Respond to this discussion post! Week 9 Menopause A 46-year-old 230-pound woman

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Week 9 Menopause
A 46-year-old 230-pound woman with a history of HTN presents today with night sweats, hot flushing, and genitourinary symptoms. She has a family history of breast cancer and a personal history of one ASCUS pap smear 5 years ago. She still has monthly menstrual cycles with her last cycle one month ago. This patient has a few different medical conditions needing to be addressed. She is on Norvasc 10mg QD and HCTZ 25mg QD with her current blood pressure 150/90. She is also experiencing menopausal symptoms with cyclic menstruation hormone replacement may help. Addressing her HTN, weight, and symptoms of menopause are important.
Medication Regimen
The use of hormone therapy (HT) has been shown to reduce the risk of bone loss and fractures. The North America Menopause Society discourages HT with advanced age due to increased health risks (2017). The patient meets the criteria to initiate HT to manage symptoms The 2017 hormone therapy position statement of the North American Menopause Society, 2017). Estrogen replacement can help to manage her vasomotor symptoms. Estrogen can be delivered in pill form, a patch, vaginal, or topical routes. Combination therapy is another option, estrogen/progestin.
Specific Drugs
Due to this patient’s family history of breast cancer, I would start her on the lowest dose of conjugated estrogen (Premarin). It is recommended that women with a uterus take estrogen/progestin, but the progestin can increase the risk for breast cancer. Estrogen (Premarin) will be prescribed at 0.3 mg/day in a cyclic schedule due to the presence of her menstrual cycle. This drug is recommended at the lowest doses to help treat her vasomotor and GU symptoms. Titrations are available with a maximum dose of 1.25 mg/day if needed (Rosenthal & Burchum, 2021).
Education
Patient education is vital when starting HT. The patient should try and modify her diet and exercise for weight loss to improve overall health. She is currently perimenopausal and lifestyle modifications can help reduce her comorbidities. Her HTN is seemingly uncontrolled (if a follow-up BP reading is also high). Modifications in her HTN therapy may need titration to reduce her risk of strokes, renal, and cardiovascular disease. With hormone replacement therapy she will be at increased risk for blood clots. Stroke risk increases with estrogen therapy. Proper education on signs and symptoms is valuable (Griffin, 2021). If the patient doesn’t experience any relief of her genitourinary symptoms, direct vaginal treatments are available in both OTC and prescription forms. Systemic estrogen with non-prescription vaginal lubricants can help to increase the quality of life for menopausal women (The 2020 genitourinary syndrome of menopause position statement of the North American Menopause Society, 2020).

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