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3 pages/≈825 words
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APA
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Health, Medicine, Nursing
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Essay
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English (U.S.)
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Case Study: Anne Morrison, Perimenopause Photo of Anne Morrison

Essay Instructions:

Case Study: Anne Morrison, Perimenopause photo of Anne Morrison
Anne Morrison, age 51, presents with complaints of depressed mood and low libido. She says she has become irritable and snaps easily at her four children and her wife. She has no interest in sex, no urge to masturbate, and has had no sexual intercourse for six months. She also complains of fatigue, dry hair and skin, warm flushes, and painful joints. She has no personal or family history of depression. She is not suicidal but she “really doesn’t want to live anymore if this is it.”
Anne says her wife is angry about the lack of sexual intercourse and she feels the stress in their marriage. She also is worrying about her oldest children leaving for college and about her mother’s ill health.
She scores 20 on the Beck Depression Inventory, which indicates that she has mild to moderate depression. Her menstrual periods remain regular, but her cycle has shortened from 29 to 24 days. She reports that some hot flashes wake her at night and that she hasn’t had a good night’s sleep in months.
Laboratory tests show follicle-stimulating hormone of 25 mIU/mL and inhibin B below 45 pg/mL. Her estradiol is 80 pg/mL—not yet in the menopausal range. Her thyroid-stimulating hormone is normal. Her shortened menstrual cycles suggest a diagnosis of perimenopause
Questions
From your perspective as Anne’s psychiatric nurse practitioner, answer the following questions in a two- to three-page double-spaced paper (not including the reference page),in APA format. Include at least three peer-reviewed, evidence-based references.
1. What additional screening tools would be appropriate for Anne?
2. What medications would you recommend for her? Are there any psychiatric medications that do not interfere with the sex drive?
3. Are there any non-pharmacological recommendations that would help her situation?
4. What referrals would you make?
5. Create a treatment plan for Anne including medications, therapies, and referrals.

Essay Sample Content Preview:

Case Study: Anne Morrison, Perimenopause Photo of Anne Morrison
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Case Study: Anne Morrison, Perimenopause Photo of Anne Morrison
Perimenopause is a natural stage in a woman’s life, and the transition period can last several years. For this reason, it is generally not diagnosed unless its symptoms are causing considerable inconvenience or discomfort. There is not a single test or sign that is sufficient to indicate that the patient has entered perimenopause. Therefore, the doctor mainly relies on patient information, including age, body changes, and menstrual history. Usually, a blood test to check for estrogen and follicle-stimulating hormone (FSH) is conducted to determine menopausal symptoms (Hillard, 2016). However, some additional screening tools that would be appropriate for Anne to rule out other underlying conditions like a thyroid condition or ovarian failure include a lipid profile, a thyroid function test, and tests for liver and kidney function.
While there is no treatment for perimenopause and most symptoms stop once the patient enters menopause, the medications recommended for Anne’s perimenopausal symptoms include hormone therapy, vaginal estrogen, antidepressants, and Neurontin. Systemic estrogen therapy in cream form, pills, gel, spray, or skin patch is an effective treatment for alleviating perimenopausal symptoms like night sweats and hot flashes. Systemic estrogen is also essential to prevent bone loss (Leventhal, 2000). However, depending on Anne’s personal and family medical history, the physician may advise the lowest doses of estrogen to relieve sleep disturbances and joint aches symptoms. If the patient still has her uterus, she will need progestin in addition to estrogen. Vaginal estrogen is administered directly to the vagina using cream, vaginal tablet, or ring.
The vaginal tissue absorbs the small amounts of estrogen released by the treatment. It can help alleviate vaginal dryness, urinary incontinence, and discomfort during intercourse. Antidepressants associated with the class of selective serotonin reuptake inhibitors (SSRIs) may reduce mood disorders and lower menopausal hot flashes (Santoro, 2016). These antidepressants are especially suitable for women who cannot take estrogen for health reasons. Another remedy for hot flashes is Neurontin, which is helpful if estrogen therapy cannot be used for health reasons. Most psychiatric medications for perimenopausal symptoms do not interfere with the sex drive. Hormone therapy and vaginal estrogen are suitable for ameliorating the physiological changes of perimenopause, which affects sexuality. However, flibanserin is approved for perimenopausal women with low libido and no other physiological issues affecting desire.
Non-pharmacological recommendations that can help Anne’s situation include phytoestrogens, bioiden...
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