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Instructors can request access to the Casebook Instructor's Guide on AccessPharmacy. Email User Services (userservices@mheducation.com) for more information.

LEARNING OBJECTIVES

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

  • Identify the signs and symptoms associated with menopause.

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

  • Describe differences between transdermal, vaginal, and oral forms of HT and their place in therapy.

  • Recommend nonpharmacologic therapy for managing menopausal symptoms.

  • Identify alternative, nonhormonal therapies for managing menopausal symptoms.

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

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

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

PATIENT PRESENTATION

Chief Complaint

“I have been having hot flashes for a few months, and they are interfering with my life at home and work.”

HPI

Nancy Wilson is a 51-year-old woman who reports experiencing two to three hot flashes per day. She also states she is awakened from sleep about two to three times per week feeling hot and “drenched with sweat.” She has trouble falling back asleep after these episodes and it leaves her feeling exhausted the next day. Her symptoms began about 6 months ago, and over that time, they have increased in frequency and severity and they are interfering with her daily function. When she is doing presentations or participating in important meetings at work, it seems to trigger a hot flash. She also complains of vaginal dryness and painful intercourse. She states that her older sister was prescribed a medication for similar symptoms, 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 states she does not want to “start having periods again.” Her anxiety is currently controlled with paroxetine. She exercises three times a week and tries to follow a healthy diet with lean protein and lots of fruits and vegetables. She admits to “stress eating” and eating unhealthy foods when she travels for work.

PMH

Generalized anxiety disorder

GERD

HTN

FH

Mother, age 70, has HTN; father died of CVA at age 68. Patient has one sister, age 54, who is in good health but has HTN.

SH

Recently divorced, mother of two healthy sons living at home, ages 16 and 20. She is a marketing executive and often travels for important meetings and presentations. She walks on her local greenway three times a week, does yoga occasionally, and is trying to follow a dietitian-designed healthy diet although inconsistently. She does not smoke ...

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