NURS 6521 Week 10: Women’s and Men’s Health

NURS 6521 Week 10: Women’s and Men’s Health
Sample Answer for NURS 6521 Week 10: Women’s and Men’s Health Included After Question

Breast cancer is not just a disease that strikes at women. It strikes at the very heart of who we are as women: how others perceive us, how we perceive ourselves, how we live, work, and raise our families—or whether we do these things at all. 

–Debbie Wasserman Schultz 

This sentiment that Schultz expressed is true for many disorders associated with women’s and men’s health such as hormone deficiencies, cancers, and other functional and structural abnormalities. Disorders such as these not only result in physiological consequences but also psychological consequences such as embarrassment, guilt, or profound disappointment for patients. For these reasons, the provider-patient relationship must be carefully managed. During evaluations, patients must feel comfortable answering questions so that you, as a key health-care provider, will be able to diagnose and recommend appropriate treatment options. Advanced practice nurses must be able to educate patients on these disorders and help relieve associated stigmas and concerns. 

This week, as you examine women’s and men’s health issues, you focus on treatments for hormone deficiencies and cancer. You also explore preventive services for women’s and men’s health. 

Learning Objectives 

By the end of this week, students will: 

Evaluate the strengths and limitations of hormone replacement therapy 
Evaluate treatments for hormone deficiencies 
Analyze preventive services for women’s and men’s health 
Analyze drug treatments for cancer patients 
Evaluate implications of cancer drug treatments on patients 
Understand and apply key terms, concepts, and principles related to prescribing drugs to treat disorders associated with women’s and men’s health 

Photo Credit: Comstock/Stockbyte/Getty Images 

NURS 6521 Week 10: Women’s and Men’s Health
Learning Resources 

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. 

This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below. 

Required Readings 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins. 

Chapter 33, “Prostatic Disorders and Erectile Dysfunction” (pp. 527-544)
This chapter examines the causes, pathophysiology, and drug treatment of four disorders: prostatitis, benign prostatic hyperplasia, prostate cancer, and erectile dysfunction. It also explores the importance of monitoring patient response and patient education.  

Chapter 34, “Overactive Bladder” (pp. 545-564)
This chapter describes the causes, pathophysiology, diagnostic criteria, and evaluation of overactive bladder. It also outlines the process of initiating, administering, and managing drug treatment for this disorder.  

Chapter 55, “Contraception” (pp. 959-970)
This chapter examines various methods of contraception and covers drug interactions, selecting the most appropriate agent, and monitoring patient response to contraceptions.  

Chapter 56, “Menopause” (pp. 971-994)
This chapter presents various options for menopausal hormone therapy and examines the strengths and limitations of each form of therapy.  

Chapter 57, “Osteoporosis” (pp. 985-994)
This chapter covers various options for treating osteoporosis. It also describes proper dosages, potential adverse reactions, and special considerations of each drug.  

Chapter 58, “Vaginitis” (pp. 995-1006)
This chapter examines various causes of vaginitis and explores the diagnostic criteria and methods of treatment for the disorder.  

Roberts, H. & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86(2016), 53-58. https://doi.org/10.1016/j.maturitas.2016.01.007  

Note: Retrieved from the Walden Library databases. 

This article provides an update on treatments on Vasomotor symptoms (VMS), genito-urinary syndrome of menopause (GSM), sleep disturbance, sexual dysfunction and mood disturbance are common during the menopause transition. 

Lunenfeld, B., Mskhalaya, G., Zitzmann, M., Arver, S., Kalinchenko, S., Tishova, Y., & Morgentaler, A. (2015). Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. Aging Male, 18(1), 5-15. doi: 10.3109/13685538.2015.1004049 

Note: Retrieved from the Walden Library databases. 

Mäkinen, J. I., & Huhtaniemi, I. (2011). Androgen replacement therapy in late-onset hypogonadism: Current concepts and controversies—A mini-review. Gerontology, 57(3), 193–202. 

Note: Retrieved from the Walden Library databases. 

This article examines the role of testosterone levels in the development of hypogonadism. It also explores health issues that are impacted by testosterone levels and the role of testosterone replacement therapy. 

Drugs.com. (2012). Retrieved from http://www.drugs.com/ 

This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker. 

