| Course | NU680 Gynecological, Reproductive, and Sexual Health |
|---|---|
| Unit | Unit 8 |
| Paper type | Treatment decision paper |
| Length | About 1,160 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | October 2026 |
Free sample paper for NU680 Unit 8
Menopause at Forty-One, on a Tuesday: A Unit 8 Treatment Decision Paper on Hormone Therapy After Risk-Reducing Surgery
[Student Name]
Purdue University Global
NU680: Gynecological, Reproductive, and Sexual Health
Unit 8 Treatment Decision Paper
[Instructor Name]
[Date]
The patient is composite; her history is illustrative; the sources cited are real.
The Patient
Ms. Castellano learned she carries a pathogenic BRCA1 variant after her sister's ovarian cancer diagnosis. She has never had cancer. Following genetic counseling she chose risk-reducing bilateral salpingo-oophorectomy at 41, which lowers ovarian cancer risk sharply for BRCA1 carriers, and she kept her uterus. She has not had a mastectomy and continues high-risk breast screening with yearly MRI and mammography, alternating every six months. Her last periods were regular until surgery.
Since the operation she has had 12 to 15 hot flashes a day, night sweats that wake her six times a night and difficulty concentrating at work. Her blood pressure is 112/70, her body mass index 22, and she does not smoke. She has no history of clots, migraine with aura or liver disease. A friend told her that anyone with "the breast cancer gene" can never take estrogen.
What Early Surgical Menopause Means
Removing both ovaries at 41 ends ovarian hormone production abruptly, about a decade before natural menopause would have occurred. Symptoms are often more severe than in natural menopause because there is no gradual transition. The longer-term concerns are bone loss, cardiovascular disease and possibly cognitive changes, all associated with early estrogen loss. The North American Menopause Society (NAMS, 2022) recommends that women with early menopause, including surgical menopause, continue hormone therapy until roughly 52, when menopause would ordinarily have arrived, unless there is a contraindication, both for symptoms and for long-term health.
The Evidence for BRCA1 Carriers Without Breast Cancer
Her concern is understandable, because estrogen exposure is linked to breast cancer risk in the general population. The question is whether replacing hormones after oophorectomy increases breast cancer risk in carriers, given that oophorectomy itself removes most of their estrogen.
Kotsopoulos et al. (2018) followed 872 BRCA1 carriers who had both ovaries removed, for an average of about seven and a half years. Use of hormone therapy was not associated with an increased risk of breast cancer overall. In an exploratory analysis, women using estrogen alone had a lower ten-year incidence of breast cancer, about 12 percent, than those using estrogen with a progestin, about 22 percent, though the authors cautioned that this comparison was not the study's main aim. A systematic review of carriers who had risk-reducing surgery reached a similar overall conclusion: the available studies did not show that hormone therapy increased breast cancer risk in carriers without a personal history of breast cancer, while it relieved symptoms and supported bone health (Gordhandas et al., 2019). Both sources note that the studies are observational and that the number of carriers studied is modest.
The gene does not forbid estrogen; a personal history of breast cancer would change the answer, and she does not have one.
The Options
Systemic estradiol with endometrial protection. Her uterus is still in place, so any estrogen she takes needs a partner progestogen that keeps the endometrium from overgrowing. Transdermal estradiol at 0.1 milligrams a day is a reasonable starting dose for young surgical menopause. Protection can come from oral micronized progesterone, for example 200 milligrams for 12 days each month or 100 milligrams nightly, or from a levonorgestrel 52-milligram IUD, which protects the endometrium locally with less systemic progestin. Given the exploratory finding about progestins, the IUD option is worth discussing with her.
Nonhormonal medicines. Low-dose paroxetine, venlafaxine, gabapentin and fezolinetant reduce hot flashes, though generally less than estrogen. None protects bone or addresses the long-term effects of early estrogen loss.
Behavioral approaches. Cognitive behavioral therapy and clinical hypnosis reduce how bothersome hot flashes are and help sleep. They can be added to either path.
No treatment. She could wait for symptoms to ease, but surgical menopause symptoms are often prolonged and the bone and heart concerns would remain untreated for a decade.
