Management Plan – Menopause

Management Plan – Menopause

Diagnostic Tests

To confirm the diagnosis of menopause and rule out all other causes of the symptoms the patient is experiencing, several tests will be done. As Peacock et al. (2023) state, the determination of Follicle-Stimulating Hormone levels, which are elevated (>30 mIU/mL) and estradiol low levels, are helpful in arriving at the diagnosis. Thyroid Function Tests are also essential to rule out thyroid dysfunction, help function as a cause of fatigue and weight gain. Since menopause increases the risk of cardiovascular disease, a lipid profile should be taken to check the cardiovascular risk factors. Also, a bone mineral density (BMD) test should be done, especially in postmenopausal women.

Medications

Hormonal and non-hormonal medications are used to manage the menopausal symptoms of the patient. Hormone Replacement Therapy (HRT) is suitable for hot flashes, irritability and vaginal dryness (Palacios et al., 2019). If no contraindications, a regimen of estrogen-progestin therapy is recommended, such as estradiol 1 mg oral tablet daily with medroxyprogesterone 2.5 mg oral tablet for women with a uterus. If HRT is not possible, non-hormonal options like SSRIs or SNRIs can be considered; venlafaxine 37.5 mg oral tablet daily is the most effective. For vaginal dryness and pruritus, 0.01% estradiol vaginal cream can be used intravaginally (Hariri & Rehman, 2020). Also, calcium carbonate 1200 mg daily and Vitamin D3 800-1000 IU daily is recommended for bone health.

Suggested Consults/Referrals

Consultation and referral are essential in patient care (Caldwell, 2019). An obstetrician or gynecologist should be involved in managing menopausal symptoms and any change in the HRT regimen. An endocrinologist if thyroid or other endocrine problems are suspected. Nutrition advice may include dietary recommendations for bone health and weight gain. If mood swings and irritability are affecting the patient’s quality of life, one may need a psychiatrist to help address these issues.

Patient Education

Patient education is also essential. The patient should be informed of what to expect during menopause, the symptoms that will occur, and how it will affect the body. Weight loss, exercise, enough calcium and vitamin D, no smoking, and reduced alcohol intake should be encouraged. Measures to control hot flashes, such as wearing multiple layers of thin clothing and circulating fans, should be explained. Explaining the need to take medications and providing the patient with information about side effects and when to see a doctor is also essential (Aremu et al., 2022).

Follow-Up

Follow-up is needed to see how the treatment plan is working and to make adjustments if needed (Dineen-Griffin et al., 2019). The first follow-up is at three months, then semi-annual for symptom control, side effects, and overall health. Return sooner if you develop side effects from meds, mood changes, or new symptoms, including bleeding.

Rationale for Interventions

They include:

• Menopause diagnosis and other conditions are ruled out with tests.
• Symptom relief and overall wellness with HRT as an intervention.
• Vaginal atrophy treatment with estrogen creams.
• Calcium and vitamin D for bone health.

Consultation ensures multidisciplinary management and addresses any difficulty or associated conditions in the patient. Patient education on menopause and behavior modification will improve treatment compliance and quality of life. It also ensures that the management plan is comprehensive and includes interventions at the right time.

References

Aremu, T. O., Oluwole, O. E., Adeyinka, K. O., & Schommer, J. C. (2022). Medication adherence and compliance: Recipe for improving patient outcomes. Pharmacy, 10(5). https://doi.org/10.3390/pharmacy10050106

Caldwell, G. (2019). The Process of Clinical Consultation Is Crucial to Patient Outcomes and safety: 10 Quality Indicators. Clinical Medicine, 19(6), 503–506. https://doi.org/10.7861/clinmed.2019-0263

Dineen-Griffin, S., Garcia-Cardenas, V., Williams, K., & Benrimoj, S. I. (2019). Helping Patients Help themselves: a Systematic Review of self-management Support Strategies in Primary Health Care Practice. PLoS One, 14(8). https://doi.org/10.1371/journal.pone.0220116

Hariri, L., & Rehman, A. (2020). Estradiol. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549797/

Palacios, S., Stevenson, J. C., Schaudig, K., Lukasiewicz, M., & Graziottin, A. (2019). Hormone therapy for first-line management of menopausal symptoms: Practical recommendations. Women’s Health, 15(24). https://doi.org/10.1177/1745506519864009

Peacock, K., Carlson, K., & Ketvertis, K. M. (2023, December 21). Menopause. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507826/#:~:text=An%20elevated%20serum%20FSH%20(%3E30

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Assessment

• Amenorrhea x 12 months preceded by oligomenorrhea
• Episode feeling of heat with sweating for <5 minutes
• Frequent nighttime awakening with excessive fatigue for months
• Vaginal pruritus and dryness, decreased libido (GYN) symptoms
  

  Management Plan – Menopause

• Female >45 years old
• Irritable Mood swings
• Gradual onset brittle nails and 8 lb weight gain
• Lack of thyroid enlargement, asymmetry, nodules

 Case statement

The patient is a previously healthy 48-year-old G2P2002 female, presenting with concerns of excessive fatigue and irritable mood swings in the setting of amenorrhea for 12 months which was preceded by a period of oligomenorrhea. Additionally, over the last year, she endorses frequent nighttime awakenings with episodic hot flashes lasting > 5 minutes, 8-pound weight gain, with gradual onset of brittle nail changes, and vaginal dryness/pruritus. Vitals are stable and the physical exam is notable for atrophic vaginal changes but is otherwise unremarkable.

Diagnosis

Management Plan: Use the expert diagnosis provided to create a pertinent, comprehensive, evidenced-based management plan. Address the following criteria in the plan:

1.) Diagnostic tests

2.) Medications (write out a complete order, even for OTC meds)

3.) Suggested consults/referrals

4.) Patient education

5.) Follow-up, including time interval and specific symptoms to prompt a return visit sooner; 6.) Provide rationales for each intervention and include references to support your plan. Clinical practice guidelines should be utilized as applicable.

References and Format: Current APA citations for references in the management plan. Use of clinical practice guidelines when applicable.

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