 

U.S. Preventive Services Task Force. (2014). The Guide to Clinical Preventive Services: Section 2. Recommendations for Adults. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2.html 

This website lists various preventive services available for men and women and provides information about available screenings, tests, preventive medication, and counseling.  

Optional Resources 

Refer to the Optional Resources listed in Week 1. 

Discussion: Hormone Replacement Therapy 

In recent years, hormone replacement therapy has become a controversial issue. When prescribing therapies, advanced practice nurses must weigh the strengths and limitations of the prescribed supplemental hormones. If advanced practice nurses determine that the limitations outweigh the strengths, then they might suggest alternative treatment options such as herbs or other natural remedies, changes in diet, and increase in exercise. 

Consider the following scenario: 

As an advanced practice nurse at a community health clinic, you often treat female (and sometimes male patients) with hormone deficiencies. One of your patients requests that you prescribe supplemental hormones. This poses the questions: How will you determine what kind of treatment to suggest? What patient factors should you consider? Are supplemental hormones the best option for the patient, or would they benefit from alternative treatments? 
To prepare: 
Review Chapter 56 of the Arcangelo and Peterson text, as well as the Roberts and Hickey (2016), Lunenfeld et al (2015), and Makinen and Huhtaniemi (2011) articles in the Learning Resources. 
Review the provided scenario and reflect on whether or not you would support hormone replacement therapy. 
Locate and review additional articles about research on hormone replacement therapy for women and/or men. Consider the strengths and limitations of hormone replacement therapy. 
Based on your research of the strengths and limitations, again reflect on whether or not you would support hormone replacement therapy. 
Consider whether you would prescribe supplemental hormones or recommend alternative treatments to patients with hormone deficiencies. 

With these thoughts in mind: 

By Day 3 

Post a description of the strengths and limitations of hormone replacement therapy. Based on these strengths and limitations, explain why you would or why you would not support hormone replacement therapy. Explain whether you would prescribe supplemental hormones or recommend alternative treatments to patients with hormone deficiencies and why. 

By Day 6 

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who provided a different rationale than you did, in one or more of the following ways: 

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library. 
Validate an idea with your own experience and additional research. 

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! 

Assignment: Cancer and Women’s and Men’s Health  

The American Cancer Society estimates that by the end of 2012, more than 226,000 women will be diagnosed with breast cancer and more than 241,000 men will be diagnosed with prostate cancer (American Cancer Society, 2012a; American Cancer Society 2012b). With such prevalence of women’s and men’s cancers, patient education and preventive services are essential. In clinical settings, advanced practice nurses must assist physicians in educating patients on risk factors, preventive services, and for patients diagnosed with cancer, on potential drug treatments. The clinical implications of women’s and men’s cancer greatly depend on early detection, which is primarily achieved through preventive services. In this Assignment, you consider the short-term and long-term implications of cancer and drug treatments associated with women’s and men’s health, as well as appropriate preventive services. 

To prepare: 
Select a type of cancer associated with women’s or men’s health such as breast, cervical, or ovarian cancer in women and prostate cancer in men. 
Locate and review articles examining the type of cancer you selected. 
Review the U.S. Preventive Services Task Force article in the Learning Resources. Think about available preventive services that providers might recommend for patients at risk of this type of cancer. 
Select two of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how these factors might impact decisions related to preventive services. 
Consider drug treatment options for patients diagnosed with the type of cancer you selected including short-term and long-term implications of the treatments. 
By Day 7 

Write a 2- to 3- page paper that addresses the following: 

Describe available preventive services that providers might recommend for patients at risk of the type of cancer you selected. 
Explain how the factors you selected might impact decisions related to preventive services. 
Describe drug treatment options for patients diagnosed with the type of cancer you selected. Explain the short-term and long-term implications of these treatments. 

Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting. 

Submission and Grading Information 

To submit your completed Assignment for review and grading, do the following:  

Please save your Assignment using the naming convention “WK10Assgn+last name+first initial.(extension)” as the name.  
Click the Week 10 Assignment Rubric to review the Grading Criteria for the Assignment. 
Click the Week 10 Assignment link. 
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK10Assgn+last name+first initial.(extension)” and click Open.  
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database. 
Click on the Submit button to complete your submission. 

