TEST 5 Flashcards
Define Menopause
the point in time in which there are been cessation of menstruation for at least 12 consecutive months. occurs in response to normal physiologic changes in the hypothalamic-pituitary-ovarian axis. occurs in most women between 48 and 55 . 51 y.o is average age for women in the western world.
Perimenopause : 3 common signs
menstrual bleeding changes, then ceases
vasomotor symptoms: the hot flush
vaginal symptoms: dryness is common Later, changes in architecture d/t lower levels of estrogen
other issues that may arise: sleeping problems, changes in mood or cognition, dyspareunia.
FSH changes
elevated FSH levels are measured to confirmed menopause. When a woman’s FSH blood level is consistently elevated to 30mlU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause
Estrogen changes
Estrone (E1) the weakest estrange is the primary estrogen present in postmenstrual women children and men. Estradiol (e2)<–placenta both are small amount
lifestyle management
dietary changes, exercise, vitamins, or supplements, vaginal lubricants and moisturizers, changes in clothing, smoking cessation, stress management techniques, sleep aids, and activities to enhance memory function
dietary changes
aggravates : refined sugar, caffeine, spicy foods, & alcohol
helps: water to augmented insensible loss of fluids through sweating.
exercise
lower activity level= forgetfulness, difficulty sleeping, heart pointing nor racing, stiffness or soreness.
increase activity level = reduced severity of menopausal symptoms such s vasomotor symptoms, depression, and forgetfulness.
also reduce CAD, osteoporosis risks, improves sleep, and assists with maintaining a healthy weight, relieving stress, reducing moodiness, and improving mental function.
vitamin & supplements
Calcium & vitamin D =postmenopausal women to maintain bone strength
vitamin E = small improvement or no change in hot flashes. = reduced risk for developing Alzheimer’s disease
B vitamins- reduce homocysteine level (associated with CAD) ,
increase fluid & veggies
AVOID IRON excess iron have negative effects on cardiovascular system or liver over time.
vaginal lubricants & moisturizers
lubricants (KY, Astroglide, Lubrin, Moist Again) for dryness & sexual activity.
moisturizers: replenish & maintain fluids in vaginal epithelial cell
V. E oil provide relief for dryness w/o interfere w/ condom or diaphragm function & rarely irritates tissues.
***CAUTION: vaseline can injure vaginal tissue and not easily removed.
douching is not effective for moisturizing & will remove normal flora & increase infection risks.
clothing & environment
layered clothes, breathable fabrics such as cotton or linen, or moisture-wicking fabrics =reduce discomfort with hot flash and sweat.
AVOID; turtlenecks, fabrics that do not allow circulation or absorb sweat.
smoking cessation
cause earlier age at menopause, increased rate of bone loss, and increased prevalence of all menopausal symptoms, except vaginal dryness.
stress management
stress increase menopause symptoms.
stress=poor sleep depression or moodiness
manage: exercise, meditation, relaxation techniques deep breathing, yoga, tai chi taking bath, reading having massage, seeking support from friends or activities r/t spirituality or religion.
sleep
sleep disruption r/t hot flashes or other menopausal symptoms.
manage: light blankets, cotton sleepwear, well ventilated room
* *it is also important to educate women that they require less sleep as they age.
mental function
slow decline in mental function is expected with aging.
management: use memory aids noting appointment and date writing list to use for complete tasks work activities or shopping. participating in activity that keep mind engaging
hormonal medications used for contraception in reproductive age women
a. estrogen plus progesterone therapies (combined methods) like combined oral contraceptive pills (COCPs), Nuvaring, Evra patch.
b. progesterone-only therapies like progestogen only pills (POPs), DepoProvera, Implanon, the levonorgestrel-releasing intrauterine system (Mirena)
c. These can be used from menarche through menopause (by appropriate candidates)
hormonal medications used for POSTMENOPAUSAL:
Estrogen only therapies
Estrogen-only therapies for women WITHOUT UTERUS; these regimens are sometimes called unopposed estrogen which would increase the risk of endometrial cancer if post menopausal woman with a uterus used them.
hormonal medications for POSTMENOPAUSAL : estrogen plus progesteron therapy
for women WITH UTERUS; the progesterone is really only for the purpose of endometrial protection
what is the different between contraceptive & hormonal therapy (HT) if they both composed of estrogen and progesterone ?
contraceptives higher dosage than HT (contraceptive does are high to suppress woman’s ovaries almost completely that’s why they work to stop ovulation & prevent pregnancy.
