Menopausal Transition PDF

1/9/24, 2:50 AM Realizeit for Student Menopausal transition Menopause is a natural process that occurs in all women’s lives as part of normal aging. Meno is derived from the Greek word for “month,” and pause is derived from the Greek word for “pause” or “halt.” Menopause is the technical term for...

1/9/24, 2:50 AM Realizeit for Student Menopausal transition Menopause is a natural process that occurs in all women’s lives as part of normal aging. Meno is derived from the Greek word for “month,” and pause is derived from the Greek word for “pause” or “halt.” Menopause is the technical term for a point in time at which menses and fertility cease (Chelmow et al., 2019). People call it many things: The change of life. The end of fertility. The beginning of freedom. Whatever people call it, menopause is a unique and personal experience for every woman. The term menopausal transition refers to the transition from a woman’s reproductive phase of her life to her final menstrual period. This period is also referred to as perimenopause. The average age of natural menopause, defined as 1 year without a menstrual period, is 51.4 years old. The average age of natural menopause has remained constant for the last several hundred years despite improvements in nutrition and health care (Woods & Utian, 2018). With current female life expectancy at 84 years, this event comes in roughly the middle of a woman’s adult life. Many women go through the menopausal transition with few or no symptoms, while some have significant or even disabling symptoms. Take Note! Humans are virtually the only species to outlive their reproductive capacities. Menopause signals the end of an era for many women. It concludes their ability to reproduce, and some women find advancing age, altered roles, and these physiologic changes to be overwhelming events that can precipitate depression and anxiety (Webster et al., 2018). Menopause does not happen in isolation. Midlife is often experienced as a time of change and reflection. Change happens in many arenas; children are leaving or returning home, employment pressures intensify as career moves or decisions are required, older adult parents require more care or the death of a parent may have a major impact, and partners are retrenching or undergoing their own midlife changes. Women must negotiate all these changes in addition to menopause. Managing this stress can be challenging for many women as they make this transition. A woman is born with approximately 2 million ova, but only about 400 ever mature fully to be released during the menstrual cycle. The absolute number of ova in the ovary is a major determinant of fertility. Over the course of her premenopausal life, there is a steady decline in the number of immature ova (Strauss et al., 2018). No one understands this depletion, but it does not occur in isolation. Maturing ova are surrounded by follicles that produce two major hormones: estrogen, in the form of estradiol, and progesterone. The cyclic maturation of the ovum is directed by the hypothalamus. The hypothalamus triggers a cascade of neurohormones, which act through the pituitary and the ovaries as a pulse generator for reproduction. This hypothalamic–pituitary–ovarian–uterine axis begins to break down long before there is any sign that menopause is imminent. Some scientists believe that the pulse generator in the hypothalamus simply degenerates; others speculate that the ovary becomes more resistant to the pituitary hormone FSH and simply shuts down (Webster et al., 2018). The final act in this well-orchestrated process is amenorrhea. As menopause approaches, more and more of the menstrual cycles become anovulatory. This period of time, usually 2 to 8 years before cessation of menstruation, is termed perimenopause (Gompel, 2018). In perimenopause, the ovaries begin to fail, producing irregular and missed periods and an occasional hot flash. When menopause finally appears, viable ova are gone. Estrogen levels plummet by 90%, and estrone, produced in fat cells, replaces estradiol as the body’s main form of estrogen. The major hormone produced by the ovaries during the reproductive years is estradiol; the estrogen found in postmenopausal women is estrone. Estradiol is much more biologically active than estrone (Oyelowo & Johnson, 2018). In addition, testosterone levels decrease with menopause. With its dramatic decline in estrogen, menopausal transition affects not only the reproductive organs, but also other body systems: Brain and central nervous system: hot flashes, disturbed sleep, mood, and memory problems Cardiovascular: lower levels of high-density lipoprotein (HDL) and increased risk of CVD Skeletal: rapid loss of bone density that increases the risk of osteoporosis Breasts: replacement of duct and glandular tissues by fat Genitourinary: vaginal dryness, stress incontinence, cystitis Gastrointestinal: less absorption