Case Study 1

Perimenopause

On a routine office visit, this 51-year-old African American woman complains of hot flushes, sleep disruption, and irritability. She has been amenorrheic for 12 months. Although she knows about hormone replacement therapy, she says that she can't take estrogen because her sister had breast cancer.

Assessment

She has a family history of heart disease (mother died of MI at 65 years) and breast cancer (sister at 60 years). The patient is 5'3", and weighs 160 lbs. A lipid profile reveals high cholesterol: total cholesterol 267 mg/dL, HDL 42 mg/dL, LDL 160 mg/dL, and triglycerides 250 mg/dL.

Nursing Management

Accurate counseling about the risks and benefits of HRT is important so that this patient can make an informed choice about her health. A family history of breast cancer is not a contraindication for HRT, and this patient could benefit from the cardioprotection offered by estrogen.

Case Study 2

Menopause and Osteoporosis

This 48-year-old white woman is in the office for an annual exam. Her height is 5'7" and she weighs 130 lbs. The patient has a sedentary lifestyle, smokes 1 pack of cigarettes per day, and is menopausal.

Assessment

In addition to the standard care for a woman this age (GYN exam and mammography) a dual-energy x-ray absorptiometry (DXA) test for BMD is ordered. During a discussion about osteoporosis and HRT, the patient decides that she does not want to initiate this therapy. She dislikes dairy products and does not take any vitamin or mineral supplements.

Nursing Implications