Women's Health - Menopause

Women's Health - Menopause

• Menopause is a normal life event for women who live past age 50.
• The average age of menopause in the United States is 52.54 years.
• Menopause is confirmed by 12 months of amenorrhea (no menstrual periods).
• Most American women spend nearly one-third of their lives in the postmenopausal period.

Terms Related to Menopause

• Premenopause: The time between the final menstrual period and the onset of perimenopause. Characterized by no symptoms, but hormonal shifts occur.
• Perimenopause: Typically lasts 6 years (occurring in the 40s to early 50s). It begins with intermenstrual cycle irregularities or other menopause symptoms and extends 1 year beyond menopause.
• Postmenopause: The period after menopause. Women have not experienced a period for over 12 months.

Clinical Presentation of Menopause

• Menopause is associated with a dramatic decline in estrogen levels which leads to various physical changes, both short and long term.
• Symptoms may vary but can include:
  • Irregular periods
  • Vasomotor symptoms (hot flashes, day sweats, night sweats)
  • Urogenital atrophy (vaginal dryness, urinary incontinence, pelvic floor dysfunction)
  • Mood changes
  • Poor sleep and sexual functioning
  • Abnormal uterine bleeding (most frequently reported perimenopausal symptom)

Symptoms of Menopause

• Menopause symptoms can include a variety of problems, some common ones mentioned are:
  • Anxiety, Depression, Headaches, Fatigue, and Weight gain in some cases
  • Other potential problems include Osteoporosis in some cases

Physical Exam

• Regular physical and preventive health exams during perimenopause are crucial.
• Lifestyle choices and health risks should be addressed during this time; Hormone Replacement Therapy benefits should be carefully considered and discussed.
  • Recommended Immunizations:
    • Yearly flu shot
    • Tdap every 10 years
    • Varicella (chicken pox)
    • Hepatitis B (if not received as a child/adolescent)
    • Shingles vaccine (age 50 or older)
    • COVID vaccines and boosters (as recommended by WHO and CDC)

Management

• Lifestyle changes are crucial for managing menopause symptoms:
  • Quit smoking
  • Exercise regularly (weight-bearing exercises are beneficial)
  • Maintain a healthy body weight
  • Balanced diet rich in fruits and vegetables, adequate vitamins and minerals
  • Limit alcohol
  • Reduce stress
• Pharmacotherapy options:
  • Contraceptive therapy
  • Hormone therapy (HRT) (with careful considerations)
    • Non-hormonal therapies (from complementary and alternative medicine)
    • Bioidentical hormones

Complementary & Alternative Medicine (CAM)

• Discuss CAM therapies with a doctor.
• Examples of herbal options include soy, isoflavones, black cohosh, and red clover. There are also others such as vitamin E and omega-3 fatty acids.
• Helpful lifestyle changes could include dressing in layers, lower room temperatures, maintaining a healthy weight, avoiding smoking, and limiting caffeine, spicy foods etc.

Immediate Referral

• Immediate referral is required if a postmenopausal woman with an intact uterus develops abnormal uterine bleeding or shows signs and symptoms suggesting breast, ovarian, lung, or colorectal cancer.