Menopause Psychosocial Impact PDF 2024 Bahrain

RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn Menopause: Psychosocial Impact Class Year 2 Direct Entry Medicine Bahrain Course Endocrinology and Breast Lecturer Dr Sally Doherty Date February 2024 Case study Samah is a 33-year old patient, who ha...

RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn Menopause: Psychosocial Impact Class Year 2 Direct Entry Medicine Bahrain Course Endocrinology and Breast Lecturer Dr Sally Doherty Date February 2024 Case study Samah is a 33-year old patient, who has reported feeling tired, irritable and feeling hot and flushed. At her GP appointment, she is hoping she may be pregnant, but the GP informs her she is going through premature ovarian insufficiency. Her mother is suspected of having also gone through early menopause. Samah is very upset by this news, in addition to her personal hopes, her mother-in-law had placed a significant amount of pressure on her to start having children. Learning outcomes What is menopause? Describe the psychosocial impact of menopause Describe strategies to support patients in managing the psychosocial effects of menopause What is menopause? Every person is unique and will experience menopause in their own way Menopause as defined by the WHO as the permanent cessation of menstruation resulting from loss of ovarian follicular activity. The word menopause is an overall term that includes perimenopause, post menopause, early menopause, premature menopause, and induced menopause. Menopause is a natural process and an unavoidable part of life for all those who experience menstrual periods. It is influenced by hormonal changes and hormonal decline. This transition usually happens between 45 and 55 years of age with the average age for menopause in Ireland and Europe being 51 years. Individuals will on average experience menopause for 1/3 of their life expectancy. Menopause is not an illness Menopause is not an illness, but the natural end of female fertility. As women age, the production of the sex hormones oestrogen and progesterone in the ovaries slows down, and the ovaries stop producing eggs. Menopause begins when a woman stops having her menstrual period for 12 consecutive months. It is a process that naturally happens between the ages of 45 – 55 years, although it can occur as early as in the 30s, and as late as in the 60s. https://www.gleneagles.com.sg/conditions-diseases/menopause/symptoms-causes Stages of menopause Individuals will undergo 3 stages of the menopause process: 1.Perimenopause or menopause transition Eight to 10 years prior to menopause, women in their 40s begin to experience perimenopause when their ovaries begin to produce less oestrogen. 2.Menopause When a woman no longer has menstrual periods for 12 consecutive months, she enters the menopause stage 3.Postmenopause menopausal symptoms begin to ease for most women  Jane, 57, says she felt uncomfortable working in an office environment when she went through the menopause as she struggled with hot flushes, but didn't feel like she could speak to her manager about it. She also felt exhausted as she couldn't sleep, which made work and socialising more difficult. "I felt like I just wanted to hide at home, where I could open the windows and relax without worrying about what people were thinking," she says. "When I finally chatted to friends about my symptoms, I realised I wasn't the only one struggling - and it really helped me. I felt like I didn't have to cover up what I was going through. How to support someone during the menopause | Patient https://health.usf.edu/care/diabetes- endocrinology/services-specialties/hormone  Menopause symptoms Hair loss or thinning Mood swings Weight gain Depression Brittle nails Psychological Anxiety Vaginal dryness symptoms Irritability Dyspareunia Difficulty concentrating Sleep disorders, Memory lapses including insomnia Loss of libido Fatigue Dizziness Recurrent urinary tract infections Incontinence Physical Vasomotor Hot flashes symptoms symptoms Breast pain Night sweats Headaches Joint pain Irregular periods Palpitations Learning outcomes What is menopause? Describe the psychosocial impact of menopause Describe strategies to support patients in managing the psychosocial effects of menopause Psychosocial impact of menopause The biopsychosocial model of menopause Psychological perspectives on menopause include the meanings and appraisals of symptoms to menopause, as well as cognitive, affective and behavioural reactions to the menopause. Social factors include socioeconomic and demographic variables, lifestyle and work settings, as well as roles