A 21-year-old female patient presents to the office for an annual exam. She has had normal, regular menstrual cycles since she was 14, but she has not had a menstrual cycle in over 6 months. A pregnancy test is negative. Navigating Beliefs and Medicine- A Case of Secondary Amenorrhe Navigating Beliefs and Medicine- A Case of Secondary Amenorrhea The FNP wants to order blood work to determine the cause of her secondary amenorrhea. When the patient hears that if all is normal, the treatment will be giving progestins to initiate a menstrual cycle, she tells the FNP that she cannot do that because she does not believe in birth control pills. The FNP tries to advise the patient that it is not birth control pills but a hormone to assist in regulating her periods, and the patient leaves the office crying. What does the FNP do now to help this patient?

Navigating Beliefs and Medicine- A Case of Secondary Amenorrhe

Amenorrhea treatment in a fundamentalist patient.

Amenorrhea is the absence of menstrual cycles in a woman who is of reproductive age.  Amenorrhea can be classified either as primary or secondary. Primary amenorrhea is defined as the situation where menstrual periods have not begun by the age of sixteen. Secondary amenorrhea is the absence of periods for a duration of three consecutive cycles (Nida Tabassum et al., 2020).

The patient has secondary amenorrhea because she hasn’t had consecutive cycles for more than three months. Pregnancy has already been ruled out as one of the possible causes of her amenorrhea. The next course of action would be to take a thought history that includes the family history, prior medical history, and medication history, and then perform a physical exam. Various lab tests are also required to help in determining the etiology of her presentation.

Serum tests that can be done other than HCG to rule out pregnancy include a thyroid function test. This will test for TSH levels to rule out thyroid disease. The LH/FSH ratio should also be performed to rule out polycystic ovarian disease (PCOS) (Cron, 2019). FSH can also be performed to rule out ovarian failure. A progesterone challenge test can be performed to rule out functional hypothalamic amenorrhea. This involves giving medroxyprogesterone acetate (Provera) 10 mg per day for 5 to 10 days. The FNP should explain to the patient that this will only induce the sloughing off of the uterus lining. The patient should know that this is only done as a one-time administration and not as an act of birth control.

However, the patient in this scenario is reluctant to use progestins intended to initiate a menstrual cycle. This is because she does not believe in the use of birth control pills. The health practitioner is expected to do what is best for the patient. This should be done while considering the patient’s beliefs, culture, and concerns. Proper patient education is key to providing the patient with the most current information and making well-informed decisions (Zhao et al., 2021). The use of various channels to educate the patient is critical. This is, however, dependent on several factors, including the patient’s literacy and comprehension levels. Proper education is essential in eliminating any myths and misconceptions that the patient may have while allowing the patient to make a well-informed decision.

References.

Cron, J. A. (2019). Amenorrhea: A systematic approach to diagnosis and management. DeckerMed Obstetrics and Gynecology. https://doi.org/10.2310/obg.19117

Nida Tabassum, K., & Namra, J. (2020). Amenorrhea-an abnormal cessation of normal menstrual cycle. Clinical Journal of Obstetrics and Gynecology, 3(1), 033–036. https://doi.org/10.29328/journal.cjog.1001046