LW has a few factors that may affect her fertility and can potentially cause delays in her getting pregnant. LW is obese and has PCOS which is a known potential cause of infertility. I would advise the patient to start making lifestyle changes in order to increase her fertility and increase the chances of her getting pregnant. I would advise the patient to start taking folic acid supplements, attend pre-pregnancy preparation classes, and to begin exercising regularly (Melo et al., 2015). The fact that the patient is taking metformin may benefit the patient. This is because it will lower her glucose levels and may actually induce ovulation (Melo et al., 2015). Diet modifications and exercise can aid in weight loss and lower glucose levels as well as cholesterol levels (Melo et al., 2015). If the diet and exercise was successful and the patient’s cholesterol was improved, I would discontinue the rosuvastatin as this drug can be harmful to the unborn child (Lundberg & Mehta, 2018). I think that this suggestion would be best for the patient because with the proper lifestyle modifications the patient can lower her glucose and cholesterol levels, potentially lose weight, and have more success conceiving.
Benign prostatic hyperplasia is a prostate adenoma that causes some degree of obstruction to the bladder and patients may or may not experience symptoms (Vasanwala et al., 2017). In this scenario, I would check the patient’s blood pressure as the terazosin could cause a drop in blood pressure that could lead to lightheadedness and dizziness (Kim et al., 2016). Terazosin is a nonselective alpha blocker and can have many side effects such as syncope, dizziness, muscle weakness, fatigue, and nasal congestion (Kim et al., 2016). The symptoms that GD is complaining of seem to be common side effects of terazosin. The fact that the patient’s lower urinary tract symptoms are unimproved would lead me to ask the patient if he would like to try an alternative medication to improve his symptoms and avoid the side effects. I would suggest trying a different class of medication such as a 5-alpha reductase inhibitor (Kim et al., 2016). I believe that this would be the best suggestion because this medication is a different class and may provide the patient with more relief from his symptoms and have less side effects.
Kim, E. H., Larson, J. A., & Andriole, G. L. (2016). Management of benign prostatic hyperplasia. Annual Review of Medicine, 67(1), 137-151. doi:10.1146/annurev-med-063014-123902
Lundberg, G., & Mehta, L. D. (2018, May 14). Familial hypercholesterolemia and pregnancy. Retrieved February 03, 2021, from https://www.acc.org/latest-in-cardiology/articles/2018/05/10/13/51/familial-hypercholesterolemia-and-pregnancy
Melo, A. S., Ferriani, R. A., & Navarro, P. A. (2015). Treatment of infertility in women with polycystic ovary syndrome: Approach to clinical practice. Clinics (Sao Paulo, Brazil), 70(11), 765–769. https://doi.org/10.6061/clinics/2015(11)09
Vasanwala, F. F., Wong, M., Ho, H., & Foo, K. T. (2017). Benign prostatic hyperplasia and male lower urinary symptoms: A guide for family physicians. Asian journal of urology, 4(3), 181–184. https://doi.org/10.1016/j.ajur.2017.05.003