and stressful life events. Psychosocial impact: knowledge Tariq et al., 2023 Psychosocial impact: knowledge Menopause knowledge refers to the degree of understanding changes in the body as a transition from a potentially reproductive to a non-reproductive state. Higher knowledge levels about menopause is associated with improved quality of life. Lower knowledge is thought in increase negative attitudes. Barriers to knowledge include lack of information, social stigma, shame Psychosocial impact: attitudes Tariq et al., 2023 Psychosocial impact: attitudes Menopause attitude means evaluative opinions, communication, and mental changes about menopause, and includes expressed feelings and thoughts about certain matters and mental attitudes as readiness to respond to certain situations or objects Negative attitude about menopause have been associated with worse symptomology Positive attitude has been associated with better menopause symptom management Psychosocial impact: cultural attitudes Cultural differences exist about how society view menopause “ Sinu Al- Amal” “the change” Year of hope Middle east Ireland & (Bahrain) UK Psychosocial impact: cultural attitudes Menopause symptoms can also vary culture. The most common symptom of menopause cross culturally is purely a physiological phenomenon – hot flashes Studies have repeatedly noted differences in rates of symptoms, based on country of residence & reported distress about menopause symptoms Example: Nappi et al., (2021) found women from Japan reported less frequent hot flashes (3/day) compared to European women (4.6/day). Women in Japan also reported less distress about symptoms. Why do you believe this happens? Psychosocial impact: cultural differences Why? 1. Differences in diet e.g. soy is thought to reduce menopause symptoms and is more common in Japanese diets compared to European diet. 2. Lifestyle, more exercise and lower rates of smoking/drinking may improve symptoms, this can vary by culture. 3. Cultural attitudes, cultural attitudes are not uniform and social positive/negative attitudes can affect individual perception e.g. in Japan, menopause is not as stigmatised as it is in Europe, and the more positive attitude may improve individual's views on the symptoms. Psychosocial impact: workplace Fawcett report 2022 in the UK of 4000 participants; 73% reported experiencing “brain fog” 77% reported at least one symptom that was “very difficult” to manage. 44% of those with jobs that were semi-skilled or unskilled manual labour, noted 3+ symptoms that were “very difficult” to manage. 1 in 10 left a job due to their menopause symptoms. 14% reduced hours, 14% went part-time & 8% didn’t go for promotion due to the symptoms on menopause. 8 in 10 said workplace had no menopause absence policy. Psychosocial impact: depression Depressive episodes following menopause have long been recognised. Originally they were theorized this was due to; Women’s grief over the loss of their fertility x The “empty nest syndrome” as adult offspring moved away from the family home x Diathesis-stress model Depressive symptoms are hypothesized to occur as a combination of pre-dispositional vulnerability (diathesis) in combination with negative life events (stress) In the case of menopause, perimenopausal women experience changes in hormone levels (diathesis), and this in combination with negative life events, increases risk for depressive symptoms. Psychosocial impact: depression Evidence suggests menopausal vasomotor symptoms increase odds of reporting depressive symptoms between 2-to 8-fold Growing evidence shows that behavioural interventions for menopause are effective, and address menopause symptoms in a way hormone treatments alone cannot. Learning outcomes What is menopause? Describe the psychosocial impact of menopause Describe strategies to support patients in managing the psychosocial effects of menopause Issues to be considered to deliver menopause- related holistic care https://www.nature.com/articles/s41574-022-00685-4 Evidence based research studies A recent survey of 4,000 perimenopausal and menopausal women conducted by the Fawcett Society in Great Britain, for instance, found that 45% of women had never talked with their general practitioner about their menopause-related symptoms, while 31% received a proper diagnosis of their menopausal symptoms only after multiple visits to their provider—signs of continued stigma and lack of patient and provider education. The longitudinal Study of Women’s Health Across the Nation, or SWAN, which began in 1996 with a cohort of 3,302 women across seven sites and is now in its 17th round of data