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Menopause..The Big M With Ease!

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Menopause..The Big M With Ease!

  1. 1. Lauren Dansereau NPWestern New England College Health Services
  2. 2. Menopause.. The Big “M”With Ease !Lauren Dansereau NPWestern New England College Health Services
  3. 3. Peri menopause
  4. 4. Peri menopause• Menopause transition (peri-menopause)
  5. 5. Peri menopause• Menopause transition (peri-menopause)• The physical signs of menopause begin
  6. 6. Peri menopause• Menopause transition (peri-menopause)• The physical signs of menopause begin• Estrogen gradually decline
  7. 7. Peri menopause• Menopause transition (peri-menopause)• The physical signs of menopause begin• Estrogen gradually decline• Irregular periods, hot flashes, sleep disturbances, mood swings, low sex drive and vaginal dryness
  8. 8. Peri menopause• Menopause transition (peri-menopause)• The physical signs of menopause begin• Estrogen gradually decline• Irregular periods, hot flashes, sleep disturbances, mood swings, low sex drive and vaginal dryness• 6-10 years
  9. 9. Peri menopause• Menopause transition (peri-menopause)• The physical signs of menopause begin• Estrogen gradually decline• Irregular periods, hot flashes, sleep disturbances, mood swings, low sex drive and vaginal dryness• 6-10 years• 1 year
  10. 10. Peri menopause• Menopause transition (peri-menopause)• The physical signs of menopause begin• Estrogen gradually decline• Irregular periods, hot flashes, sleep disturbances, mood swings, low sex drive and vaginal dryness• 6-10 years• 1 year
  11. 11. Confirming Menopause
  12. 12. Confirming Menopause• Menopause is a normal, natural life event.
  13. 13. Confirming Menopause• Menopause is a normal, natural life event.• End of fertility
  14. 14. Confirming Menopause• Menopause is a normal, natural life event.• End of fertility• Average at age 51
  15. 15. Confirming Menopause• Menopause is a normal, natural life event.• End of fertility• Average at age 51• Final menstrual period (absence of 12 consecutive periods)
  16. 16. Confirming Menopause• Menopause is a normal, natural life event.• End of fertility• Average at age 51• Final menstrual period (absence of 12 consecutive periods)• Experience moderate to severe hot flashes or other menopausal symptoms
  17. 17. Confirming Menopause• Menopause is a normal, natural life event.• End of fertility• Average at age 51• Final menstrual period (absence of 12 consecutive periods)• Experience moderate to severe hot flashes or other menopausal symptoms• Have lost bone mass and either arent able to tolerate other treatments or arent benefitting from other treatments
  18. 18. Confirming Menopause• Menopause is a normal, natural life event.• End of fertility• Average at age 51• Final menstrual period (absence of 12 consecutive periods)• Experience moderate to severe hot flashes or other menopausal symptoms• Have lost bone mass and either arent able to tolerate other treatments or arent benefitting from other treatments• Stopped having periods before age 40 (premature menopause) or lost normal function of your ovaries before age 40 (premature ovarian failure)
  19. 19. Induced and Premature Menopause
  20. 20. Induced and Premature Menopause• Induced: At any age, no menstrual periods due to a medical intervention
  21. 21. Induced and Premature Menopause• Induced: At any age, no menstrual periods due to a medical intervention• Premature: Age 40 or younger. Result of genetics, autoimmune disorders, or medical conditions
  22. 22. Induced and Premature Menopause• Induced: At any age, no menstrual periods due to a medical intervention• Premature: Age 40 or younger. Result of genetics, autoimmune disorders, or medical conditions• CONCERNS.......
  23. 23. Induced and Premature Menopause• Induced: At any age, no menstrual periods due to a medical intervention• Premature: Age 40 or younger. Result of genetics, autoimmune disorders, or medical conditions• CONCERNS.......• Abrupt loss of estrogen intense menopause changes---> more increased need for treatment of symptoms. Younger women- increased risk of osteoporosis and heart disease, must be monitored closely and treated.
  24. 24. Hot Flashes
  25. 25. Hot Flashes• The most common discomfort is the “hot flash/hot flush”
  26. 26. Hot Flashes• The most common discomfort is the “hot flash/hot flush”• Changes in hypothalamus (gland which regulates body temperature) The Hyopothalamus senses body heat, attempts to cool down Blood flows to surface to dissipate heat. Pulse rate and perspiration increase. Chills may follow.
  27. 27. Hot Flashes• The most common discomfort is the “hot flash/hot flush”• Changes in hypothalamus (gland which regulates body temperature) The Hyopothalamus senses body heat, attempts to cool down Blood flows to surface to dissipate heat. Pulse rate and perspiration increase. Chills may follow.• Hot flashes usually stop on their own over time without treatment.
  28. 28. Hot Flashes• The most common discomfort is the “hot flash/hot flush”• Changes in hypothalamus (gland which regulates body temperature) The Hyopothalamus senses body heat, attempts to cool down Blood flows to surface to dissipate heat. Pulse rate and perspiration increase. Chills may follow.• Hot flashes usually stop on their own over time without treatment.• Treatments: lifestyle changes, nonprescription remedies, prescription remedies-estrogen and progesterone, antidepressants, Neurontin-(anti- seizure medication), Clonidine- (BP medication).