The Shared Decision
The visit followed a shared decision approach. The clinician first corrected the misunderstanding about the gene, then presented each option with what it would and would not do. Ms. Castellano asked two questions. Would hormones make her MRI harder to read? She was told that hormone therapy can increase breast density in some women, which her breast imaging team should know about, and that MRI remains effective. Would she need to stop at 52? She was told the plan would be reviewed then, as for any woman, rather than stopped automatically.
She chose transdermal estradiol 0.1 milligrams twice weekly with a levonorgestrel IUD for endometrial protection, placed in the office at the next visit, and oral micronized progesterone 200 milligrams for 12 days a month until then. Her breast specialist and the genetics team were informed and agreed. The decision, the evidence discussed and her preferences were documented.
Why Not Remove the Uterus Too?
A classmate's question during the course discussion of this case asked why she had not simply had a hysterectomy at the same operation, which would have allowed estrogen alone. The answer is that the decision belonged to her and her surgeon, weighed against a longer operation and recovery, and that hysterectomy at the time of risk-reducing surgery in BRCA1 carriers remains a matter of individual counseling rather than routine practice. For this paper the uterus is a fact of her situation, and the plan works within it. The levonorgestrel IUD offers much of the practical advantage of estrogen-alone therapy, because its progestin acts mainly on the uterine lining, while sparing her a second operation. If she later develops abnormal bleeding or another gynecologic reason for hysterectomy, estrogen alone would then become an option, and the plan would be revised.
Bone and Heart
A baseline bone density scan was ordered, because she will have spent some weeks without estrogen and her lifetime exposure will be shorter than average. Calcium and vitamin D intake were reviewed, weight-bearing exercise encouraged, and her lipid profile and blood pressure will be checked yearly.
Follow-Up
She returns in eight weeks. The visit will review hot flash frequency, sleep, mood, bleeding and blood pressure, and the dose can be adjusted if symptoms persist. Unscheduled bleeding after the IUD settles, a breast lump, calf pain or sudden shortness of breath would prompt an urgent visit. Her breast screening continues on the existing schedule, with imaging teams aware of the therapy.
Conclusion
The friend's warning reflected a common misunderstanding. For a BRCA1 carrier without breast cancer who has had her ovaries removed at 41, the available evidence does not show that hormone therapy raises breast cancer risk, and guidance recommends it until the usual age of menopause for both symptoms and long-term health. The decision paper presents that evidence with its limits, offers alternatives and documents a choice that fits her priorities.
References
Gordhandas, S., Norquist, B. M., Pennington, K. P., Yung, R. L., Laya, M. B., & Swisher, E. M. (2019). Hormone replacement therapy after risk reducing salpingo-oophorectomy in patients with BRCA1 or BRCA2 mutations: A systematic review of risks and benefits. Gynecologic Oncology, 153(1), 192-200. https://doi.org/10.1016/j.ygyno.2018.12.014
Kotsopoulos, J., Gronwald, J., Karlan, B. Y., Huzarski, T., Tung, N., Moller, P., Armel, S., Lynch, H. T., Senter, L., Eisen, A., Singer, C. F., Foulkes, W. D., Jacobson, M. R., Sun, P., Lubinski, J., & Narod, S. A. (2018). Hormone replacement therapy after oophorectomy and breast cancer risk among BRCA1 mutation carriers. JAMA Oncology, 4(8), 1059-1065. https://doi.org/10.1001/jamaoncol.2018.0211
North American Menopause Society. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767-794. https://doi.org/10.1097/GME.0000000000002028
Reading the NU 680 Unit 8 instructions
The eighth unit usually asks for a treatment decision for menopausal symptoms in a patient with mixed or unusual risk factors. Prompts typically want the patient's history and priorities, the evidence on benefits and risks for her specific situation, a comparison of hormonal and nonhormonal options, the shared decision and a follow-up plan. When a genetic, cancer or cardiovascular history shapes the risk discussion, instructors expect students to present the studies that address that population, with their limitations, rather than general statements. The decision should be documented as shared, with the patient's questions and the reasons for her choice. Most sections expect a decision paper of around five APA pages. Sources usually include the current menopause position statement and one or two studies specific to the risk factor in question, plus any guidance on dose and endometrial protection.
