: Perimenopause

Anne Morrison, age 51, presents with complaints of depressed mood and low libido. She says she has become irritable and snaps easily at her four children and her husband. She has no interest in sex, no urge to masturbate, and has had no sexual intercourse for six months. She also complains of fatigue, dry hair and skin, warm flushes, and painful joints. She has no personal or family history of depression. She is not suicidal but she “really doesn’t want to live anymore if this is it.”

Anne says her husband is angry about the lack of sexual intercourse and she feels the stress in their marriage. She also is worrying about her oldest children leaving for college and about her mother’s ill health.

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She scores 20 on the Beck Depression Inventory, which indicates that she has mild to moderate depression. Her menstrual periods remain regular, but her cycle has shortened from 29 to 24 days. She reports that some hot flashes wake her at night and that she hasn’t had a good night’s sleep in months.

Laboratory tests show follicle-stimulating hormone of 25 mIU/mL and inhibin B below 45 pg/mL. Her estradiol is 80 pg/mL—not yet in the menopausal range. Her thyroid-stimulating hormone is normal. Her shortened menstrual cycles suggest a diagnosis of perimenopause.

Questions
From your perspective as Anne’s psychiatric nurse practitioner, answer the following questions in a two- to three-page double-spaced paper (not including the reference page) and in APA format. Include at least three peer-reviewed, evidence-based references.

What additional screening tools would be appropriate for Anne?
What medications would you recommend for her? Are there any psychiatric medications that do not interfere with the sex drive?
Are there any non-pharmacological recommendations that would help her situation?
What referrals would you make?
Create a treatment plan for Anne includibcqng medications, therapies, and referrals.

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