Problem:
Harmony Hughes is a 45-year-old female who has returned to the clinic for her 2-day post-assessment after completing a total hysterectomy with bilateral salpingo-oophorectomy. Ms. Hughes had this procedure done to treat her endometriosis. She does not report and post op complications, and the incision site is healing well with no signs of infection. Patient reports minimal pain, 3/10, and states she feels well overall. Her past medical history includes endometriosis, and no known drug allergies. She does not smoke and drinks alcohol once every few months. While the patient is here in the clinic, medication adjustments and additions will be further discussed. Her current pain regimen includes hydrocodone 5mg/acetaminophen 325mg (Vicodin) by mouth as needed every 4 hours. The medication that will be added today for this patient is conjugated equine estrogen (Premarin) 30mg, one tablet once daily by mouth. Based on my client's current health status, Premarin would be beneficial to her in preventing or decreasing the symptoms associated with menopause due to the hysterectomy. This has depleted her body's ability to create its own hormones to help regulate symptoms such as night sweats, hot flashes, mood swings, and metabolic changes. Hormone replacement therapy (HRT) is also known to help prevent osteoporosis in menopausal women. (Yanachkova, V. et al., 2025). However, there are risk that comes with HRT due to my client's history of endometriosis. After a hysterectomy, it is still possible that endometrial tissue could have been deposited outside the uterine cavity. Oftentimes in the diaphragm, lungs, skin, and brain. HRT can place a patient at risk for the reactivation of the endometrial foci and potentially malignancies. Continuous monitoring is required for patients on HRT. (Amer, S., & Bazmi, S., 2023). Based on my professional assessment, I would include and educate about the pros and cons of HRT. I would continue routine follow-ups to assess for any potential side effects of the medication and potential residual endometrial tissue that may be causing concerns. Educating my client about a proper diet and weight-bearing exercise to prevent osteoporosis. As well as addressing all her needs and concerns about medication therapy.
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