Melissa Parker is a 45 year old married woman with 3 children. She presents to y
ID: 241732 • Letter: M
Question
Melissa Parker is a 45 year old married woman with 3 children. She presents to you concerned that she may be perimenopausal. She reports a change in sleep pattern and is being awakened at night by what she believes to be hot ollowed by diaphoresis. Over the last six months her perlods have beco irregular but more alarm experienced. Her mother aunt who survived breast cancer. Mrs. Parker admits to smoking 1 ppd for the flushes me ing to Melissa is the increase in flow she had died at the age of 56 from heart disease and there is an 20 years and states that although she use to work out frequently, recentily she has been too busy at work to exercise. What is perimenopause and is this an issue for Melissa? (2 points) last What risk factors are significant for Melissa? (2 points) What will you prescribe and how will you monitor for efficacy and toxicity? (3 points)Explanation / Answer
Perimenopause is Menopause transition or climacteric (critical period), takes place over several years in advance of the menopause. It's the time when the ovaries gradually begin to make less estrogen. It usually starts in a woman's 40s. As a result, you may have irregular bleeding or spotting. Some months, your period may be longer and heavier. Other months, it may be shorter and lighter. Some of the symptoms of perimenopause include, hot flashes, night sweats, weight gain, mood changes, vaginal dryness, vaginal pain, and pain with sexual intercourse. Not all women experience all the symptoms of perimenopause to the same degree, and symptoms vary among women. In Mellisa’s case it is normal as she is 45 years old women who is entering menopausal age and perimenopausal sysmptoms are normal according to her age.
Although the menstrual period may become irregular during perimenopause, you should be alert for abnormal bleeding, which can signal a problem not related to perimenopause. A good rule to follow is to tell your health care provider if you notice any of the following changes in your monthly cycle:Very heavy bleeding,Bleeding that lasts longer than normal,Bleeding that occurs more often than every 3 weeks,Bleeding that occurs after sex or between periods .These changes can be due to polyps, endometrial atrophy, endometrial hyperplasia. In Mellisa’s case there is increase in flow so it is a warning sign.
The risk factor in Mellisa’s case are heart disease and breast cancer there is family history. Also she is smoker and inactivity can be other risk factor.
Hormone replacement therapy is best treatment .But taking HRT has some risks. For some women, hormone therapy may increase their chances of getting blood clots, heart attacks, strokes, breast cancer, and gallbladder disease. If you do decide to take HRT, it should be the lowest dose that helps and for the shortest time needed. You should check if you still need to take HRT every 3-6 months.