of calcium from food, increasing the risk for fractures Integumentary: dry, thin skin and decreased collagen levels Body shape: more abdominal fat; waist size that swells relative to hips Therapeutic Management Menopausal transition should be managed individually. In the past, despite the wide diversity of symptoms and risks, the traditional reaction was to reach for the one-size-fits-all therapy: hormone therapy (HT). A number of treatment options are available, but factors in the client’s history should be the driving force when determining therapy. Women need to educate themselves about the latest research findings and collaborate with their health care providers on the right menopause therapy. The following factors should be considered when planning management: The risk/benefit ratio is highest in younger women who begin HT not long after menopause. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zUraqIasLrohurDGqXpGq6QB9gdqiPJLc88OmWKG9Kloy4LbjaH… 1/3 1/9/24, 2:50 AM Realizeit for Student HT is approved for two indications: relief of vasomotor symptoms and prevention of osteoporosis. Research suggests that HT may be beneficial for preventing diabetes, improving mood, or avoiding urinary tract problems. Using HT long beyond menopause carries increased risks, which for some women may be outweighed by the benefits (Delamater & Santoro, 2018). Many women consider nonhormonal therapies such as bisphosphonates and selective estrogen receptor modulators (SERMs). Consider weight-bearing exercises, calcium, vitamin D, smoking cessation, and avoidance of alcohol to treat or prevent osteoporosis. Regular breast examinations and mammograms are essential. Local estrogen creams can be used for vaginal atrophy. BOX 4.9 COMMON SYMPTOMS OF MENOPAUSE Hot flashes or flushes of the head and neck Dryness in the eyes and vagina Personality changes Anxiety and/or depression Loss of libido Decreased lubrication Weight gain and water retention Night sweats Atrophic changes—loss of elasticity of vaginal tissues Fatigue Irritability Poor self-esteem Insomnia Stress incontinence Heart palpitations Adapted from The North American Menopause Society (NAMS). (2020). Women’s health and menopause FAQs. Retrieved June 16, 2020, from http://www.menopause.org/for-women/expert-answers-to-frequently-asked-questions-about-menopause/women-s-health-and-m symptoms and relief. Retrieved May 22, 2018, from https://www.womenshealth.gov/menopause/menopause-symptoms-and-relief; and American College of Obstetricians and Gynecologists (ACOG). (2018c). Practice Bulletin No. 141: Management of menopausal symptoms Managing Hot Flashes and Night Sweats The emergence of hot flashes and night sweats (also known as vasomotor symptoms) coincides with a period in life that is also marked by dynamic changes in hormone and reproductive function that interconnect with the aging process, changes in metabolism, lifestyle behaviors, and overall health (Oyelowo & Johnson, 2018). Hot flashes and night sweats are classic signs of estrogen deficiency and the predominant complaint of perimenopausal women. A hot flash is a transient and sudden sensation of warmth that spreads over the body, particularly the neck, face, and chest. Hot flashes are caused by vasomotor instability. This instability causes inappropriate peripheral vasodilation of superficial blood vessels, which gives the sensation of heat. COMPLEMENTARY AND ALTERNATIVE THERAPIES FOR MANAGEMENT OF HOT FLASHES Many women are choosing alternative treatments for managing menopausal symptoms. Bioidentical hormones have the ability to bind to receptors in the human body and function in the same way as a woman’s natural hormones. They simulate three estrogens (estradiol, estriol, and estrone), as well as progesterone, testosterone, dehydroepiandrosterone (DHEA), thyroxine, and cortisol. Bioidentical hormones are not, however, natural hormones. The estrogens are derived via a chemical process from soybeans (Glycine max) and progesterone from Mexican yam (dioscorea villosa). As with conventional hormones, however, bioidentical hormones are available only with a physician’s prescription and through a pharmacy. Managing Urogenital Changes Menopausal hormonal changes are relevant to the causes of sexual dysfunction during reproductive aging. The frequency of sexual intercourse declines as women enter midlife. While partner availability and function may play a role, menopausal symptoms, such as vaginal dryness, are also present (Bachmann, 2018). Vaginal atrophy occurs during menopause because of declining estrogen levels. These changes include thinning of the vaginal walls, an increase in pH, irritation, increased susceptibility to infection, dyspareunia (difficult or painful sexual intercourse), loss of lubrication with intercourse, vaginal dryness, and a decrease in sexual desire related to these changes. Decreased estrogen levels can also influence a woman’s sexual function