Menopause
Menopause is the permanent cessation of menstruation or the definitive end of fertility characterized by the absence of menstruation for 12 consecutive months that occurs independently of any other biological or physiological cause (Stoppler, 2016). It can happen naturally as the ovaries' production of sex hormones gradually decreases, or it can happen artificially after hysterectomy, chemo and radiation therapy, or primary ovarian shortage (Mayo Clinic Staff, 2015).
Estrogen and Progesterone Production
Together with the symptoms experienced by patient EP, decreased estrogen and progesterone production occurs, and these are the true reasons of those symptoms. Replacement Hormone Treatment (administered as estrogen alone or in combination with progesterone) is therefore given to menopausal women in a bid to alleviate the hormone related discomfort and symptoms like vaginal dryness, night sweats and hot flashes, and risk of osteoporosis. HRT has however been associated with serious complications such as increased risk for breast, endometrial and cervical cancers, endometriosis, fibroids and clotting disorders, and this could be the source of patient EP's concern (Kaur, 2016).
Alternatives to Hormone Replacement Therapy
Patients such as EP who appear to be worried about the effects of HRT need to explore other alternatives. Foods or supplements abundant in calcium and vitamin D help strengthen bones thus reducing the risk of osteoporosis. To prevent bone loss, medications such as Raloxifene, Alendronate and Risedronate could be prescribed to the patient. Antidepressant and anti-seizure drugs such as venlafaxine, paroxetine and fluoxetine are approved by the FDA for use in treating hot flashes (National Cancer Institute, 2011). Lifestyle changes such as wearing light clothing, frequent hydration, avoidance of alcohol and smoking, having adequate rests, exercising in a well aerated environment and eating a balanced diet are recommended to the patient to help improve quality of life and reduce discomfort associated with menopausal symptoms.
Menopause at Age 50
At 50 years of age one is considered to be elderly but not yet a geriatric. Considering her symptoms-the drenching night sweats, hot flashes and the sleep disturbances, it is quite clear that menopause has set in. Menopause occurs at an average of 51 years but the case is different for each woman since there exists no definitive test for menopause. There are those who might experience menopause as early as at forty years, or in their sixties. At the age of patient EP therefore, in addition to her symptoms, it is quite apparent that she is already experiencing menopause.
Treatment Regime
From my point of view, the best regime for the patient would be a combination of both pharmacological and non-pharmacological interventions. Low dose hormonal therapies in the form of tablets or patches containing opposed estrogen, for the shortest period would be the main pharmacological strategy of choice. The aspects of a low dosage in addition to use of opposed estrogen are aimed at protecting the patient from hormonal side effects. FDA approved bio identical products would be a suitable alternative incase the patient appears not to be comfortable with the synthetic products. Antidepressants such as paroxetine at a dose of 20mg daily to manage the hot flushes as well as zoledronic acid to prevent bone resorption and risk for osteoporosis would be part of my regime.
Non-Pharmacological Interventions
Pharmacotherapy aside, I would emphasize more on positive lifestyle changes. From the patient's data, it is clear that her weight is headed towards obesity. This in combination with hormone therapy would increase risk for cancer. Exercise to reduce weight, healthy diet, adequate fluid intake, avoidance of stress, spicy foods and caffeine and use of air conditioners are just a few of non-pharmacological interventions that would improve patient's quality of life and decrease need for prolonged medication use.
References
Kaur, K. (2016, September 20). Menopausal Hormone Replacement Therapy. Retrieved April 26, 2017, from Medscape: http://emedicine.medscape.com/article/276104-overview#a1
Mayo Clinic Staff. (2015, January 7). Menopause. Mayo Clinic.
National Cancer Institute. (2011, December 5). Menopausal Hormone Therapy and Cancer. Retrieved April 26, 2017, from NIH: https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/mht-fact-sheet#q9
Stoppler, M. C. (2016, June 10). Menopause definition and facts. Retrieved April 26, 2017, from MedicineNet.com: http://www.medicinenet.com/menopause/article.htm
