Abnormal Uterine Bleeding in Perimenopause Essay

Respond to your colleagues’ posts and explain how you might think differently about the types of tests or treatment options that your colleagues suggested and why. Use your learning resources and/or evidence from the literature to support your position. NEED 2 Scholarly Resources APA format.

Patient Information:

M.R. 45y/o, Female, white

S.

CC (chief complaint): Pain on right breast for two weeks Abnormal Uterine Bleeding in Perimenopause Essay

HPI: M.R. is a 44-year-old female G2 P2, that came to the clinic with a CC variable menstruation cycle. Client indicates that her menstruation cycles are strange with variable and heavier flow. Client indicates that is been happening for the last six month with pre-menstrual symptoms, irregular menstrual cycles, hot flashes, night sweats, and she is always tired. Drink daily multivitamins. No other medical history.

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Location: lower abdomen

Onset: six months

Character: heavy menstrual flows,

Associated signs and symptoms: abdominal pain, cramps, hot flashes, night sweats, and she is always tired.

Timing: menstrual cycle (every 26-40 days)

Exacerbating/relieving factors:

Severity: 5/10 pain scale

Current Medications: Multivitamins Abnormal Uterine Bleeding in Perimenopause Essay

Allergies: No allergies.

PMHx: immunizations are up to date. No previous medical history

Soc & Substance Hx: No smoke, no drink alcohol, never used illicit drugs. Client is a medical office operational manager.

Fam Hx: mother- HBP

Father- DM type 2

Sister- no medical hx

Daughters- no medical hx

Surgical Hx: Tonsillectomy when she was 8year old.

Mental Hx: No hx of depression or anxiety

Violence Hx: No Concern or issues

Reproductive Hx: LMP 2 weeks ago, Menarche start when she was 13 years. Her menstrual cycles are irregular, 26-49 days and last from 5-10 days. No other sexual concerns at the moment. She does not have a sexual partner right now.

ROS:

GENERAL: No weight loss, fever, chills. Client is feeling tired all the time. She is having a hard time trying to sleep at night. Night sweat, hot flashes Abnormal Uterine Bleeding in Perimenopause Essay

HEENT: Eyes: She went to the optometrist appointment 3 weeks ago, No visual changes, no blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, no sneezing, no congestion, no runny nose, or sore throat.

SKIN: No skin issue reported

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath.

GASTROINTESTINAL: No abdominal pain or blood. No anorexia, nausea, vomiting, or diarrhea.

NEUROLOGICAL: Occasional headache before menstrual cycle starts, no dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities.

MUSCULOSKELETAL: No muscle pain, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, Heavy menstrual blood flow.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

PSYCHIATRIC: No history of depression or anxiety.

ENDOCRINOLOGIC: Reports of night sweating, hot flashes. No polyuria or polydipsia. Abnormal Uterine Bleeding in Perimenopause Essay

GENITOURINARY/REPRODUCTIVE: No Burning on urination. Pregnancy. LMP: 12/12/23. No Breast-lumps, pain, discharge. No reports of vaginal discharge, Client is not sexually active now of the visit. Indicate last sexual encounter last year.

ALLERGIES: No history of asthma, hives, eczema, or rhinitis.

O.

H 5’4”, Weight 150lbs, B/P 124/86, P 90, R 22.

Physical exam: M.R. is a 44-year-old female G2 P2, that came to the clinic with a CC variable menstruation cycle. Client indicates that her menstruation cycles are strange with variable and heavier flow. Client indicates that is been happening for the last six month with pre-menstrual symptoms, irregular menstrual cycles, hot flashes, night sweats, and she is always tired. Drink daily multivitamins. No other medical history.

Diagnostic results:

CBC-

Pelvic examination-

Pelvic ultrasound-

Serum FSH, LH, estradiol, TSH and prolactin- Abnormal Uterine Bleeding in Perimenopause Essay

A.

Peri-Menopause (N95.1)- The menopausal transition is roughly divided into 2 phases, which were initially based solely on menstrual patterns, but these patterns appears to have endocrine correlations (Santoro et al,  2021, para 2)

Hypothyroidism (E03.9)- Thyroid disorders are significantly more common in women compared to men and increase in incidence with age (Frank-Raue & Friedhelm, 2023, para 3)

Anemia (D64.9)- Anovulatory cycles can be highly variable in their bleeding patterns. The definition of abnormal uterine bleeding (AUB) is ‘flow outside of normal volume, duration, regularity or frequency (Goldstein & Lumsden, 2017, para 3)

O.

Client has some irregular menses at age of 45 and should be evaluated to rule out any other medical condition.

CBC- Normal limits results. No anemia Abnormal Uterine Bleeding in Perimenopause Essay

HGB125g/L

Platelets 245×10/L

RBC 4.5×10/L

Pelvic examination- Vaginal dryness

Pelvic ultrasound- thickened and hyperechogenic endometrium and the ovaries are small, no evidence if follicular growth.

Serum FSH, LH, estradiol, TSH and prolactin-

FSH 35mIU/mL

LH 22mIU/mL

E2 80pg/mL

TSH 1.9mcIU/mL

Prolactin 18 ng/mL

• These labs suggest that the patient is entering menopause.

