Hypertension (HTN) and premenopausal

Read the scenario and analysis below and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples.
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Based on this week’s scenario the patient is 46-year-old female presented with premenopausal like symptoms of a hot flush, night sweats, and genitourinary abnormality. The patient is obese based on her current weight that is 230 lb. The patient is already suffering from HTN and is currently on two medication a long-acting calcium channel blocker Norvasc 10 mg daily and diuretics HCTZ 25 mg daily. The patient is currently up to date on her annual mammogram and pap smear with a history of Atypical squamous cells of undetermined significance (ASCUS) five years ago. The patient’s menstrual cycle is regular with no other abnormality.
Perimenopause
Perimenopause is the time approaching menopause during which a woman starts to develop symptoms of declining estrogen levels. This period is characterized by menstrual irregularities such as prolonged and heavy menstruation with intermittent episodes of amenorrhea, decreased fertility, vasomotor symptoms, and insomnia. Some of these symptoms may emerge 4 years before menses cease. During the menopausal transition, estrogen levels decline and levels of FSH and LH increase (Dalal, & Agarwal, 2015)
Non-Pharmacologic Approach
As the patient is the young, she may be benefited from lifestyle modification and diet therapy as a first line of treatment for her Vasomotor Symptoms (VMS) of a hot flush, night sweats, and genitourinary difficulties. Hormone replacement therapy (HRT) may be used as a secondary option due to concerns surrounding its potential health risk. Physicians normally recommend a non-pharmacologic approach that includes adopting a healthy lifestyle e.g., healthier eating, increased physical activity, losing excess weight, primarily to mitigate metabolic impairments and secondarily to curb menopausal symptoms. As an Advance Practice Registered Nurse (APRN), we can continue her current regimen of medication, and educate the patient on diet regulation like maintaining a balance of carbohydrate, fat, protein, vitamins, and avoid caffeine, alcohol and processed foods and drink plenty of water. Educating the patient of regular exercise and staying active to reduce weight and keep a stress-free approach by keeping a positive attitude and be kind to yourself and take time for yourself. Practicing yoga and meditation can be helpful (Marlatt, Beyl, & Redman, 2018)
Pharmacologic Approach
If the patient still has symptoms an APRN can add Hormone Replacement Therapy (HRT) like estrogen. Consideration should be given to the type of estrogen and the route by which it is to be given, as well as the need for progestin and the most appropriate progestin regimen. Estrogen is available in many forms such as oral, transdermal, topical gels and lotions, intravaginal creams and tablets, and vaginal rings. We can start the patient on transdermal 17-beta estradiol because it is associated with a lower risk of venous thromboembolism (VTE), stroke, and hypertriglyceridemia than oral estrogens. The transdermal route is particularly important in women with hypertriglyceridemia or risk factors for thromboembolism (Martin, & Barbieri, 2019). As our patient has hypertension and is obese the patient may have a higher risk for hyperlipidemia and Venous thromboembolism. Suggesting the patient on regular follow-ups and annual mammograms and pap smears are also important. Menopause is a very difficult transitional period for women and an APRN should have adequate knowledge of management of perimenopausal symptoms.