Women’s Health Case Study

Women’s Health Case Study

Women’s Health Case Study

Women Health

Women’s health problems are a significant source of disease burden to the affected populations. Nurses and other healthcare providers play the crucial roles of identifying best practice interventions to optimize the outcomes of the affected populations. Pharmacological and non-pharmacological interventions effectively manage most women’s health problems. Therefore, this paper examines women’s health problems, including menopause, osteoporosis, and dyspareunia. It focuses on patient presentation, associated differential diagnoses, therapeutic plans, counseling and patient education, and pharmacological and non-pharmacological interventions for their management.

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Patient Presentation

Menopause is a biological process that occurs at the end of menstrual cycles due to age and hormonal changes. Patients present to the hospital with symptoms associated with changes in the levels of hormones in their bodies. They include irregular menstrual cycle, vaginal dryness, hot flashes, night sweats, mood changes, chills, and loss of breast tissue (Sydora et al., 2018). Other symptoms include irritability, headache, dizziness, muscle and joint pain, dysuria, and recurrent urinary tract infections. Physical examination often reveals symptoms including dry skin, thinning hair, weight gain, forgetfulness, and loss of body balance (Lello et al., 2017).

Osteoporosis is a disorder characterized by bone deterioration. The density, porosity, and brittleness of the bones increase. As a result, patients experience problems related to bone fractures and fragility. Patients with osteoporosis complain of receding gums, loss of jawbone, reduced grip strength, weak fingernails, and fractures. The assessment findings found during physical examination include weak bones, fractures, and brittle fingernails (Prior, 2018). Dyspareunia is a condition characterized by pain during sexual intercourse. Patients with dyspareunia present with symptoms that include pain during penetration, with every penetration, during thrusting, or burning, aching, and throbbing pain that lasts after sexual intercourse (Schvartzman et al., 2019).

Differential Diagnoses

Osteoporosis, dyspareunia, and menopause have differential diagnoses that should be considered during patient assessment. Vulodynia, vaginismus, atrophic tissue, adnexal pathology, and chronic cervicitis are the differentials for dyspareunia. Chronic cervicitis has deep pain, similar to that of dyspareunia. Culture, colposcopy, and laparoscopy should be performed to rule it out. Adnexal pathologies may also have localized, deep pain associated with dyspareunia. Laparoscopy can be performed to determine the cause accurately. The presence of tenderness and enlarged adnexia also rules out adnexal pathology in dyspareunia. Vaginal tissue atrophy may impair or reduce the production of vaginal secretions. As a result, entry and vaginal pain may be experienced during intercourse. Physical examination findings and discussion of issues related to foreplay and arousal rule out vaginal tissue atrophy. Vaginismus is associated with well-defined entry pain and difficulty in penile insertion. The presence of vaginal muscles spasm rules it out in patients suspected of dyspareunia. Lastly, vulodynia is characterized by well-defined pain during entry and vulvular irritation or poor response to treatment (Tayyeb & Gupta, 2021). Colposcopy and tissue biopsy helps in ruling it out in case of dyspareunia.

The differential diagnoses that should be considered for osteoporosis include scurvy, sickle cell anemia, multiple myeloma, and hyperparathyroidism. Hyperparathyroidism is characterized by hypercalcemia, where the rate of bone loss is increased. The functioning of the parathyroid hormones should be evaluated to rule out hyperparathyroidism as the cause of osteoporosis in women. Sickle cell anemia may also cause brittle bones and easy fractures in severe forms. However, blood analysis will reveal sickling, hence, not the cause of osteoporosis. Patients with multiple myeloma also experience bone pain and easy fractures of the long bones. Bone aspiration, however, reveals elevated levels of blastocysts in myeloma, ruling out osteoporosis. Scurvy arises from the dietary deficiency of vitamin C (Hertz & Santy-Tomlinson, 2018). Diagnostic investigations will reveal normal levels of serum vitamins, hence, osteoporosis.

