A Clinical Study on Menopause

This clinical case study focuses on menopause and its effects on a woman's body. It discusses the symptoms, diagnosis, and treatment options for menopause. The study also includes a detailed analysis of a specific case, along with dietary recommendations and lifestyle changes. It provides insights into the impact of menopause on the female reproductive system, nervous system, immune system, and musculoskeletal system. The study concludes with future tests and recommendations for managing menopausal symptoms.

Running head: A CLINICAL STUDY ON MENOPAUSE
A CLINICAL STUDY ON MENOPAUSE
Name of the Student
Name of the University
Author’s Note

1A CLINICAL STUDY ON MENOPAUSE
Executive Summary
Menopause marks the end of the fertile childbearing phase of a woman. The following
clinical case study is on a fifty one year old Karen who is experiencing hot flashes, excessive
sweating, vaginal dryness, and reduced sexual urges along with twitchy eyelid. The analysis
of her diagnostics revealed elevated blood pressure along with increased levels of
triglycerides and low density lipoproteins. Menopause has been determined as the differential
diagnosis for her conditions and accordingly short term and long term health care plans has
been proposed. Therefore, incorporation of these therapeutic treatments will help Karen
manage the symptoms of menopause and will bring about a positive change in her lifestyle.

2A CLINICAL STUDY ON MENOPAUSE
Table of Contents
Introduction................................................................................................................................4
Biomedical study........................................................................................................................5
Case specifics.........................................................................................................................5
Medical history.......................................................................................................................5
Pathology................................................................................................................................5
Etiology..................................................................................................................................6
Differential diagnosis.............................................................................................................6
Comprehensive Analysis............................................................................................................7
Dietary analysis......................................................................................................................7
Nutritional status....................................................................................................................8
Anthropometrics.....................................................................................................................8
Treatment prescribed..................................................................................................................9
Treatment aimed at the female reproductory system.............................................................9
Treatment aimed at the nervous system.................................................................................9
Treatment aimed at the immune system...............................................................................10
Treatment aimed at the musculoskeletal system..................................................................10
Dietary changes....................................................................................................................10
Therapeutic...........................................................................................................................10
Lifestyle................................................................................................................................10
Future relevant tests.............................................................................................................11

3A CLINICAL STUDY ON MENOPAUSE
Conclusion................................................................................................................................11
References................................................................................................................................12

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Introduction
A woman goes through quite a few epic hormonal changes throughout their lives. The
onset of menarche, pregnancy, childbirth and finally menopause, all these vital physiological
and psychological events are guided and controlled by the female gonadal hormones, mainly
the estrogen, follicle stimulation hormone, luteinizing hormone and the progesterone
(Santoro, Epperson & Mathews, 2015). Menopause marks the natural depletion of the ovarian
oocytes that was present since birth and functional for fertilization since the menarche. The
menopause puts an end to the childbearing phase of a woman with drastic declines in the
level of estrogen and progesterone, which in turn increases the levels of luteinizing hormone
(LH) and follicle stimulating hormone (FSH) (Kaunitz & Manson, 2015). These marked
changes in the hormonal levels during menopause attributes to various neurological changes,
stoppage of the menstrual cycle, changes in bone density, affects the joints and so on
(Bjørnerem et al., 2018).
The onset of menopause is influenced by heredity, lifestyle choices, diseases and
surgical interventions along with the severity of the menopausal symptoms, which varies in
women (Greer, 2018). The age of menopause onset is mostly inherited; however research
shows that alcohol and tobacco abuse, few steroidal medicines and chemotherapy are likely
to influence an early onset of menopause along with hysterectomy and other surgical
interventions which leads to removal of the ovaries (Blümel et al., 2016). The common
symptoms of menopause consist of excessive sweating, shivers, skin reddening, hot flashes;
troubles sleep patterns, mood fluctuations, twitchy eyelids, and vaginal dryness and so on
(Santoro, Epperson & Mathews, 2015).
The following clinical case study aims at diagnosing Karen and structuring a proper
medical and therapeutic health care plan for her.