Grading Criteria  

To access your rubric: 

Week 10 Assignment Rubric 

Check Your Assignment Draft for Authenticity 

To check your Assignment draft for authenticity: 

Submit your Week 10 Assignment draft, and review the originality report 

Submit Your Assignment by Day 7 

To submit your Assignment: 

Week 10 Assignment 

Week 10 Quiz 

This week’s Quiz covers the content you have explored this week. The Quiz may include the following topics: 

Drug classifications by indication—contraceptives, hormones (female and male), obstetrics and gynecology, urogenital system 
Drug dosage calculations 
Drug interactions 
Drugs to treat osteoporosis, overactive bladder, sexually transmitted diseases, and also for use during pregnancy and lactation 

By Day 7 

You have 100 minutes to complete this 41-question Quiz. 

This quiz is a test of your knowledge in preparation for your certification exam. No outside resources including books, notes, websites, or any other type of resource are to be used to complete this quiz. You are expected to comply with Walden University’s Code of Conduct. 

Submission and Grading Information 

Submit Your Quiz by Day 7 

To submit your Quiz: 

Week 10 Quiz 

Week In Review 

This week week you evaluated treatments for hormone deficiencies including the strengths and limitations of hormone replacement therapy. You also analyzed preventive services for women and men’s health and drug treatments for cancer patients, including implications of those treatments on the patients. 

Next week you will examine the practice of prescribing off-label drugs to children and strategies for making off-label drug use safer for children from infancy to adolescence. 

Next Week 

Go to next week: 

A Sample Answer For the Assignment: NURS 6521 Week 10: Women’s and Men’s Health
Title: NURS 6521 Week 10: Women’s and Men’s Health
Introduction 

Hormone therapy (HT) for postmenopausal women refers to drug treatment involving the hormones estrogen and progestin for managing symptoms related to menopause.  Goals of therapy include reducing the severity and frequency of the vasomotor and associated genitourinary symptoms and thereby improving the patients quality of life (Arcangelo, Peterson, Wilbur, & Reinhold, (Eds.), 2017). Hormone replacement therapy (HRT) is rampantly debatable in recent years. Advanced Practice Nurses have responsibility for prescribing medications including supplemental hormones. Therefore, they need to consider the strengths and limitations of hormonal therapies prescribed. If the specialist determines that the limitations outweigh the strengths, they should suggest alternative options of treatment such as the use of herbs, change of diet, exercise or other natural remedies.  

Scenario 

In this case, advanced practice nurses serving at community health clinic often encounter treating female and sometimes male patients with hormone deficiencies. In one situation, a patient requested to be prescribed with supplemental hormones. At this point, the APN must determine what kind of treatments to suggest, patient factors to consider, best treatment options for the patient or the possibility for alternative treatments.  

Strengths and limitations of HRT 

For many women below the age of 60 years, the benefits of hormone replacement therapy outweigh the limitations. Hormone therapy (HT) for postmenopausal women refers to drug treatment involving the hormones estrogen and progestin for managing symptoms related to menopause(Arcangelo, Peterson, Wilbur & Reinhold, 2017). Goals of therapy include reducing the severity and frequency of the vasomotor and associated genitourinary symptoms and thereby improving the patients quality of life (Arcangelo, Peterson, Wilbur, & Reinhold, (Eds.), 2017). The benefits include a reduction in vasomotor symptoms that improve within four weeks of treatment such as frequency of hot flushes (Arcangelo, Peterson, Wilbur & Reinhold, 2017). They enhance the quality of life such as sleep improvement, a decrease in muscle aches and pain. HRT can improve mood and reduce symptoms of depression especially from menopause chronicles (Willacy & Payne, 2018). Also, research shows that HRT improves vaginal dryness and sexual function alongside improving on symptoms of urinary frequency. 

