Week 9 – Initial Discussion Post – Holly Orme
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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.
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.