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Biomedical study
Case specifics
A fifty one year old, Karen, is suffering from 5-6 hot flashes a day which leads to
redness of face, feeling of heat rising from feet to head and occasionally accompanied with
sweating. Her sleep pattern is disturbed and she wakes 3 to 4 times a night, covered in sweat
and forcing her to change clothes during the night. She reduced sexual urge, vaginal dryness
and associated discomfort along with twitchy eyelid on and off over the last few weeks. Her
high stress and anxiety levels are attributed to her hot flashes and excessive sweating along
with low energy levels and feeling of exhaustion due to lack of proper rested sleep.
Medical history
Married with three children, Karen works as an administrator at a private hospital
whereas her husband is a secondary school teacher. She is not under any prescribed
medication; however she takes self prescribed over the counter multivitamins, fish oil and
vitamin C for energy and vitamin benefits. Age twelve marked the onset of Karen’s menarche
with steady regular menstrual cycles throughout, until recent irregularities and lack of
menstrual cycles for around last six months.
Pathology
Karen has complaints of twitchy eye; presence of tongue scallops along the edges,
brittle nails, and right shoulder pain along with the hot flushes, excessive sweating, elevated
body temperature of 36.8 °C and vaginal dryness. Routine breast exam and pap smear
showed normal results. Scan of body vitals and recent blood work revealed a few notable
pathological issues with Karen. Her clinical diagnostic reports have been tabulated below in
Table 1.

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Table 1: Clinical and physical reports of Karen
Diagnostics Reported Optimal range Remarks
LDL 3.1 mmol/L < 3.36 mmol/L No risk
HDL 1.49 mmol/L > 1.55 mmol/L Intermediate risk of having low
high density lipopropretin
Triglycerides 1.7 mmol/L < 1.69 mmol/L Intermediate risk of high lipid
Ferritin 10 12-150 ng/mL Iron deficient
Fasting blood
glucose
5.3 mmol/L < 5.6 mmol/L Not diabetic
Blood pressure 130/90 < 120/80 Hypertension Stage one
Body fat 35% < 30% Borderline obese
Weight 75 kg 60-64 kg Overweight for 163 cm height
Etiology
The hot flushes, extreme sweating, reduced sexual urges, marked irregular menstrual
cycles and vaginal dryness can be attributed as the etiological manifestations of menopause in
Karen (Santoro, Epperson & Mathews, 2015).
Differential diagnosis
Studies show that lack of estrogen leads to dried itchy eyes and twitchy eyelids which
might lead to unnecessary twitching (Versura & Campos, 2005). The reduced level of
estrogen in menopause also causes alterations in body lipid profile by lowering high density
lipoprotein and increasing the levels of triglycerides and low density lipoproteins, thus
elevating the risk of cardiovascular diseases. Reduced sleep due to the excessive sweating
builds up on the exhaustion and anxiety along with stress and mood dysfunctions.

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Hypertension stage 1 can also be attributed to the hot flashes caused during menopause along
with elevated body temperature of 36.8 °C.
Comprehensive Analysis
Dietary analysis
Karen’s diet does not reflect well balanced nutritional status. The table below
summarizes her daily dietary intake for further comprehensive analysis and
recommendations.
Meal Dietary intake
Morning tea Full fat milk coffee 250 ml
1 sweet biscuit tim tam 1 or oreo
Breakfast 60grams special K skinny milk 100mls,
Banana,
12 grams coffee and milk 50ml skinny milk with 2 sugars (10gm,
white)
Lunch Sourdough white 55 grams
nuttlex 15 grams (or margarine )
salad 60 grams,
30 grams lite (25% reduced fat) cheese,
coffee 50 mls with skinny milk
Afternoon tea fruit 1/2 mango
100 grams tim tam,
50 grams almonds
Dinner 100 grams beef
100 grams sweet potato,
50 grams green beans
100 mls korma curry sauce
150 grams basmati rice
200 grams vanilla lite jalna,
120 grams banana,
50 grams lindt dark chocolate
4 dried dates
pizza or chicken & chips as takeaway once a week
Water 1 to 1.25 liters of water per day
Alcohol 2-3 glasses on Friday & Saturday,
Occasional glass of sweet white wine on other nights (2-3/5)
Alcohol equivalent to 200 mls per night
Snacks Chocolate – 2-4 squares of dark chocolate (50 grams dark
chocolate)
sweet biscuits or cakes when tired