 Replacement of hormones leads to the reduction of osteoporosis risk such as preventing osteoporotic fractures in women and increasing bone mineral density (BMD) (Arcangelo, Peterson, Wilbur & Reinhold, 2017). HRT is FDA-approved to relieve these symptoms and potentially improve the quality of life for post-menopausal women (Arcangelo, Peterson, Wilbur & Reinhold, 2017).  Prematurely menopausal women, less than 40-years-old, who are prescribed HRT until their approximate natural menopause age can potentially reduce the known risks associated with early menopause.  These risks include coronary artery disease, osteoporosis, declines in cognitive function, and early death (Willacy & Payne, 2018). HRT helps in reducing cardiovascular diseases such as coronary heart disease if it begins within the ten years of menopause. Estrogens control the level of cholesterol depending on dose and androgen. They reduce the risk of patients contracting colorectal cancer. Other benefits of the therapy include reduction of osteoplastic resorption, maintenance, and enhancement of muscle strength, mass, and connective tissue, increase skin thickness, elasticity, and hydration, reduce the risk of Alzheimer’s disease and dementia, and stabilize hormonal fluctuations. (Arcangelo, Peterson, Wilbur & Reinhold, 2017)  

The limitations of HRT are significant, and they include thromboembolic disease, pulmonary embolism, gallbladder disease, stroke, breast, and endometrial cancer. Most of the HRT concerns were raised by WHI and Million Women Study (MWS). However, for menopause women, it results in a favorable benefit-risk ratio. In this case, oral HRT increases VTE risk along with other factors such as age, obesity, history, smoking, and immobility. Oral HRT or combined process results to stroke especially on dosage-related. Nurses need to regulate prescription to control the disease (Willacy & Payne, 2018). Further, combined HRT increases the risk of breast cancer, endometrial cancer, and ovarian cancer. In women with a uterus, estrogen-only increases the risk of endocrine cancer. 

My support for HRT 

HRT provides an improvement in the quality of life for many women and prevention of complications related to early menopause (Willacy & Payne, 2018). It is a valuable therapy for many women. However, it may also present serious risks for others.  As an NP provider, I would determine to find the balance between the risks and benefits for each individual patient. Based on the analysis of the benefits and limitations of HRTs, I will support the process of hormonal replacement especially among women. The treatment options are numerous, and others have been proven not to be disastrous. Also, the benefits of the therapy outweigh the limitations which can be treated using other effective interventions (Willacy & Payne, 2018).  

Recommendation 

For patients that seek hormonal replacements, I recommend undergoing sufficient screening and testing depending on their factors such as age, gender, and history of past diseases. In some cases, I will recommend men to undergo such therapies in emergency cases (Willacy & Payne, 2018). Women who are suitable in hormonal imbalance can also withstand the hormone replacement therapy. I would prescribe supplemental hormones for the right patient and at the right time using evidenced-based guidelines.  There are many women who face moderate to severe symptoms related to this disorder(Arcangelo, Peterson, Wilbur & Reinhold, 2017).  Many others face early menopause which places them at high risk of complications related to adequate hormone levels.  Both groups should have the option of weighing out the risks and benefits of HRT with their provider.   

Conclusion 

Healthcare providers should conduct a proper analysis and assessment of the patient before arriving at such conclusions. However, other alternative treatment options can be recommended if the therapy becomes unsuitable. 

References 

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins. 

Willacy, H., & Payne, J. (2018, January 29). Hormone Replacement Therapy. Retrieved January 28, 2019, from patient info: https://patient.info/doctor/hormone-replacement-therapy-including-benefits-and-risks 

A Sample Answer 2 For the Assignment: NURS 6521 Week 10: Women’s and Men’s Health
Title: NURS 6521 Week 10: Women’s and Men’s Health

               Hormones are chemicals that are created and released by the endocrine glands (Huether & McCance, 2017). Their role is to convey regulatory messages among the cells and organs, and they are also integrated in the central nervous system (Huether & McCance, 2017). They are classified and released by specific glands, and excretion of specific hormones can decrease with age (Huether & McCance, 2017). This post will explain the mechanism of action of hormones, explore hormone replacement therapies (the benefits and risks), discuss the support or lack of support for HRT, and explore supplemental hormone therapies or alternative treatments. 

The Mechanism of Action Hormones 

               As hormones are secreted by specific endocrine organs, they affect the target cells through a negative or positive feedback system (Huether & McCance, 2017). The role of the hormone is to maintain a homeostatic internal environment (Huether & McCance, 2017). The excretion of hormones usually occur in response to an altered cellular environment or in response to the need to maintain the level of another hormone or substance through direct (obvious changes occur) or permissive (facilitates the maximal performance of a cell) mechanisms to obtain the homeostatic environment (Huether & McCance, 2017). 

