Perimenopause

Perimenopause

Kristelle,

Great post! I like the detailed nature of your discussion. I agree that black cohosh is an effective herbal product that can be used for perimenopausal symptoms. However, other herbal products have been included in studies and found effective in similar treatments. These products include fennel, Hayfork, fenugreek, valerian, and sage. They are effective in managing hot flashes, memory deterioration, night sweats, and palpitations. Therefore, the patient can also use one of these if the black cohosh is not readily available (Kargozar, Azizi, & Salari, 2017). The inclusion of additional alternative practices, such as diet regulation to avoid symptom triggers, sufficient sleep, and physical exercises, among others, may help further. Besides using cranberry juice and other herbal products, patients should also consider the use of dietary supplements, which work effectively in avoiding UTI recurrence. Fermented milk is also recommended due to the presence of probiotic bacteria. All these herbal products may be slow in treating serious UTIs (Das, 2020).

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It is important to note that St. John’s Wort may be ineffective in treating severe depression and requires the doctor’s direction prior to consumption. Vitamin A is a beneficial nutrient to the body that naturally occurs in food. However, it should be used minimally to avoid its negative effects, which you have highlighted. As you have stated, pregnant women need to prevent a vitamin to avoid congenital disabilities. The first vaccination after birth is important in ensuring that children are protected from the severe condition that Hepatitis B causes due to its contagious nature.

References

Das, S. (2020). Natural therapeutics for urinary tract infections—a review. Futur J Pharm Sci., 6(1), 64. doi:10.1186/s43094-020-00086-2

Kargozar, R., Azizi, H., & Salari, R. (2017). A review of effective herbal medicines in controlling menopausal symptoms. Electron Physician., 9(11), 5826-5833. doi:10.19082/5826

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Perimenopause

Post your answers to the six questions corresponding to this week’s content on primary care medication management. Provide your responses and rationales. Support your explanations with high-level evidence.

1. Your patient is perimenopausal and would like to use an herbal product; what do you recommend?

As the ovaries carefully stop releasing eggs during perimenopause, secretion of the hormones estrogen and progesterone may become inconsistent triggering symptoms that vary from night sweats to muscle aches to vaginal dryness. Most women start perimenopause in their early 40s and may last an average of four years, but it may take between two and eight years to make the full transition from regular ovulation to menopause (Pag, 2018). I would recommend black cohosh as an herbal supplement for patients who are going through perimenopause. A study was done by Meherpooya et al. (2018), who proposed that the mechanism of black cohosh in relieving menopausal syndrome is unclear, but there are several hypotheses proposed, such as acting as a selective estrogen receptor modulator, acting through the serotonergic system as an antioxidant, and inflammatory mechanism. According to their study, black cohosh, when compared to primrose oil, is more effective in preventing hot flashes (Meherpooya et al., 2018).

In addition to herbal supplements, I would also recommend that patients assess the triggering factor of their hot flashes. For many women, triggers may include hot beverages, caffeine, spicy foods, alcohol, stress, hot weather, and even a warm room (Menopause, 2020). I would suggest getting enough sleep, avoiding caffeine and alcohol, practicing relaxation techniques, doing Kegel exercises to strengthen pelvic floor muscles, eating a balanced diet, stopping smoking, and exercising regularly (Menopause, 2020). According to Pag, 2018, deep breathing exercises also help control hot flashes by possibly calming temperature regulations in the brain.

2. Which natural product helps to prevent bacteria from adhering to the urinary tract and bladder wall?

Unitary tract infections in women are the most common infections occurring at various stages of life (Czajkowski et al., 2021). According to Rosenthal & Burchum (2021), cranberry juice is utilized to prevent urinary tract infections (UTIs) and to lower urine odors in patients with urinary incontinence. Proanthocyanidins are a group of compounds that stop bacteria from adhering to the urinary tract wall (Rosenthal & Burchum, 2021). Cranberry juice does not treat an existing UTI but helps prevent future UTIs. Antibiotic treatment is the first choice of treatment for patients with an existing UTI.

3. Which herbal product is used in OTC cold prevention preparations?

Maintaining a normal and healthy immune system is important in the prevention of diseases such as the common cold. Vitamins C, D, Zinc, and Echinacea have evidencedbased efficacy on these resistant system barriers (Rondanelli, 2018). Based on immunity, vitamin C contributes to the prevention of the common cold in four ways (Ran et al., 2021). First, vitamin C is a constituent of white blood cells, which fight diseases through engulfment and phagocytosis of pathogens. Second, adequate vitamin C can help with the production of nutrients such as proteins, lipids, selenium, vitamin A, and vitamin R through a reduction reaction. In addition, vitamin C helps in specific immune responses with T-cell-mediated immunity and B-cell-mediated humoral immunity. Furthermore, vitamin C also enhances immunity through phagocyte activation.

4. Which herbal product can be effective in treating depression and why?

Since the mid-1980s, several in vivo and in vitro research studies have shown that a standardized St John’s wort extract can be successfully used to treat mild to moderate depression (Boyle, 2018). The only danger in using herbal products is that supplements are not regulated by the Food and Drug Administration, which means the quality and ingredients can vary. Manufacturers don’t have to prove product consistency or purity of elements, and the dosage listed on labels may not reflect actual concentrations of components (Beating Depression, 2020).

Hypericum perforatum (HYP) extract is one of the most commonly used complementary alternative medicines (CAMs) for the treatment of mild-to-moderate depression. According to a study by Concerto et al. (2018), HYP extract affects cortical plasticity in humans, suggesting a modulatory effect that bears some similarities to conventional antidepressants.

