home medications are Norvasc 10mg qd and HCTZ 25mg qd. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago. Menopause Vasomotor instability, also referred to as hot flashing or hot flushing, is a subjective sensation of heat associated with cutaneous vasodilation and a compensatory decrease in core body temperature that lasts about 4 minutes. Women in their menopausal stage experience vasomotor instability such as hot flushes, obvious perspiration especially at night and heightened anxiety. Many among menopausal women commonly reported symptoms of hot flushes. For some women, this symptoms subsides and for others it persist for several years. The thermoregulation change in the hypothalamus is the mechanism and low level of estrogen are the mechanism for hot flushes. Genitourinary syndrome of menopause, a new term for a condition more renowned as atrophic vaginitis, is a hypoestrogenic condition with external genital, urological, and sexual implications that affects >50% of postmenopausal women (Gandhi et al., 2016). Managing Menopause There are ways to manage symptoms of menopause. One of them is through non-pharmacologic way such as Behavioral techniques. This includes encourage layered clothing since this allows patients to remove some clothes off for core body temperature control. Secondly, change in dietary habits: avoid alcohol, decrease caffeine intake and avoid spicy foods. Regular physical activity: balanced diet and stress reduction Pharmacological way: In this case study, the patient is already on Norvasc and HCTZ for her hypertension. Given that the patient’s blood pressure is high, I would adjust the dose by increasing it rather than changing the antihypertensive medication. For the vasomotor instability such as her hot flushes, night sweats, I would suggest starting SSRI and the drug of choice would be escitalopram. Treatment with SSRIs or SNRIs reduces the frequency and severity of hot flashes in menopausal and post-menopausal women. Studies demonstrated that paroxetine (Paxil), citalopram (Celexa) and escitolapram (Lexapro) were the most effective SSRIs, and venlafaxine (Effexor) was the most effective first line SNRI, with desvenlafaxine as a second option (Stubbs et al., 2017). Escitalopram is a reasonable first choice since it is well tolerated, reduces the frequency, severity and also interference associated with VMS, improves quality of life, improves sleep and does not cause sexual dysfunction when used for VMS. Moreover, for the genitourinary symptoms, Vaginal estrogen is effective and whilst systemic absorption does occur, it does not induce endometrial hyperplasia (Roberts & Hickey, 2016). The key clinical consideration guiding treatment is how “bothersome” symptoms are. As advance practice nurses, it is imperative to treat patient as a whole to obtain a successful treatment outcome.