How this NU680 Unit 8 example is built
The Castellano paper opens with her genetic history, surgery, symptoms and the friend's warning, then explains why early surgical menopause is treated for long-term health and not only comfort, citing the NAMS position statement. The evidence section summarizes Kotsopoulos and colleagues' cohort, including its exploratory finding on estrogen alone, and Gordhandas and colleagues' review, with the limits of both, under a highlighted line correcting the friend's claim. Options are compared on what each relieves and what each leaves untreated, which a margin note marks. A section answers why the uterus was kept and how the IUD offers some of the advantage of estrogen alone. The shared decision records her two questions and the answers. Her choice of transdermal estradiol with an IUD is documented with the specialists' agreement. Bone and heart monitoring and a follow-up visit at eight weeks complete the plan.
Reading the NU680 Unit 8 grading rubric
Marks on this decision paper follow six criteria: whether the carrier studies are reported accurately, how they are applied to her, the comparison of options, shared decision making, safety planning and writing. Evidence credit depends on citing studies of the relevant population and stating their limits, since observational data on carriers is modest. Application rewards papers that connect each finding to the patient's own situation, such as her intact uterus. The comparison is judged on fairness, including what nonhormonal options cannot do. Shared decision making is scored through the patient's questions and documented reasoning, not a sentence claiming the decision was shared. Safety planning means dose, route, endometrial protection, monitoring and warning signs are all specified. Coordination with the specialists involved earns credit. Clear structure and APA references for the position statement and studies complete the rubric in most NU680 sections.
Common NU680 Unit 8 mistakes, and how to avoid them
Decision papers lose marks most often by treating a BRCA variant, or any family history, as an automatic contraindication to hormone therapy without examining the evidence. The opposite error is overstating the studies as proof of safety. Some papers prescribe estrogen to a woman with a uterus without a progestogen, a serious omission. Others recommend menopausal doses that are too low for a woman of 41 or forget that guidance supports treatment until the usual age of menopause. Leaving out bone health is common. Nonhormonal options are sometimes dismissed in a sentence. Before drafting, list the patient's risk factors and find one source that addresses each directly. Then state what each option would and would not do for her. Send the case and your instructions, and a decision paper can weigh the evidence for that patient.
Get an NU680 Unit 8 example written to your instructions
Send the case, the patient's risk factors and preferences and the paper instructions with the rubric. A custom decision paper compares the options on benefit, risk and fit and documents the shared decision. The first paper is free, delivered within 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
More NU680 papers and MSN samples
- NU680 Unit 1: Sexual History Discussion Post
- NU680 Unit 2: Amenorrhea Workup Paper
- NU680 Unit 3: Contraceptive Counseling Plan
- NU680 Unit 4: Infertility Evaluation Brief
- NU680 Unit 5: Seminar Reflection
- NU680 Unit 6: Genitourinary Syndrome Case Analysis
- NU680 Unit 7: Diagnostic Reasoning Paper
- NU680 Unit 9: Policy Brief
- NU680 Unit 10: Inclusive Care Plan
- MN501 Unit 8: Role Interview Write-up
- NU678 Unit 8: Case Presentation, Tardive Dyskinesia
- MN502 Unit 8: Theorist Comparison
- NU677 Unit 8: Capacity Assessment for Discharge Home
NU680 Unit 8 questions, answered
Is hormone therapy safe after risk-reducing surgery in a BRCA carrier?
For carriers who have not had breast cancer, the available studies have not shown a higher breast cancer risk with hormone therapy after the ovaries are removed, and menopause guidance supports offering it until the usual age of menopause. A paper should present this evidence and its limits.
Why do women with early surgical menopause need higher estrogen doses?
Their bodies lose ovarian hormones abruptly and years early, and the goal is to replace what the ovaries would have made, protecting bone and heart as well as relieving symptoms. Doses are often higher than those used for natural menopause in a woman of 55.
How is follow-up handled in a treatment decision paper?
State when you would reassess, what you would measure and what side effects or warning signs would change the plan. A follow-up visit within a few months is common, with longer-term checks for bone health.
Where can I find a free NU680 Unit 8 sample paper?
This page holds the complete NU680 Unit 8 treatment decision paper. It weighs hormone therapy against nonhormonal options for a composite 41-year-old BRCA1 carrier after risk-reducing surgery and documents her choice of estradiol with a levonorgestrel IUD.
Why does the NU680 Unit 8 patient need a progestogen?
She kept her uterus, so estrogen alone would raise the risk of endometrial hyperplasia and cancer. The levonorgestrel IUD protects the lining locally, which she chose after the exploratory finding on progestins was discussed.