6. Your patient is taking a megadose of Vitamin A; why is this dangerous?

Vitamin A is a fat‐soluble vitamin involved in the maintenance of normal immune, visual, and reproductive functions (Fox et al., 2020). Vitamin A toxicity is rare but may occur if someone is taking a really high dose of supplements, which may lead to a condition called hypervitaminosis A (English, 2020). Symptoms include muscle and bone pain, headaches, nausea, and hair loss. Pregnant women should be especially careful to avoid taking too much vitamin A, as it can cause congenital disabilities. Since vitamin A is a fat-soluble medication, it gets stored in fat tissues and the liver. Excessive doses may lead to hepatotoxicity and liver failure.

7. Your patient asks which vaccine will be given at birth; what is your response?

Hepatitis B vaccine at birth is one of the recommended immunizations. According to the Centers for Disease Control and Prevention (CDC) (2020), hepatitis B is a contagious liver disease caused by the hepatitis b virus. This vaccine protects people from the disease because patients are usually asymptomatic and may pass the infection to others without knowing that they are infected. After the introduction of the hepatitis B vaccine in the United States in 1982, there is a greater than 90% reduction in the infection rate (Elimination of Perinatal Hepatitis B, 2017). Prevention of perinatal hepatitis B relies on the proper and timely identification of infants born to mothers who are hepatitis B positive and to those mothers who are unsure of hepatitis b status to ensure the administration of appropriate post-exposure prevention of the hepatitis B vaccine. To decrease the incidence of perinatal hepatitis B transmission, the Americal Academy of Pediatrics recommends that all newborn infants with a birth weight of greater than or equal to 2000 g receive the hepatitis B vaccine by 24 hours of age (Elimination of Perinatal Hepatitis B, 2017).

References

Beating Depression: Dietary Supplements Offer Little Value. (2020). Tufts University Health & Nutrition Letter, 38(7), 3.

Boyle, Manuela, PhD., M.H.Sc. (2018). An evidence-based critical review of the botanicals bilberry fruit, black cohosh, bladderwrack, and St John’s wort in clinical practice. Journal of the Australian – Traditional Medicine Society, 24(2), 89-93. https://www.proquest.com/scholarly-journals/evidence-based-critical-review-botanicals/docview/2378921613/se-2?accountid=100141

Concerto, C., Boo, H., Hu, C., Sandilya, P., Krish, A., Chusid, E., Coira, D., Aguglia, E., & Battaglia, F. (2018). Hypericum perforatum extract modulates cortical plasticity in humans. Psychopharmacology, 235(1), 145–153. https://doi.org/10.1007/s00213-017-4751-1

Czajkowski, K., Broś-Konopielko, M., & Teliga-Czajkowska, J. (2021). Urinary tract infection in women. Przeglad Menopauzalny, 20(1), 40-47. http://dx.doi.org/10.5114/pm.2021.105382

Elimination of Perinatal Hepatitis B: Providing the First Vaccine Dose Within 24 Hours of Birth. (2017). Pediatrics, 140(3), 1–5. https://doi.org/10.1542/peds.2017-1870

English, A. (2020). Vitamin A toxicity is rare, but taking supplements increases your chance of developing it. US edition

Fox, R., Stace, N., Wood, K., & French, C. (2020). Liver toxicity from vitamin A. JGH Open, 4(2), 287-288. http://dx.doi.org/10.1002/jgh3.12201

Hepatitis B and the vaccine (Shot). (2020, October 26). Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/parents/diseases/hepb.html

Mehrpooya, M., Rabiee, S., Amir Larki-Harchegani, Amir-Mohammad Fallahian, Moradi, A., Ataei, S., & Javad, M. (2018). A comparative study on the effect of “black cohosh” and “evening primrose oil” on menopausal hot flashes. Journal of Education and Health Promotion, 7(1), 36. http://dx.doi.org/10.4103/jehp.jehp_81_17

Menopause. (2020). (). Rochester: Tribune Content Agency LLC. Retrieved from ProQuest Central https://www.proquest.com/reports/menopause/docview/2545213775/se-2?accountid=100141

Pag, n, C. N. (2018). PERIMENOPAUSE: A Survival Guide. Health, 32(8), 100–103.

Ran, L., Zhao, W., Wang, H., Zhao, Y., & Bu, H. (2020). Vitamin C as a Supplementary Therapy in Relieving Symptoms of the Common Cold: A Meta-Analysis of 10 Randomized Controlled Trials. BioMed Research International, 1–9. https://doi.org/10.1155/2020/8573742

Rondanelli, M., Miccono, A., Lamburghini, S., Avanzato, I., Riva, A., Allegrini, P., Faliva, M. A., Peroni, G., Nichetti, M., & Perna, S. (2018). Self-Care for Common Colds: The Pivotal Role of Vitamin D, Vitamin C, Zinc, and0RW1S34RfeSDcfkexd09rT2 Echinacea1RW1S34RfeSDcfkexd09rT2 in Three Main Immune Interactive Clusters (Physical Barriers, Innate, and Adaptive Immunity) Involved during an Episode of Common Colds—Practical Advice on Dosages and on the Time to Take These Nutrients/Botanicals in order to Prevent or Treat Common Colds. Evidence-Based Complementary and Alternative Medicine, 2018, 36. http://dx.doi.org/10.1155/2018/5813095

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). St. Louis, MO: Elsevier.