Two Benefits and two risks of hormone therapy
For the relief of menopausal symptoms, hormone therapy (HT) is an approved treatment. Two basic typed of hormone therapy are estrogen-only therapy (ET) and estrogen plus progestogen (EPT) therapy. ET is prescribed for those women without a uterus while the EPT is prescribed to women with a uterus because it works against endometrial cancer ("Menopause Hormone Therapy (HT)", 2016). Hundreds of studies have supported the effectivity of hormone therapy in controlling menopausal symptoms. It helps in hot flashes, night sweats, bone density loss and vaginal dryness. If these symptoms are controlled, this can lead to better sleep and improved sexual relations. Another benefit of hormone therapy is that is reduces the risk of developing osteoporosis ("Hormone Therapy", 2013). The risk of bone breakage is reduced because estrogen is not depleted. Overall, the quality of life is improved.
It is recommended that HT is given in the lowest effective dose in a short period of time because long-term use of HT can lead to health risks ("Menopause Hormone Therapy (HT)", 2016). Like all other treatments, this therapy is not risk-free. Health risks include increased risk of blood clots and stroke and increased risk of endometrial cancer if the woman is taking estrogen only therapy and still has her uterus intact ("Hormone Therapy", 2013).
Based on a study The Journal of the American Medical Association in 2002, overall health risks exceeded benefits with the use of EPT among healthy postmenopausal women in the US (Rossouw, & Anderson, 2002). Over 1 year, 10 000 women EPT compared with placebo might experience 7 more CHD events, 8 more strokes, 8 more PEs, 8 more invasive breast cancers, 6 fewer colorectal cancers, and 5 fewer hip fractures (Rossouw, & Anderson, 2002). But this study was done one healthy postmenopausal women with an intact uterus thus needs further research.
One potential alternative that I can recommend to the patient is non-estrogen treatments which include Paroxetine and gabapentin, these are non-hormonal therapies that are approved to relieve hot flashes (Santen, 2015). When taken in low doses, these can help in controlling hot flashes.
Learning about QSEN prelicensure patient-centered care competency, I will listen and respect the individual expression of values, preferences and expressed needs. After informing the patient on HT and alternative therapies for menopausal symptoms, I will ask the patient if she needs any clarification. I will not coerce the patient to choose the therapy that I want for her. I will allow her to decide after I have laid out all the information needed for her to make a decision. Initially, I will recognize my personal values and beliefs on the management of pain and discomfort. This will help me in aligning my beliefs and respecting the beliefs of the patient. I will give value to the patient’s expertise on her own health and symptoms. A patient-centered care will allow the health care team to provide the most appropriate care for this patient.
Reference
Hormone Therapy. (2013). My.clevelandclinic.org. Retrieved 19 April 2016, from https://my.clevelandclinic.org/health/diseases_conditions/hic-what-is-perimenopause-menopause-postmenopause/hic-hormone-therapy
Menopause Hormone Therapy (HT). (2016). Menopause.org. Retrieved 19 April 2016, from http://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/hormone-therapy-benefits-risks
Santen, R. (2015). Nonhormonal treatments for menopausal symptoms. Uptodate.com. Retrieved 19 April 2016, from http://www.uptodate.com/contents/nonhormonal-treatments-for-menopausal-symptoms-beyond-the-basics
Rossouw, J., & Anderson, G. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women. principal results from the women’s health initiative randomized controlled trial. ACC Current Journal Review, 11(6), 38-39. http://dx.doi.org/10.1016/s1062-1458(02)00919-4