collection. It continues to reveal new information about the physiology, biology, psychology, and social aspects of menopause, https://www.apa.org/monitor/2023/09/easing-transition-into- menopause#:~:text=Fortunately%2C%20there%20are%20myriad%20ways,health%3B%20and%20health%20care%20provider Physical interventions symptom areas that can impact quality of life: sleep trauma hot flashes. Cognitive behavioral therapy for insomnia (CBT-I) and brief behavioral therapy for insomnia (BBT-I) have both proven effective during menopause, including for women with hot flashes Cognitive Behavioural therapy Cognitive behaviour therapy is a brief, non-medical approach that can be helpful for a range of health problems- ✓anxiety and stress, ✓depressed mood ✓hot flushes and night sweats, ✓sleep problems and fatigue CBT helps people to develop practical ways of managing problems and provides new coping skills and useful strategies. https://www.womens-health-concern.org/wp-content/uploads/2023/02/02-WHC-FACTSHEET-CBT-WOMEN-FEB-2023-A.pdf Remember – anxious/stressful thoughts are not facts but are just one view of a situation. Ask yourself: Is there really a threat? What would a calm person think in this situation? What would you say to a close friend if they were in this situation? Have I managed similar situations before? As with anxiety and stress – remember that depressive thoughts are not facts but are just one view of a situation. Ask yourself: Is this view of myself really accurate? What would a close friend/ family member say to me? What would a self-supportive alternative be? For example, instead of ‘I’m not good enough’, ask yourself who is saying this and what is the evidence – we are usually harder on ourselves that we need be. Talking to other people can help to gain a helpful perspective. Small changes such as gradually doing things that you have enjoyed, or new things, and writing down three things that went well at the end of each day (however small) can lift mood and improve wellbeing. An important part of CBT is to encourage people to value their own qualities, strengths and competencies. If problems are persistent, e.g. financial, health, housing etc, then ‘problem-solve’ considering all options with someone else, and seek practical help and advice. https://www.womens-health-concern.org/wp-content/uploads/2023/02/02-WHC-FACTSHEET- CBT-WOMEN-FEB-2023-A.pdf Cognitive and behavioural therapy (CBT) Cognitive and behavioural strategies Paced breathing is an important part of the CBT approach for hot flushes. As with any skill it requires regular practice – breathing from your stomach. At the onset of a flush – relax your shoulders – breathe slowly from your stomach – concentrate on your breathing. Paced breathing involves focusing on your breathing, accepting that the hot flush will pass and just letting the hot flush flow over you. https://www.shecares.com/menopause/menopause-stress Workplace and practical social interventions Guide developed by Irish Civil service for menopause support, as guide for managers to staff. Workplace and practical social interventions High priority placed on the mental health symptoms of menopause, and supporting them in the workplace. Http://assets.gov.ie Guidance on understanding and improving menopause support in the workplace https://www.nhsemployers.org/articles/menopause-and-workplace video interesting  6 Unexpected Benefits You’ll Be Happy to Know About 1. No more periods 2. no more stress about PMS ( premenstrual symptoms, That can Menopause include irritability, fatigue, changes in appetite, depression, anxiety, bloating, and breast tenderness). 3.The End of Menstrual Headaches 4. Sex Without Pregnancy Worries 5. Uterine Fibroids Shrink 6. Increased Confidence and Inner Strength https://www.everydayhealth.com/menopause-pictures/positives-of- menopause.aspx Conclusions Menopause is unique to each individual but, is commonly associated with challenging symptoms. Individual and societal knowledge/attitudes can affect how menopause is experienced. Menopause can be disruptive psychologically and socially. Interventions focus on a number of areas; physical, cognitive, workplace. Resources https://www.nhsinform.scot/healthy-living/womens-health/later-years- around-50-years-and-over/menopause-and-post-menopause- health/menopause-and-your-mental-wellbeing/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8746897/pdf/menop- 28-875.pdf https://www.everydayhealth.com/menopause-pictures/positives-of- menopause.aspx https://link.springer.com/article/10.1007/s00404-019-05238-1 https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s1290 5-023-02424-x#Sec7