HT doses are little enough to control symptoms like hot flashes or vaginal dryness.
smokers shouldn’t take estrogen -containing contraceptive between 35 or 40 y.o. and menopause but that same woman would be permitted to use hormone therapy after menopause, even if she cont. smoking
HT systemic dosing (oral, transdermal, and ONE PARTICULAR vaginal therapy called FEMRING) is larger than local treatments like vaginal creams or the vaginal ring that contain estrogen called ESTRING
What do perimenopausal women use ?
–>symptomatic time lead up to menopause (which is the final menstrual period/FMP) and for about a year after then FMP
until a women is absolutely menopausal (it’s been one year since her FMP) its still possible for her to get pregnant so she would need CONTRACEPTIVE THERAPY rather than HT
contraceptive therapies are often used during the perimenopause not only to provide contraception to women who still might get pregnant, but also for symptom-relief for issues like hot flashes and irregular bleeding patterns.
Remember that these women are generally between 45 and 55 y.o. and while many women in this age range are healthy and do not smoke and so are candidates for estrogen-containing contraceptive medication; you need to adhere to careful prescribing practices.
Get into the habit of checking Medical Eligibility Criteria for each method along with woman’s age and any other pertinent aspects of her history.
testosterone
circulating levels of testosterone remain relatively CONSTANT in women who are either perimenopausal or postmenopausal, partly d/t the presence of high FSH & LH levels, which stimulate the ovarian stromal tissues to increase their testosterone production
pharmacologic options to management of menopausal symptoms
oral estrogen, transdermal and topical estrogens, oral progestogens, oral combination estrogen-progestogen products, transdermal combination estrogen-progestogen products, antidepressant, anticonvulsants, antihypertensives, estrogen vaginal creams, tablets, and ring. Progestogen gels and IUD (levonorgestrel)
complementary & alternative therapies
Black Cohosh - vasomotor symptoms
chastetree berry- menstrual irregularity
dong quai- gynecologic conditions
evening primrose oil- hot flashes, mastalgia
Ginkgo- memory change
Ginseng- general tonic improved mood, fatigue
Kava- irritability and insomnia
Licorice root- menopause-related symptoms
passion flower- sedative
St. Johns Wort- vasomotor symptoms, irritability, and depression
Valerian root- sedative antianxiety
Wild Yam- Menopausal symptoms
Hormone therapy
encompassing term for ET/EPT
Estrogen-Progesterone Therapy (EPT)
used for women who HAVE NOT HAD HYSTERECTOMY. Progestogen is added for endometrial protection. It is common to have break through bleeding when using a combination of estrogen and progestogen unless used as a continuous regimen on a daily basis.
Estrogen Therapy (ET)
exclusively for client have HAD HYSTERECTOMY, due to the increased risk of endometrial hyperplasia and cancer. Estrogen therapy can be prescribed systemically as an oral tablet or as a transdermal patch. Additionally, ET is available as a local preparation as cream, tablet or rings.
Vaginal atrophy treatment
vaginal estrogens ( ring or creams) which treat only vaginal atrophy. These are NOT systemic or systemic absorption is very small, so even women with an endometrium can use those w/o adding a progestogen for treating symptoms of vaginal atrophy NOT vasomotor symptoms.
systemic estrogen
pills patches creams sprays and one type of vaginal ring, will treat both vasomotor symptoms AND vaginal atrophy, but must be given with a progestogen if she has a uterus.
Combined hormonal contraception
in addition to providing contraception in the perimenopausal years, can help with both vaginal atrophy and vasomotor symptoms, but the doses are larger than the doses for menopausal symptoms alone. But you cannot give combined hormonal contraception (OCPs, contraceptive ring, or contraceptive patch) to smoker over age 35.
absolute contraindication to estrogen
known or suspected cancer of the breast
known or suspected estrogen-dependent neoplasia
hx. uterine or ovarian cancer
hx of coronary artery disease or stroke
hx of biliary tract disorder
undiagnosed, abnormal genital bleeding
hx. of or active thrombophlebitis or thromboembolic disorders
absolute contraindications to progestogen use
active thrombophlebitis or thromboembolic disorders liver dysfunction or disease known or suspected cancer of the breast undiagnosed abnormal vaginal bleeding pregnancy