The differential diagnoses for menopause include pituitary apoplexy, pituitary cachexia, hypoprolactinemia, and hypothyroidism. Hypothyroidism causes menstrual irregularities due to a decline in estrogen hormones in the body. Thyroid function tests should be performed to determine the cause. Pituitary apoplexy arises from hemorrhage to the pituitary gland. History such as severe headache, nausea, and vomiting should be obtained to rule out pituitary adenoma. Pituitary cachexia arises from the destruction of the anterior portion of the pituitary gland. Information about tumors, embolic infarction, and tuberculosis should be obtained to rule out a cause (Sperling, 2020).

Therapeutic Plan

A multimodal treatment approach is recommended for treating dyspareunia. The treatment focuses on all the aspects of emotional, physical, and behavioral pain associated with sexual intercourse. The providers involved in the treatment include pain management experts, gynecologists, sexual therapists, mental health professionals specialized in chronic pain, and physical therapists. The treatments available for patients suffering from dyspareunia include the hormonal replacement, tricyclic antidepressants, oral non-steroidal anti-inflammatory drugs, cognitive behavioral therapy, and botox injections. The identified causes of dyspareunia are also treated using antibiotics, antivirals, and antifungal therapies. Psychotherapy can be used in patients who fear and develop anxiety towards dyspareunia (Tayyeb & Gupta, 2021).

The treatment of osteoporosis aims to reduce the risk of fractures and restore bone density by preventing calcium loss. Bisphosphonates effectively reduce the risk of fractures in post-menopausal women. RANK ligand inhibitors such as denosumab also prevent osteoporosis in high-risk postmenopausal women. Anabolic agents that include teriparatide are recommended to stimulate bone resorption and formation (Eastell et al., 2019).

The treatment for menopause is achieved with estrogen replacement therapy. Estrogen-alone, estrogen-progestogen, tissue-selective estrogen complex, and low-dose vaginal estrogen therapies are the replacement therapies used. Women with hysterectomy require estrogen-alone therapy, while estrogen-progestogen therapy is used in those with an intact uterus. Tissue selective estrogen complex is indicated for women with an increased risk of uterine bleeding. Low-dose vaginal estrogen therapy is used for symptoms of menopause, such as dyspareunia and vaginal dryness (Anagnostis et al., 2020).

Plan Options

The cost-effective method to treat dyspareunia entails the identification of its cause and managing it. For example, dyspareunia due to vaginitis should be treated with antibiotics. Psychotherapies, including cognitive-behavioral treatment, are also effective in facilitating coping with dyspareunia symptoms. The cost-effective method of treating osteoporosis in women entails the use of Bisphosphonates. Bisphosphonates are highly effective in improving bone mineral density and lowering the risk and incidence of fractures (Prior, 2018). The cost-effective methods of treating menopause depend primarily on the patient factors. For example, women with hysterectomy should receive estrogen-alone therapy, while those experiencing symptoms such as vaginal dryness should be treated with low-dose vaginal estrogen therapy (Anagnostis et al., 2020).

Counseling and Patient Education

Patient counseling and education are essential for the effective management of menopause, dyspareunia, and osteoporosis. For menopause, patients should be counseled about the anticipated physiological changes due to low sex hormones. They should also be educated about the importance of adherence to hormonal replacement therapy for managing severe symptoms of menopause. For osteoporosis, patients should be educated about the importance of engaging in mild-moderate activities that strengthen bones and reduce their risk of fractures. Counseling also focuses on the importance of dietary supplementation of calcium and vitamin D. Counseling and education on treatment adherence and signs and symptoms of worsening health status should be provided. For dyspareunia, patients should be counseled and educated about the importance of discussing their sexual health with their healthcare providers. Dyspareunia may be a challenging topic for patients to discuss with their healthcare providers. Therefore, healthcare providers should reassure their patients and refer them for specialized treatment based on the disorder’s etiology. Psychotherapy sessions should also be provided to the patients to promote their coping (Tayyeb & Gupta, 2021).

Pharmacological and Non-Pharmacological Treatments

Pharmacological and non-pharmacological treatments are effective in dyspareunia, osteoporosis, and menopause. As shown above, hormonal replacement therapy is the standard approach to treating menopause. Drugs such as non-steroidal anti-inflammatory drugs, oral tricyclic antidepressants, botox injections, and hormonal replacement are also indicated in dyspareunia (Tayyeb & Gupta, 2021). A wide range of drugs, including Bisphosphonates, RANK ligand inhibitors, and anabolic agents, is indicated for osteoporosis. Non-pharmacological interventions such as dietary supplementation of calcium and vitamin D are also used for osteoporosis (Anagnostis et al., 2020; Dizavandi et al., 2019; Eastell et al., 2019). Cognitive-behavioral therapy may also facilitate coping in patients suffering from menopausal symptoms and dyspareunia.

