Vaginal Atrophy Related to Menopause

Topics: Menopause, Vagina, Cancer Pages: 9 (3435 words) Published: September 4, 2013
Individual Case Study #1

Individual Case Study #1
Assigned Scenerio
A 47 year old woman presents to the clinic. She has been menopausal but can't deal with the hot flashes anymore. Recently she started to have pain during intercourse. She is Caucasian, 5'6", and weighs 152 pounds. She is a gravida 2, para 2, NSVD x 2, no complications. You learn in her history that she had breast cancer and had a successful lumpectomy 7 years ago. Her vitals today are 148/82, 76, 22, 97.9 Potential Working Diagnosis: 2 points

This patient is previously known to be experiencing menopause per the description. The differential diagnoses will focus on her new onset symptom of dyspareunia. Although dyspareunia is common in relation to vaginal dryness and atrophy in menopause, differential diagnoses will be considered because this complaint began recently. Many women with hypothyroidism or hyperthyroidism may present with similar symptoms related to menopause such as hot flashes and dryness (Natural Standard, 2013). It is recommended to rule Thyroid Disease out when seeing a new patient with menopause related symptoms (Schuiling & Likis, 2013). Based on the information provided, treatment will be focused on both vasomotor instability and vaginal discomfort during intercourse, both classic presentations of menopause. Potential Working Diagnoses:

* Vaginal Atrophy related to Menopause
* Bacterial Vaginosis
* Vaginal Candidiasis
* Trichomoniasis
* Atopic Vaginitis
* Vaginismus
* Thyroid Disease
What lifestyle alterations could you recommend? (7 pts)
Stress management may be important to discuss with the patient. Education should be provided about the impact of stress on increased menopausal symptoms. In addition, her blood pressure is elevated. This should be addressed while asking about current stressors and discussing a plan to decrease the stress in her life. In order to find an individualized approach to stress management, the patient should be introduced to interventions including exercise, meditation, deep breathing, taking baths, reading, having a massage, spiritual activities, and social support. Pacing respiration in the form of yoga breathing can help reduce hot flashes and stress, and should be explained to the patient if she is comfortable with this practice (Schuiling & Likis, 2013). Blood pressure should be reassessed at follow-up in addition to reviewing improvement of symptoms. Diet should be reviewed with the patient to assess for possible benefit of dietary modifications. Avoiding certain foods and dietary substances can help to decrease frequency and severity of hot flashes. Some dietary changes to discuss with the patient would include eliminating intake of refined sugars, caffeine, spicy foods, and alcohol (Schuiling & Likis, 2013). If the patient is unable to avoid these foods, she should consider only consuming them in moderation. While discussing dietary changes, it would be beneficial to recommend that the patient increase water intake to reduce symptoms and balance the loss of fluid due to increased perspiration. Increasing water intake, particularly cold water, can decrease her symptoms of hot flashes as well as dryness (Schuiling & Likis, 2013). Instruction would include drinking six to eight glasses of water per day. Discussing issues such as incontinence and nocturia can help guide the patient in planning what time periods are best to increase fluids. If she experiences nocturia, it would be best to limit the increased fluids to earlier in the day, while women with incontinence may want to avoid fluid intake during occasions when access to restrooms may be limited (Schuiling & Likis, 2013). The patient’s choice of clothing can reduce the discomfort related to hot flashes. She should be instructed to avoid wearing turtle necks and confining fabrics such as polyester and silk. Instead, breathable fabrics such as cotton or linen should be encouraged. It...

References: National Center for Complementary and Alternative Medicine (2012, February). Menopausal symptoms and complementary health practices. Retrieved from
Natural Standard (2013)
Schuiling, KD & Likis, FE. (2013). Women 's Gynelogical Health (2nd ed.), Burlingham, MA: Jones & Bartlett
Simon, J
U.S Department of Health and Human Services. (2013). Standard bmi calculator. Retrieved from
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