P.

Reflection

This client is experiencing some life changes that can affect her mood, emotions, and mental health. This visit is an excellent opportunity to teach the client what to expect and what to do during these changes. Menopause can increase the risk of cardiovascular diseases and can also worsen some lipid profiles. Menopause can be diagnosed based on the clinical absence of menses for 12 consecutive months; in this case, the patient still has some irregular menses but has some pre-menopausal symptoms. The hot flashes, night sweats, and trouble sleeping are strongly associated with peri-menopausal dx. Abnormal Uterine Bleeding in Perimenopause Essay

The client needs to be evaluated and educated about depression symptoms because the rate of new-onset depression is higher in peri-menopausal clients. The client will benefit from hormone replacement therapy. A follow-up visit will be held in three months to follow up on the patient’s symptoms. If any abnormal bleeding or other concerning symptoms occur, the client can contact the clinics for an early evaluation.

Treatment

As a result of low estrogen, client will need a vaginal lubricants or moisturizer and oral hormone therapy. Prior to prescribing HT, it is imperative that clinicians and their patients review any cautions or contraindications to hormone use (Likis &nSchuiling 2017 p. 283)

Recommendation to use a water-based lubricant and client will start with enjuvia 0.3mg daily. Follow up in three months. Abnormal Uterine Bleeding in Perimenopause Essay

References

Frank-Raue, K. &. (2023). Thyroid Dysfunction in Peri- and Postmenopausal Women-Cumulative Risks. Deutsches Ärzteblatt International, 120(18), 311-316.

Goldstein, S. R. (2017). Abnormal uterine bleeding in perimenopause. Climacteric, 20(5), 414-420.

Likis, K. D. (2017). Women’s Gynecologic Health. Burlington, MA: World Headquarters.

Santoro, N. R.-P. (2021). The Menopause Transition: Signs, Symptoms, and Management Options. Journal of Clinical Endocrinology & Metabolism, 106(1), 1-15.

CLASS Resources

• Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care(4th ed.). Jones and Bartlett Learning.
  • Chapter 23, “Urinary Tract Infections” (pp. 469–478)
  • Chapter 24, “Urinary Incontinence” (pp. 479–492)
  • Chapter 23, “Menstrual-Cycle Pain and Premenstrual Syndrome” (pp. 495–510)
  • Chapter 26, “Normal and Abnormal Uterine Bleeding” (pp. 511–526) Abnormal Uterine Bleeding in Perimenopause Essay

RESOURCES FOR LGBTQ+

• Aisner, A. J., Zappas, M., & Marks, A. (2020). Primary Care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) PatientsLinks to an external site.. The Journal for Nurse Practitioners, 16(4), 281–285. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1016/j.nurpra.2019.12.011
• Office of Disease Prevention and Health Promotion (ODPHP). (2020, April 18). Lesbian, gay, bisexual, and transgender healthLinks to an external site.. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health
• Sadlak, C. A., Boyd, C. J., & Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ)
  Health Expert Panel (2016). American Academy of Nursing on Policy: Health care services for transgender individuals: Position statementLinks to an external site.. https://www.nursingoutlook.org/action/showPdf?pii=S0029-6554%2816%2930120-8
• Wingo, E., Ingraham, N., & Roberts, S. C. M. (2018). Reproductive Health Care Priorities and Barriers to Effective Care for LGBTQ People Assigned Female at Birth: A Qualitative StudyLinks to an external site.. Women’s Health Issues, 28(4), 350–357. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1016/j.whi.2018.03.002 Abnormal Uterine Bleeding in Perimenopause Essay

FNP RESOURCES

• American Academy of Nurse Practitioners Certification Board (AANPCB). (2018). Welcome to the American Academy of Nurse Practitioners Certification BoardLinks to an external site.. https://www.aanpcert.org/
• American Academy of Nurse Practitioners National Certification Board, Inc. (AANPCB). (2018). FNP & AGNP Certification Candidate HandbookLinks to an external site.. https://www.aanpcert.org/resource/documents/AGNP%20FNP%20Candidate%20Handbook.pdf

CLINICAL GUIDELINE RESOURCES

As you review the following resources, you may want to include a topic in the search area to gather detailed information (e.g., breast cancer screening guidelines; CDC for zika in pregnancy, etc.).

• American Cancer Society, Inc. (ACS). (2020). Information and Resources about Cancer: Breast, Colon, Lung, Prostate, SkinLinks to an external site.. https://www.cancer.org/
• American College of Obstetricians and Gynecologists (ACOG)Links to an external site.. (2020).  https://www.acog.org/
• American Nurses Association (ANA). (n.d.). Lead the profession to share the future of nursing and health careLinks to an external site.. https://www.nursingworld.org/
• Centers for Disease Control and Prevention. (CDC). (n.d.). CDC in actionLinks to an external site.. https://www.cdc.gov
• HealthyPeople 2030. (2020). Healthy People 2030 FrameworkLinks to an external site..  https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/Framework
• The American Association of Nurse Practitioners (AANP). (2020). What’s Happening at your associationLinks to an external site.. https://www.aanp.org/Abnormal Uterine Bleeding in Perimenopause Essay