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Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.  
 
TB Discussion:
Risk and benefits should be discussed with Ms. Martin. This patient has been on hormone therapy for 4 years, last mammogram was 2 years ago and last pap 5 years ago. If this patient is having vasomotor symptoms, it is important to know if the regime she is taking is working for her and the symptoms that she was having before she was prescribed the hormones. Benefits to hormone therapy can be extensive. They can include elimination of hot flashes, increase in vaginal lubrication and pleasure during intercourse, reduced risk of osteoporosis, improved mood swings and clarity, lowered risk of colon cancer, cervical cancer and stabilization of weight. The risks this patient should be aware of would include possible risk of blood clot if using a systemic estrogen and increased risk of breast cancer if carrying the brca 1 or 2 gene (Hawkins, Roberto-Nicholas & Stanley-Haney, 2020).
To decrease the risk of blood clots, transdermal estrogen can be used alongside yearly labs in order to understand how the patient’s lifestyle is affecting her cardiovascular risk. Cardiovascular risks can be seen with yearly labs including HgB A1c, lipid panel and cardiac inflammatory marker. This patient should be given information on a genetic counselor to assess factual risk of breast cancer. She should be doing breast mammograms at least yearly and possibly every 6 months depending on the genetic counselors suggestions and the suggestions of the mammogram results. If she has a HPV test alongside her PAP smear today in the office, and it comes out negative, she would be required to have another PAP in the next 3-5 years. If she only wants to do PAP smears, she would be recommended to have a PAP every 1-3 years along with the yearly pelvic exam as long as her previous PAPs were normal (Monticciolo, Newell, Moy, Niell, Monsees, Sickles, 2018)
Depending on the patient’s current status on the hormone therapy, I would suggest she keep up with her routine. Taking hormone therapy within 10 years of onset of menopause and under the age of 65 allows the hormones to be cardioprotective, prevent osteoporosis, atrophy of vaginal tissue, increase pleasure with intimacy, decrease likelihood of dementia and alzhiemers. I would encourage her to walk daily, at least 30 min a day and do weight training at least 3 times a week to help fight against osteoporosis and help increase endorphins. Keeping up to date with her mammogram, dexa scans and colonoscopies is highly important in prevention and early detection of cancers (Hawkins, Roberto-Nicholas & Stanley-Haney, 2020). 
References
Hawkins, J., Roberto-Nicholas,D. & Stanley-Haney, J. (2020). Guidelines for nurse practitioners in gynecologic settings (12th ed.). Springer Publishing. ISBN-13: 9780826173263
Monticciolo DL, Newell MS, Moy, L, Niell B, Monsees B, Sickles EA. Breast cancer screening in women at higher-than-average risk: Recommendations from the ACR. Journal of the American College of Radiology 2018;15(3 Pt A):408–414.