What does the FNP do now to help this patient?

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. 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?
ANSWER
The FNP should first respect the patient’s decision to refuse progestins. It is important to understand the patient’s reasons for refusing and to provide her with accurate information about the treatment options available.
The FNP should also assess the patient’s risk factors for secondary amenorrhea. This includes asking about her medical history, medications, lifestyle, and diet. The FNP may also order additional tests, such as blood tests or imaging studies, to rule out underlying medical conditions.
Once the FNP has a better understanding of the patient’s case, she can discuss other treatment options. These options may include:
* **Lifestyle changes:** The FNP may recommend lifestyle changes, such as weight loss, stress management, and exercise, to help regulate the patient’s menstrual cycle.
* **Other medications:** There are other medications that can be used to induce menstruation, such as clomiphene citrate and letrozole. These medications may be an option for patients who are not able to take progestins.
* **Natural therapies:** Some patients may choose to try natural therapies, such as herbs and supplements, to help regulate their menstrual cycle. The FNP should advise patients about the potential risks and benefits of natural therapies before they use them.
It is also important to provide the patient with support and resources. The FNP can refer the patient to a specialist in reproductive endocrinology and infertility or to a counselor who can help her cope with the emotional challenges of secondary amenorrhea.
Here are some specific things the FNP can do to help the patient:
* **Validate the patient’s feelings:** The FNP should acknowledge that the patient is feeling upset and that she has the right to refuse progestins.
* **Educate the patient about her options:** The FNP should explain the other treatment options available to the patient and the potential risks and benefits of each option.
* **Respect the patient’s decision:** The FNP should respect the patient’s decision, even if she does not agree with it.
* **Provide support and resources:** The FNP can refer the patient to a specialist or counselor who can help her manage her condition.
It is important to remember that the patient is the ultimate decision-maker in her own healthcare. The FNP should work with the patient to develop a treatment plan that meets her individual needs and preferences.