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Others Red meat- 3 to 4 times a week
Chicken- 3 times a week
Fish- rarely, Instead has over the counter 1 capsule of fish oil/day
Legumes- rarely
Nutritional status
The analysis of the daily dietary intake chart of Karen reflects poorly planned diet and
lacks balance. Karen consumes maximum quantity of food at dinner before bedtime, and
comparatively less amount at lunch with the least quantity during the breakfast. The diet
includes excessive carbohydrates with high sugar content along with elevated levels of
caffeine and increased amount of fat too. High intake of wine during the meals along with
daily consumption of cheese and margarine and occasional red meat consumption reveals
poor planning of diet and low nutritional value.
High amounts of caffeine due to three cups of coffee and 2 to 4 squares of chocolate a
day might affect the sleep pattern and lead to reduced sleep. Caffeine also increases the body
temperature and contributes to increased basal metabolic rate and also causes excessive
sweating. Daily consumption of cheese and margarine along with frequent intake of red meat
and sweet wine can elevate the lipid profile and have detrimental effects on health. Regular
intake of water is also low as normal intake of water must be around 2 to 2.5 liters of water
per day.
Anthropometrics
Feature Measurement
Height 163 cm
Weight 75 kg
Waist 95 cm
Hip 105 cm

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Anthropometrical analysis of the body measurements of Karen reveals her to be an
overweight, large sized woman with a heavy central mass. Ideal body weight of a female of
163 cm height is about 60 to 64 kg where as Karen has a body mass of 75 kg, making her
overweight with an increased waist and hip measurements.
Treatment prescribed
The treatment must be aimed at improving and maintaining the health of the female
reproductory system, the nervous system, the immune system, the musculoskeletal system,
diet and the lifestyle for the holistic improvement of the patient.
Treatment aimed at the female reproductory system
Improvement of the menopausal condition can be achieved by lowering the
occurrence of the hot flashes, with the aid of herbal preparations of Actaea racemosa
(Depypere & Comhaire, 2014). Estrogen levels can be naturally boosted with the
consumption of yam and chickpea (Ma et al., 2013). They are known to have natural
analogues of estrogen and will thus help in reducing vaginal dryness and will increase sexual
urge (Komesaroff et al., 2011).
Treatment aimed at the nervous system
Anxiety and sleeplessness can be improved by the consumption of chamomile tea before
bedtime which is known to lower anxiety and induce better sleep (Kheirkhah, Naieri &
Tabari, 2018). Lubricating eye drops can be used daily along with the consumption of
magnesium sulphate to ease the twitching eyelids and improve tired eyes (Versura &
Campos, 2005). Intake of Vitamin B6 on a regular basis might promote better serotonin
levels, which might help in combating anxiety and depression and increase energy levels
(Colao, 2017).

10A CLINICAL STUDY ON MENOPAUSE
Treatment aimed at the immune system
Consumption of iron supplements can be used to treat iron deficiency along with
improving the immunity by boosting the production of blood and thereby uplifting the well
being of the immune system (Pearce & Tremellen, 2016).
Treatment aimed at the musculoskeletal system
The bone health gets comprised with the lack of estrogen levels in menopause
(Gallagher & Nordin, 2018). Therefore, intake of calcium supplementation to improve bone
health is required for the overall improvement of the musculoskeletal system.
Dietary changes
A major change in the diet is required to bring about adequate health improvements in
the patient. A balanced diet with high calorie content which is protein rich must be structured
for the patient. Lowering the sugar content of the meals and the wine consumption during the
meals is crucial. The daily consumption of cheese and margarine must be limited to
occasional intake over the week along with reduced red meat consumption to once a week
Therapeutic
Hormone therapy might be considered as a therapeutic treatment to check the
symptoms of menopause. This includes consumption of hormones in steroidal forms which
may aid in the management of effects caused by menopause (Boardman et al., 2015).
Lifestyle
Change in food intake and inclusion of a well balanced diet along with increasing the
physical activities will bring about a positive lifestyle change for Karen. Lifestyle changes
must incorporate the following.

