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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Identify the signs and symptoms associated with menopause.

  • List the risks and benefits associated with hormone therapy (HT), and identify appropriate candidates for HT.

  • Differentiate between topical and systemic forms of HT.

  • Recommend nonpharmacologic therapy for menopausal symptoms.

  • Identify alternative, nonhormonal therapies for women unable to take HT.

  • Design a comprehensive pharmacotherapeutic plan for a patient on HT including treatment options and monitoring.

  • Determine the desired therapeutic outcomes for a patient taking HT.

  • Educate patients on the treatment options, benefits, risks, and monitoring of HT.

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PATIENT PRESENTATION

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Chief Complaint

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“I have been having hot flashes for the past few months, and I just can’t take it anymore.”

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HPI

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Emma Peterson is a 50-year-old woman who reports experiencing two to three hot flashes per day, occasionally associated with insomnia. She also states she is awakened from sleep about two to three times per week needing to change her bed clothes and linens. Her symptoms began about 3 months ago, and over that time they have worsened to the point where they have become very bothersome. She states that her mother was prescribed a pill for this, but she is hesitant to take the same thing because she heard on the news and from friends that the medication may not be safe. She also does not want to “get her period back” if possible. Successfully treated for depression in the past, she is currently controlled on paroxetine therapy. She exercises three times a week and tries to follow a low-cholesterol diet.

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PMH

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  • Depression

  • GERD

  • HTN

  • Hypothyroidism

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FH

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Mother died of stroke at age 67; father died of lung cancer at age 62. Patient has one brother, 52, and one sister, 48, who are alive and well, but both with HTN.

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SH

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Married, mother of two healthy daughters, ages 21 and 25. She is an RN in a neighboring physician’s office. She walks on her treadmill three times a week and is trying to follow a dietitian-designed low-cholesterol diet. She does not smoke and occasionally drinks a glass of red wine with dinner.

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Meds

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  • Hydrochlorothiazide 25 mg PO once daily

  • Omeprazole 20 mg PO once daily

  • Paroxetine 20 mg PO once daily

  • Synthroid 0.075 mg PO once daily

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All

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NKDA

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ROS

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(+) Hot flashes, occasional night sweats and insomnia, vaginal dryness. (–) weight gain, constipation. LMP 12 months ago.

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Physical Examination

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Gen
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WDWN female in NAD

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VS
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BP 128/86 mm Hg, P 78 ...

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