Initiating Hormone Replacement Therapy
Hormone replacement therapy (HRT) reduces menopausal symptoms by replacing the decreasing female hormones (Holloway, 2010). The target hormones for replacement are estrogen and progesterone. The decline in estrogen levels leads to numerous effects unlike a decline in progesterone levels. This paper explores factors to consider before initiating hormone replacement therapy (HRT), the contraindications, advantages, disadvantages, and alternatives to HRT.
Patient Factors to Consider before Initiating HRT
The nurse practitioner (NP) should perform a thorough clinical assessment of the patient to make a diagnosis of menopause by basing on the symptoms the patient experiences. HRT has contraindications in pregnancy, undiagnosed vaginal bleeding, patients with a history of endometrial breast cancer, and chronic hypertension (Hormone replacement therapy in women, n.d.). The therapy is also not suitable in patients with circulatory system diseases and cerebrovascular disease.
Advantages of HRT
HRT is useful in managing symptoms of early and late menopause because it decreases vasomotor signs like hot flushes in menopause, especially at night. The therapy relieves conditions of the genitourinary tract like vaginal dryness, atrophy of the vagina, and vaginal pH alterations. HRT is also important in regulating bone mass hence reducing the risk of osteoporosis that often leads to fractures in menopausal women (Arcangelo, & Peterson, 2011). Overall, HRT improves the quality of life as the patient can have adequate sleep, muscle pain relief, and general alleviation of other uncomfortable symptoms.
Disadvantages of HRT
Despite having numerous benefits, the therapy predisposes a patient to some health conditions. For example, prolonged HRT use in association with other factors like alcoholism increases the risk of breast, ovarian and endometrial cancers. Other associated risks are thrombosis, embolism, cerebrovascular accidents, and cardiovascular diseases (Lippincott Williams & Wilkins, 2009).
Reasons Not To Initiate HRT
From the above case, the NP should not commence HRT immediately upon the client’s request. HRT has serious side effects and requires the NP to obtain a comprehensive history and thereafter an extensive physical assessment of the patient. The NP should consider alternative therapies with minimal side effects if the patient is unsuitable for HRT due to possible risks. If the patient is below forty or forty-five years and has menopausal symptoms, the NP should counsel the patient on the dangers of HRT and the need to consider other alternatives.
The patient could be having an underlying disease like hypertension and blood clotting disorders, which are contraindications in HRT. Therefore, the NP should advise the patient to consider alternative therapies as the disadvantages of HRT outweigh the benefits in this case.
Alternative Treatments to HRT
The NP may opt for non-hormonal methods to handle the menopausal symptoms effectively. The NP may advise the client to consume a balanced diet that reduces weight gain, the risk of heart diseases and osteoporosis. Adequate exercise promotes the health of the cardiovascular system, reduces stress, and is effective in managing hot flushes and sweats (Gulanick, & Myers, 2013). Adequate rest in menopausal women is important in relieving stress and anxiety, which augment the risk of heart diseases and exacerbate hot flushes and sweats.
The NP may prescribe clonidine twice a day to control hot flushes in some women. Fluoxetine, which is a selective serotonin reuptake inhibitor (SSRI), helps reduce flushes, night sweats and controls mood swings (Menopause – Treatment, n.d.). SSRIs have few side effects in small doses. The NP may give Calcium and Vitamin D supplements if the patient has a low dietary intake of calcium. These supplements protect the bones and reduce the risk of fractures. However, the best way to get enough calcium is through a calcium-rich diet (Gulanick, & Myers, 2013).
Initiation of HRT depends on various factors such as the onset and severity of menopause symptoms, the health condition of the patient and the possible side effects. Therefore, NPs should assess the clients comprehensively to settle on appropriate interventions that have maximum benefits.
Arcangelo, V. P., & Peterson, A. M. (2011). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins. Web.
Gulanick, M., & Myers, J. L. (2013). Nursing care plans: Nursing diagnosis and intervention. Philadelphia, PA: Elsevier Mosby. Web.
Holloway, D. (2010). Clinical update on hormone replacement therapy. British Journal of Nursing, 19(8), 496–504. Web.
Hormone replacement therapy in women. (n.d.). Web.
Lippincott Williams & Wilkins. (2009). Professional guide to diseases. Philadelphia: Lippincott Williams & Wilkins. Web.
Menopause – Treatment. (2014). Web.