11A CLINICAL STUDY ON MENOPAUSE
a. Low calorie dinner followed by intake of chamomile tea to help induce good
sleep (Kheirkhah, Naieri & Tabari, 2018).
b. Lowering the caffeine intake to maximum of one cup a day
c. Intake of water must be increased to around 2 to 2.5 liters of water per day
d. Thirty minutes of walk along with her dog will aid in uplifting the mood along
with ensuring physical activity.
Future relevant tests
To monitor Karen’s progress, a few diagnostic tests must be prescribed to Karen after
a month’s gap namely lipid profile test, blood glucose, ferritin along with regular blood
pressure measurements.
Conclusion
In conclusion, it can be summarized that Karen is undergoing menopause and
introducing a few short term and long term treatments along with therapeutic therapy in
addition to changing her diet and lifestyle will help Karen combat the stressful symptoms of
menopause.

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References
Bjørnerem, Å., Wang, X., Bui, M., Ghasem‐Zadeh, A., Hopper, J. L., Zebaze, R., & Seeman,
E. (2018). Menopause‐Related Appendicular Bone Loss is Mainly Cortical and
Results in Increased Cortical Porosity. Journal of Bone and Mineral Research, 33(4),
598-605.
Blümel, J. E., Fica, J., Chedraui, P., Mezones-Holguín, E., Zuñiga, M. C., Witis, S., ... &
Ojeda, E. (2016). Sedentary lifestyle in middle-aged women is associated with severe
menopausal symptoms and obesity. Menopause, 23(5), 488-493.
Boardman, H. M., Hartley, L., Eisinga, A., Main, C., i Figuls, M. R., Cosp, X. B., ... &
Knight, B. (2015). Hormone therapy for preventing cardiovascular disease in post‐
menopausal women. Cochrane Database of Systematic Reviews, (3).
Colao, A. (2017). Nutritional Management of Menopausal Women. In Menopause (pp. 283-
299). Springer, Cham.
Depypere, H. T., & Comhaire, F. H. (2014). Herbal preparations for the menopause: beyond
isoflavones and black cohosh. Maturitas, 77(2), 191-194.
Gallagher, J. C., & Nordin, B. E. C. (2018). Calcium metabolism and the menopause.
In Biochemistry of women(pp. 145-163). CRC Press.
Greer, G. (2018). The change: Women, ageing and the menopause. Bloomsbury Publishing.
Kaunitz, A. M., & Manson, J. E. (2015). Management of menopausal symptoms. Obstetrics
and gynecology, 126(4), 859.

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Kheirkhah, M., Naieri, S. D., & Tabari, N. S. (2018). The effect of herbal tea capsule on
menopause hot flashes. Journal of Family Medicine and Primary Care, 7(5), 1074.
Komesaroff, P. A., Black, C. V. S., Cable, V., & Sudhir, K. (2011). Effects of wild yam
extract on menopausal symptoms, lipids and sex hormones in healthy menopausal
women. Climacteric, 4(2), 144-150.
Ma, H. R., Wang, J., Qi, H. X., Gao, Y. H., Pang, L. J., Yang, Y., ... & Aisa, H. A. (2013).
Assessment of the estrogenic activities of chickpea (Cicer arietinum L) sprout
isoflavone extract in ovariectomized rats. Acta Pharmacologica Sinica, 34(3), 380.
Pearce, K., & Tremellen, K. (2016). Influence of nutrition on the decline of ovarian reserve
and subsequent onset of natural menopause. Human fertility, 19(3), 173-179.
Santoro, N., Epperson, C. N., & Mathews, S. B. (2015). Menopausal symptoms and their
management. Endocrinology and Metabolism Clinics, 44(3), 497-515.
Versura, P., & Campos, E. C. (2005). Menopause and dry eye. A possible
relationship. Gynecological endocrinology, 20(5), 289-298.