as well. Delayed clitoral reaction, decreased vaginal lubrication, diminished circulatory response during sexual stimulation, and reduced contractions during orgasm have all been linked to low estrogen levels. Genitourinary tract disorders susceptible to estrogen deficiency are progressive and worsen over time (Casarotti et al., 2018). Management of these changes might include the use of estrogen vaginal tablets (Vagifem) or Premarin cream; Estring, an estrogen-releasing vaginal ring that lasts for months; testosterone patches; and over-the-counter moisturizers and lubricants (Astroglide) (Skidmore-Roth, 2020). A positive outlook on sexuality and a supportive partner are also needed to make the sexual experience enjoyable and fulfilling. Nurses can improve the sexual health and quality of life in menopausal women by educating them about their symptoms and offering them choices about managing them. Preventing and Managing Osteoporosis https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zUraqIasLrohurDGqXpGq6QB9gdqiPJLc88OmWKG9Kloy4LbjaH… 2/3 1/9/24, 2:50 AM Realizeit for Student Osteoporosis is the state of diminished bone density. This disorder is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility (National Osteoporosis Foundation [NOF], 2020). Women are greatly affected by osteoporosis after menopause. Bone mass declines to such an extent that fractures can occur with minimal trauma. Bone loss begins in the third or fourth decade of a woman’s life and accelerates rapidly after menopause (Levin et al., 2018). This condition puts many women into long-term care with a resulting loss of independence. Two of the major risk factors for coronary heart disease are hypertension and dyslipidemia. Both are modifiable and can be prevented by lifestyle changes and if needed, controlled by medication. This is why prevention is essential. In addition, women who experience early menopause lose the protection afforded by endogenous estrogen to the cardiac system and are at greater risk for more extensive atherosclerosis. Major preventive strategies include a healthy diet, increased activity, exercise, smoking cessation, decreased alcohol intake, and weight reduction. The nurse is often a woman’s first and most consistent point of contact within the health care system. Nurses who work in primary care settings can identify women at risk for CVD, counsel them about their risk factors, and encourage and initiate primary and secondary prevention strategies. Nurses, particularly those caring for women during their reproductive years, are uniquely positioned to provide education and support for women’s long-term cardiovascular health. Nursing Management There is no “magic bullet” in managing menopause. Nurses can counsel women about their risks and help them prevent disease and debilitating conditions with specific health maintenance education. Women should make their own decisions, but the nurse should make sure they are armed with the facts to do so intelligently. Nurses can offer a thorough explanation of the menopausal process, including the latest research findings, to help women understand and make decisions about this inevitable event. If the woman decides to use HT to control her menopausal symptoms after being thoroughly educated, she will need frequent reassessment. There are no hard-and-fast rules that apply to meeting a woman’s individual needs. The nurse can provide realistic expectations of the therapy to reduce the woman’s anxiety and concerns. It is also useful to emphasize the value of friends to gain support and share information and resources. Often just talking about emotional difficulties such as the death of a parent or problematic relationships helps solve problems. It also shows the woman that her emotional responses are valid. Healthy lifestyles and stress management techniques are vital to health and longevity, and it is important to keep these on the client’s agenda when discussing menopause (The North American Menopause Society, 2020). Evidence-based interventions include lifestyle modifications, risk management therapies, and preventive drug interventions, such as: Participate actively in maintaining health. Stay current on health screenings and vaccinations. Exercise regularly to prevent CVD and osteoporosis. Take supplemental calcium and eat appropriately to prevent osteoporosis. Stop smoking to prevent lung and heart disease. Reduce caffeine and alcohol intake to prevent osteoporosis. Monitor blood pressure, lipids, and diabetes (drug therapy management). Use low-dose aspirin to prevent blood clots. Reduce dietary intake of fat, cholesterol, and sodium to prevent CVD. Maintain a healthy weight for body frame. Perform breast self-examinations for breast awareness. Control stress to prevent depression (Office on Women’s Health, 2019). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zUraqIasLrohurDGqXpGq6QB9gdqiPJLc88OmWKG9Kloy4LbjaH… 3/3