Hormone Replacement Therapy 

               Hormone Replacement Therapy (HRT) is utilized in both men and women to negate the impact of the decrease in hormone production. In menopausal women, estrogen and progestin can be utilized to improve or decrease the symptoms of menopause, with timing being a crucial component of the efficacy of treatment (Arcangelo, Peterson, & Reinhold, 2017). Strengths of estrogen and progestin treatments include decreasing the intensity or occurrences of night sweats and occurrences of wakefulness, reduce sleep latency, decrease the occurrences of hot flashes, and improve the overall quality of sleep (Arcangelo, Peterson, & Reinhold, 2017). The weaknesses, or risks of HRT, include increased risks of endometrial hyperplasia (can result in endometrial cancer), venous thromboembolism (which can be mitigated by the form of HRT prescribed), Chronic Heart Disease, stroke, and pulmonary embolism (Arcangelo, Peterson, & Reinhold, 2017). Breast Cancer can be caused by HRT and is usually correlated with the use of Progestin (Liu, Chen, & Hwang, 2016). Treatment with progestin should be limited to 3-5 years and estrogen to 7 years to minimize the risk of developing the risks. 

Support or Not to Support HRT 

               The decision for the utilization of hormone replacement therapy would be based on the individual patient. The risk factors would be taken into consideration in the process. The patient who has had a past medical history of stroke or any event resulting from an issue with clotting would be less likely to be prescribed the HRT. A familial history of associated cancers and strokes, myocardial infarction, etc. would also be taken into consideration. The timing of the symptoms would be considered due to the impact on the efficacy of treatment. The severity of the symptoms would also help determine the risk versus the benefits. 

Supplemental Hormone or Alternative Treatment 

               Alternative treatments include diet, exercise, acupuncture, and vitamins (Bavendar, 2018). Improving the quality of the individual’s diet has been recommended to improve the symptoms of menopause. Increasing the intake of fruits and vegetables are indicated (Bavendar, 2018). Aerobic exercising, such as swimming and running, can reduce hot flashes (Bavendar, 2018). Acupuncture can increase hormone production (Bavendar, 2018). And Vitamin E in addition to Black Coosh can help with symptoms (Bavendar, 2018). Caution is advised with black coosh due to the increased possibility of hepatic toxicity (Bavendar, 2018). 

Summary 

               Hormones assist with maintenance of a homeostatic environment in the body. As an individual ages, the hormone production can decrease, resulting in a variety of undesired symptoms. Hormone replacement therapy has helped improve some of the symptoms; however, there are many risks associated with hormone replacement therapy. The decision to utilize or not utilize HRT would have to be determined after a risk/ benefit analysis takes place. If the risk outweighs the benefits, alternative treatments such as diet, exercise, and vitamins can be utilized. 

References 

Arcangelo, V. P., Peterson, A. M., & Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice: A Practical Approach. Ambler, PA: Lippincott Williams & Wilkins. 

Bavendar, K. L. (2018). Hormonal Havoc: Alternative Therapies to Hormone Replacement. Jounal of the Council on Nutrition of American Chiropractic Association, 18-23. 

Huether, S. E., & McCance, K. L. (2017). Understanding Pathophysiology. S. Louis, Missouri: Elsivier. 

Liu, J.-Y., Chen, T.-J., & Hwang, S.-J. (2016). The Rik of Breast Cancer in Women Using Menopausal Hormone Replacement Therapy in Taiwan. International Journal of Environmental Research and Public Health, 1-6. 

A Sample Answer 3 For the Assignment: NURS 6521 Week 10: Women’s and Men’s Health
Title: NURS 6521 Week 10: Women’s and Men’s Health
Benefits and Risk of Hormonal Replacement Therapy.  

There are many risks and benefits that go along with the usage of hormonal replacement therapy. Take for instance, according to Sood, Faubion, Kuhle, Thielen, and Shuster (2014) menopausal hormone therapy (MHT) can have great benefits for those females who are under the age of 60 but are within ten years of menopause. Women who used this form of replacement therapy are said to experience fewer progression of disorder such as atherosclerotic disease, which in turn lower the cardiovascular risk factors and it’s mortality rate (Scood et al., 2014). Other advantages of MHT are that it helps to decrease other disorders such as osteoporosis, and cognitive declined (Scood, et al., 2014). MHT works by reducing certain symptoms that such as hot flashes, irritability, problems with sleep and trouble with a concentration that are associated with menopause (Scood, et al., 2014).

