Week 9 – Initial Discussion Post – Holly Orme

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Hello Everyone, 

I would have posted this yesterday, however the blackboard was down and I was unable.

Nursing 6521; Advanced Pharmacology

Week 9 – Initial Post

Menopause is an unspoken, unattended, reality of life, the cause of
which is still not completely understood by human kind. Menopause
transition consists of fluctuating ovarian function and occurs 2 to 8
years before menopause and up to 1 year after the final menses. It is a
progressive process that eventually leads to persistent ovarian failure.
The change in hormones during this period is often responsible for the
clinical signs and symptoms that many women experience. Systems affected
by the perimenopausal phase include skin and hair, genitourinary (GU),
neuroendocrine, cardiovascular, and skeletal. A female ovary has the
greatest number of oocytes during the fifth month of gestation and has
about 1 to 2 million oocytes at birth. As a woman ages, the process of
atresia reduces the number of oocytes, so that at the time of menopause a
woman may have only a few hundred to a few thousand oocytes left. The
ovary primarily produces estrogen, progesterone, and androgens. World
Health Organization (WHO) has defined post-menopausal women as those
women who have stopped menstrual bleeding one year ago or stopped having
periods as a result of medical or surgical intervention
(Hysterectomy/Oophorectomy) or both. Another report by WHO states that
hot flushes are prevalent more in European and North American
populations as compared to Asians. Studies have shown that very few
women know the correct cause of menopause. According to literature, at
least 60% of women suffer from mild symptoms, 20% suffer severe
symptoms, and 20% from no symptoms (Tumbull, S., 2010). Prevalence of
symptoms have been reported as emotional problems (crying spells,
depression, irritability) 90.7%, headache 72.9%, lethargy 65.4%, dysuria
58.9%, forgetfulness 57%, musculoskeletal problems (joint pain, muscle
pain) 53.3%, sexual problems (decreased libido, dyspareunia) 31.8%,
genital problems (itching, vaginal dryness) 9.3%, and changes in voice
8.4%. Mahajan, et al, did a study in North India regarding health
issues of menopausal women and found that mean number of symptoms was
found to be increasing linearly with rising age of the study
subjects.  Menopause is a midlife stage which can be overcome easily or
make a woman miserable depending on her luck (and genetic
predisposition). This phase of life is shrouded with lots of myths and
taboos. Early recognition of symptoms can help in reduction of
discomfort and fears among the women. It is important to know the
symptomatology and reasons for menopause.

The prevalence of post-menopausal symptoms varies from women to woman
with the mean age of onset being approximately 48 – 49 years. There are
many misunderstandings regarding menopausal symptoms among even the
most educated of women, but creating awareness by disseminating health
education for postmenopausal women is of prime importance. Health
workers may be most useful in this area. When teaching patients about
menopause, we should emphasize it’s a normal event with varying
symptoms, which can be managed effectively through various pharmacologic
and nonpharmacologic therapies. As appropriate, follow up with them by
telephone to assess the effectiveness of management, help validate their
concerns, and provide additional support. Finally, stay up-to-date on
the current literature on menopause and women’s health so you can be
sure you’re using an evidence-based approach when counseling and
educating women

The degree of discomfort from symptoms should guide discussions about
treatment. Moderate dose estrogen-containing hormone therapy (HT) is
currently the most effective treatment for vasomotor symptoms (VMS) and
also improves vaginal dryness. The indication for HT is moderate to severe VMS in women without contraindications.
It should not be prescribed or continued for the treatment of chronic
disease. Gentro-urinary symptoms can effectively be treated with vaginal
(topical) estrogens. The dose, delivery system and duration of treatment for
HT should be individualised to relieve symptoms. For most healthy women
aged 50–59 years, the risks of HT are low. Several widely available
non-hormonal agents can treat VMS for those who should avoid or do not
wish to take estrogen. These include selected antidepressants and
gaba-agonists (Roberts, H., & Hickey, M. (2016).

With increasing life expectancy, women spend 1/3rd of life in this
phase. It is estimated that by the end of 2020 there will be 50 million
post menopausal women in the USA, necessitating a substantial amount of
care (Vaze, N. Joshi, S, 2010). Menopausal symptoms, though well
tolerated by some women, may be particularly troublesome in others.
Severe symptoms compromise overall quality of life for those
experiencing them. Management should be patient-centered, tailored to
the patient’s specific symptoms and risk profile. It may include
hormonal and nonhormonal pharmacologic therapies and various
nonpharmacologic approaches. Nurses can play a valuable role in teaching
patients about management options, as well as in screening women for
menopause symptoms and encouraging them to ask about treatment options.

References:

Borker, S. A., Venugopalan, P. P., & Bhat, S. N. (2013). Study of
menopausal symptoms, and perceptions about menopause among women at a
rural community in Kerala. Journal of mid-life health, 4(3), 182–187.
doi:10.4103/0976-7800.118997

Kulshreshtha B, Ammini A. Hormone replacement therapy. In: Sharma OP,
editor. Geriatric care: A textbook of geriatrics and gerontology. 3rd
ed. New Delhi: Viva Books Publishers; 2008. pp. 647–50. 

Mahajan N, Aggarwal M, Bagga A. Health issues of menopausal women in North India. J Midlife Health. 2012;3:84–7. 

Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86(2016), 53–58. https://doi.org/10.1016/j.maturitas.2016.01.007

Tumbull S. Yoga as a treatment for menopausal symptoms. J Yoga Ontogenet and Therap Investig. 2010;2:14–5. 

Vaze N, Joshi S. Yoga and menopausal transition. J Midlife Health. 2010;1:56–8. [PMC free article] [PubMed] [Google Scholar]

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