Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders NURS 6521

 Firstly, it is vital to obtain a thorough medical history with proper tests to differentiate possible diagnoses and to select the appropriate therapy. Our case scenario is a 46-year-old lady with a family history of breast cancer. The patient also had Atypical Squamous Cells of Undetermined Significance (ASCUS) five years ago, which can be caused by an infection, inflammation, low hormone levels, or benign growth such as cyst or polyp (National Cancer Institute, 2021). The patient is currently on a calcium channel blocker, Norvasc (Amlodipine) 10 mg orally daily and Aquazide (Hydrochlorothiazide) 25 mg orally daily for her hypertension and possible edema. The patient is mainly bothered by symptoms of hot flushing, night sweats, and genitourinary symptoms. Although these symptoms may indicate an estrogen deficiency commonly found in menopause, we cannot completely exclude the possibility of cervical cancer or infection. It is beneficial to check for labs such as complete blood counts and urine culture and sensitivity to rule out infection. Furthermore, a pap smear with human papillomavirus test (HPV) can be made to assess for the risk of cervical cancer. Given the patient’s medical history, there is a high possibility that she is experiencing the initial phase of menopause.

Since the patient is symptomatic and her symptoms are troublesome, a hormonal replacement therapy (HRP) can be suggested. Hormonal therapy such as the estrogen, Estrace (Estradiol), and progesterone Megace (megestrol acetate) may be started as it is the most common non-contraceptive therapy for post-menopause (Rosenthal & Burchum, 2021). The purpose of estrogen is to control menstrual symptoms by replacing the estrogen lost from menopause while taking progestin works by counterbalancing estrogen-mediated stimulation, which increases the risk of cancer and endometrial hyperplasia (Rosenthal & Burchum, 2021). We may start at the lowest dose possible and adjust the dose as per the patient’s response to treatment or severe side effects. Also, selective estrogen receptor modulators (SERMs) such as Nolvadex (Tamoxifen) may be prescribed in conjunction with hormonal therapy to reduce the incidence of breast cancer, uterine cancer, thromboembolism, and osteoporosis (Rosenthal & Burchum, 2021).

Before prescribing hormonal therapy, it is essential to screen the patient for contraindications such as a history of deep vein thrombosis, pulmonary embolus, stroke, or breast cancer since taking hormonal therapy might increase their risk. Educate the patient that nausea is the most frequent side effect of estrogen and usually subside with continued use. Also, educate the patient to report fluid retention or edema as it is a common finding in hormonal therapy. Therefore, it is vital to keep a close monitoring of patient weight and blood pressure. If edema or blood pressure worsens, increasing the patient’s diuretic or blood pressure doses may be explored.