It is believed that estrogen by itself lower the risk of developing breast cancer, compare to when treatment consists of a combination of estrogen and progestogen (Scood, et al., 2014). When the combination of estrogen and progestogen are used beyond five years the chances of developing breast cancer increase. Estrogen-only hormonal replacement therapy is mainly used in females who have a hysterectomy done, while the combination of estrogen and progestogen is used for those with an intact uterus (Scood, et al., 2014). Combination hormonal therapy of estrogen and progestogen is the preferred method of treatment for women who have had endometrial ablation due to the increase due to the continuous risk of endometrial cancer (Scood, et al., 2014).  The form of estrogen use also makes a difference,  “because, in contrast, oral estrogen, low-dose transdermal estrogen appears to be linked to a lower risk of cholecystitis, stroke, and deep venous thromboembolism”, Scood, et al., 2014).

“Oral estrogens increase the hepatic production of sex hormone-binding globulin with the associated lowering of free testosterone, potentially adversely affecting sex drive and sexual responsiveness. Oral estrogens also stimulate other hepatic enzymes, which can affect the cardiovascular, thrombotic, and vascular systems”, (Scood, et al., 2014). The primary purpose of progestogen is hormonal replacement therapy is to protect against the development of endometrial cancer or to prevent overproduction of endometrial cells (Scood et al, 2014). While there are great benefits to this form of hormonal therapy there are also negative implications if used in the wrong group of females. This form of therapy is not indicated for females who have pre-existing conditions such as stroke, coronary artery disease and who are at risk for deep vein thrombosis among other (Scood, et al., 2014).  

Other Alternatives Treatments Away from Hormonal Replacement Therapy 

 As a clinician, careful history of the patient’s health history and current health history and the patient’s preference must be taken into consideration before the initiation of hormonal replacement therapy. Based on some of the risk factors such as stroke, heart attacks, and breast cancer that are associated with the use of hormonal replacement therapy, as a clinician, the student would choose lifestyle modifications first and other means to control symptoms of pre-menopause and use hormonal replace therapy as last resort. According to the American Cancer Society (2017), the soy-based product consists of phytoestrogens which have a similar characteristic as estrogen is effective in control some menopausal symptoms and is safer than estrogens that are used in pre-menopausal. There are medications such as venlafaxine, catapres, and gabapentin that are not hormonal and are effective in control hot flashes.  It is believed that antidepressant such as venlafaxine reduced hot flashes by working on the certain neurotransmitter in the hypothalamus which plays a role be body heat regulation.

When the medication is administered serotonin, level increased which cause the desensitization of the receptor in the hypothalamus that is responsible for heat (American Cancer Society, 2017).  Some adverse reactions from venlafaxine are insomnia, nausea, constipation  (American Cancer Society). According to Zagaria, (2010) catapres is effective in relieving hot-flashes because it reduces “central adrenergic outflow which is responsible for blood flow to cutaneous vessels” (Zagaria, 2010). Side effects include tiredness, hypotension, and dizziness, among others. Some researchers also believe that acupuncture can also help relieve pre-menopausal symptoms. Other ways that might help to alleviate some symptoms is to limit alcohol consumption and quit smoking and maintaining ideal body weight and trying to eat well-balanced meals that consist of whole grains, beans and green leafy vegetables (dark) among other modifications (American Cancer Society, 2017). There are also many other herbal products that are being explored to see how they can alleviate premenopausal symptoms, to prevent the use of hormonal replacement therapy whenever possible.  

While there are great benefits that are associated with hormonal replacement therapy, there are also negative aspects that go along with its usage, therefore careful assessment must be done prior to initiating this form of treatment. Working with the mental health population the student has seen where the initiation of growth hormone therapy in kids can lead to such things as increased aggression and other behavioral issues. There have been several cases where patients on the behavioral health unit for kids are being admitted because parents reported increase physical aggressive behaviors in the children who did not have any prior inci