Menopause Case Study
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Menopause Case Study

Josephine is a 68-year-old, G3P3003, widowed White female. She breastfed all of her children for one year. Her last physical exam was 3 years ago. At that time she was 5 feet, 5 inches tall and weighed 110 lbs.

Family History

Mother died of a heart attack at age 82; father is living but has Alzheimer’s and is living in a complete care facility. She has two sisters; one is 72 and is very healthy except for some minor problems with osteoporosis, and the other one is 76 and is fighting the final stages of breast cancer. She takes short walks, but lately she has been afraid to walk alone since there have been some muggings of older people in her neighborhood. Her children have encouraged her to come live with them to get away from her changing neighborhood, but she has many good memories of her husband there and does not want to leave her home. Besides, she does not want to become a burden to her children. She has a dog, who is now 12 years old, and a cat, 13 years old, as her only companions. She is very attached to her pets.

Medical History

Asthma as a child and into the teens. She smoked one pack of cigarettes a day for 20 years, but quit smoking 14 years ago when she could not afford it anymore.

Surgical History

Hysterectomy and oophorectomy at age 48 for menometrorrhagia. She took HRT for five years for hot flashes and mood swings and then decided to discontinue them herself.

Psychosocial History

She is living on a diminishing income. Her husband died 4 years ago after a long fight with lung cancer. With his death, her income dropped to half. She has Medicare but cannot afford the supplemental coverage. Her children do not know how financially needy she is, and she will not tell them. She says, “They all have children in college and they need their money.” Some days she is only able to eat one meal and often that meal is a bowl of cereal. She does make sure that the pets eat each day.

Case Study

Today Josephine is being seen in the Well Women clinic for progressively worsening backache. On exam her height is 5 feet, 3 inches and her weight is 106 lbs.

Questions

  1. Identify at least three health risks for Josephine and give at least two pieces of supporting data for each of your choices.
  2. How does her history of breastfeeding for 3 years affect her risk for osteoporosis?
  3. How does breastfeeding affect her risk for cancer today?
  4. Define menometrorrhagia.
  5. Does Josephine need a PAP smear today?
  6. What other screening tests are appropriate for her at this visit?
  7. How does surgical menopause differ from natural menopause?
  8. What effect does her 5 years on HRT have on her health risk for heart disease?
  9. What effect does her 5 years on HRT have on her health risk for osteoporosis?
  10. What resources can you suggest to help with her financial and living situation?
  11. Develop a teaching plan to help Josephine minimize her health risk.
  12. What alternative medical therapies would you recommend to Josephine?

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