Conclusion

Overall, osteoporosis, dyspareunia, and menopause are health problems with adverse effects on women’s health. Healthcare providers should consider the differentials to determine the actual cause of the women’s problems. Pharmacological and non-pharmacological interventions are effective for osteoporosis, dyspareunia, and menopause. Therefore, treatment decisions should consider efficiency, effectiveness, and quality patient outcomes.

References

Anagnostis, P., Bitzer, J., Cano, A., Ceausu, I., Chedraui, P., Durmusoglu, F., Erkkola, R., Goulis, D. G., Hirschberg, A. L., Kiesel, L., Lopes, P., Pines, A., van Trotsenburg, M., Lambrinoudaki, I., & Rees, M. (2020). Menopause symptom management in women with dyslipidemias: An EMAS clinical guide. Maturitas, 135, 82–88. https://doi.org/10.1016/j.maturitas.2020.03.007

Dizavandi, F. R., Ghazanfarpour, M., Roozbeh, N., Kargarfard, L., Khadivzadeh, T., & Dashti, S. (2019). An overview of the phytoestrogen effect on vaginal health and dyspareunia in peri- and post-menopausal women. Post Reproductive Health, 25(1), 11–20. https://doi.org/10.1177/2053369118823365

Eastell, R., Rosen, C. J., Black, D. M., Cheung, A. M., Murad, M. H., & Shoback, D. (2019). Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 104(5), 1595–1622. https://doi.org/10.1210/jc.2019-00221

Hertz, K., & Santy-Tomlinson, J. (2018). Fragility Fracture Nursing: Holistic Care and Management of the Orthogeriatric Patient. Springer.

Lello, S., Capozzi, A., & Scambia, G. (2017). The Tissue-Selective Estrogen Complex (Bazedoxifene/Conjugated Estrogens) for the Treatment of Menopause. International Journal of Endocrinology, 2017, e5064725. https://doi.org/10.1155/2017/5064725

Prior, J. C. (2018). Progesterone for the prevention and treatment of osteoporosis in women. Climacteric, 21(4), 366–374. https://doi.org/10.1080/13697137.2018.1467400

Schvartzman, R., Schvartzman, L., Ferreira, C. F., Vettorazzi, J., Bertotto, A., & Wender, M. C. O. (2019). Physical Therapy Intervention for Women With Dyspareunia: A Randomized Clinical Trial. Journal of Sex & Marital Therapy, 45(5), 378–394. https://doi.org/10.1080/0092623X.2018.1549631

Sperling, R. (2020). Obstetrics and Gynecology. Wiley.

Sydora, B. C., Yuksel, N., Veltri, N. L., Marillier, J., Sydora, C. P., Yaskina, M., Battochio, L., Shandro, T. M. L., & Ross, S. (2018). Patient characteristics, menopause symptoms, and care provided at an interdisciplinary menopause clinic: Retrospective chart review. Menopause, 25(1), 102–105. https://doi.org/10.1097/GME.0000000000000942

Tayyeb, M., & Gupta, V. (2021). Dyspareunia. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK562159/

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Select three different types of women’s health conditions or disorders from among the topics included in Topics 6-9 (only subject per topic). In a narrative format, write a paper (1,000 – 1,250 words) in which you implement the clinical reasoning process. Include the following:

Presentation of the patient included expected HPI and possible physical exam findings.
Identify diagnostic testing with rationale.
List possible differential diagnoses with rationale.
Develop therapeutic plan options based on quality, evidence-based clinical guidelines.
Outline plan options based on cost-effectiveness and least invasive techniques.
Present counseling and patient education, along with pharmacological and nonpharmacological treatments.
Provide adequate resources to support your rationale.
Utilize appropriate abbreviations when necessary.
You are required to cite three to five sources to complete this assignment. Sources must be clinician-level, peer-reviewed, and published within the last 5 years.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite Technical Support Articles is located in Class Resources if you need assistance.