Women's Health: Menopause Chapter 148 PDF

Women’s Health Chapter 148 MENOPAUSE Definition A normal life event that every woman will experience if she lives past age 50 Average of menopause (United States) is 52.54 years. The permanent decline in gonadal hormone levels confirmed by 12 months of amenorrhea ◦ Most American women will spend...

Women’s Health Chapter 148 MENOPAUSE Definition A normal life event that every woman will experience if she lives past age 50 Average of menopause (United States) is 52.54 years. The permanent decline in gonadal hormone levels confirmed by 12 months of amenorrhea ◦ Most American women will 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  No symptoms, but experience hormonal shift Perimenopause- typically lasts 6 years (occurs in the 40’s to early 50’s)  Begins with the onset of intermenstrual cycle irregularities and/or other menopause related symptoms and extends beyond menopause to include the 12 months after the FMP, thus lasting 1 year longer than the menopausal transition. Postmenopause  The period of life after menopause.  The time when a woman has not experienced a period for over 12 months.  Still at risk for pregnancy until they have been amenorrheic for 1 year Clinical Presentation of Menopause Symptoms may vary. Associated with a dramatic decline in estrogen levels causing a number of short- and long-term physical changes Cycle irregularity 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 Physical Exam Regular physical and preventive health examinations ◦ Most optimal time to begin is the perimenopausal period to recommend healthy lifestyle choices and discuss health risks in transition into late midlife. Begin discussion of risks and benefits of Hormonal Replacement therapy. Immunizations ◦ Influenza yearly, Tdap every 10 years, Varicella 2 doses if never had chickenpox, never received as child , or born after 1980. Hepatitis B vaccine 2, 3, or 4 doses depending on if you did not receive as a child, adolescent , until age 59 yrs. Shingles (herpes zoster) vaccine at or after age 50. ◦ Covid vaccines and boosters (recommendation of WHO and CDC) The Stages of Reproductive Aging Workshop (STRAW+10) document provides definition and description characterizing reproductive aging through menopause. North American Menopause Society has published preventative service guidelines. Management Smoking cessation Weight-bearing exercise Maintaining a normal body weight ◦ Healthy diet ◦ Vitamins and minerals: a balanced diet rich in fruits and vegetables Limiting alcohol intake Reducing stress levels Vasomotor symptoms Vaginal atrophy Pharmacotherapy ◦ Contraceptive therapy ◦ Hormones- HRT studies in research and recommendations ◦ Nonhormonal therapy- Complementary and Alternative Medicine (CAM) ◦ Bioidentical products  Complementary Alternative Medicine therapies Discuss the use of lifestyle changes and CAM interventions Discuss the following: Potential for side effects, Lack of long term clinical studies demonstrating efficiency/safety and Potential for drug/herb interactions Examples of herbal products: Soy, isoflavone, black cohosh, red clover, vitamin E and omega-3 fatty acids are popular to reduce VMS Inform women of lifestyle options such as the following to reduce CMS: ◦ A. dress in layers ◦ B. Lower room thermostat ◦ C. Maintain health weight ◦ D. Avoid smoking ◦ E. Avoid triggers such as hot drinks, caffeine, spicy foods, alcohol ◦ F. Use paced respirations (deep, slow, abdominal breathing) Immediate referral ! Is indicated for postmenopausal women with an intact uterus, who develop abnormal uterine bleeding or signs and symptoms suggestive of breast, ovarian, lung or colorectal cancer.