  29. 29. What About Supplements?
  30. 30. What About Supplements?• “Natural” remedies marketed as “dietary” supplements (including even topical progesterone cream and other nonprescription hormone treatments) Black cohosh, licorice, don quai, wild yam, evening primrose, are not (FDA) approved
  31. 31. What About Supplements?• “Natural” remedies marketed as “dietary” supplements (including even topical progesterone cream and other nonprescription hormone treatments) Black cohosh, licorice, don quai, wild yam, evening primrose, are not (FDA) approved• Prescription medications are FDA approved
  32. 32. What About Supplements?• “Natural” remedies marketed as “dietary” supplements (including even topical progesterone cream and other nonprescription hormone treatments) Black cohosh, licorice, don quai, wild yam, evening primrose, are not (FDA) approved• Prescription medications are FDA approved• Herbal Alternatives for Menopause Trial (HALT)showed no increased effectiveness of herbals versus estrogen for relief of menopausal symptoms.
  33. 33. Sleeping?
  34. 34. Sleeping?• Perimenopausal insomnia is often occurs due to hot flashes during the night as well as mid life stressors.
  35. 35. Sleeping?• Perimenopausal insomnia is often occurs due to hot flashes during the night as well as mid life stressors.• Treatment of sleep disturbances should first focus on improving sleep routine with good sleep hygiene.
  36. 36. Sleeping?• Perimenopausal insomnia is often occurs due to hot flashes during the night as well as mid life stressors.• Treatment of sleep disturbances should first focus on improving sleep routine with good sleep hygiene.• When lifestyle changes fail to alleviate sleep disturbances, health care providers should be consulted to discuss other options and to rule out other causes such as thyroid abnormalities, allergies, anemia, restless leg, depression, or sleep apnea (breathing problems).
  37. 37. Headaches
  38. 38. Headaches• Women are at increased risk for hormonal headaches during peri-menopause if they have had menstrual headaches in the past
  39. 39. Headaches• Women are at increased risk for hormonal headaches during peri-menopause if they have had menstrual headaches in the past• Most hormonal headaches do not require treatment or can be treated with nonprescription pain medications.
  40. 40. Headaches• Women are at increased risk for hormonal headaches during peri-menopause if they have had menstrual headaches in the past• Most hormonal headaches do not require treatment or can be treated with nonprescription pain medications.• More serious headaches such as migraines, may require prescription medication.
  41. 41. Memory
  42. 42. Memory• No evidence that menopause causes memory loss. However... difficulty remembering and concentrating are common complaints during peri- menopause and the years right after menopause.
  43. 43. Memory• No evidence that menopause causes memory loss. However... difficulty remembering and concentrating are common complaints during peri- menopause and the years right after menopause.• Remaining physically, socially, and mentally active may help prevent memory loss.
  44. 44. Memory• No evidence that menopause causes memory loss. However... difficulty remembering and concentrating are common complaints during peri- menopause and the years right after menopause.• Remaining physically, socially, and mentally active may help prevent memory loss.• Women who are concerned about declining cognitive performance are advised to consult with their healthcare provider.
  45. 45. Moody?
  46. 46. Moody?• Few scientific studies prove that menopause contributes to true clinical depression, severe anxiety, or erratic behavior.
  47. 47. Moody?• Few scientific studies prove that menopause contributes to true clinical depression, severe anxiety, or erratic behavior.• During peri-menopause- there are reports of tearfulness, mood swings, and feeling blue or discouraged.
  48. 48. Moody?• Few scientific studies prove that menopause contributes to true clinical depression, severe anxiety, or erratic behavior.• During peri-menopause- there are reports of tearfulness, mood swings, and feeling blue or discouraged.• A healthcare provider can help determine the cause of mental health stressors, assess options, and prescribe appropriate treatment.
  49. 49. Dryness etc...
  50. 50. Dryness etc...• At least one-third of all women will experience some troubling symptoms in the vulvo-vaginal area
  51. 51. Dryness etc...• At least one-third of all women will experience some troubling symptoms in the vulvo-vaginal area• Vaginal discharge, irritation, burning, dryness, itchiness, and pain (both with or without sexual activity).
  52. 52. Dryness etc...• At least one-third of all women will experience some troubling symptoms in the vulvo-vaginal area• Vaginal discharge, irritation, burning, dryness, itchiness, and pain (both with or without sexual activity).• Many possible causes. Do not assume due to reduced estrogen levels. Symptoms should be investigated by a clinician to identify the cause and possible treatment. A regular pelvic exam is recommend for all women age menopause and beyond, w/wo symptoms or even if not sexually active.
  53. 53. Libido
  54. 54. Libido• Libido (sex drive) generally decreases with age in both sexes, but varies individually.
  55. 55. Libido• Libido (sex drive) generally decreases with age in both sexes, but varies individually.• Research shows women 2-3x less desire than men. Low desire common in relationships of long duration.
  56. 56. Libido• Libido (sex drive) generally decreases with age in both sexes, but varies individually.• Research shows women 2-3x less desire than men. Low desire common in relationships of long duration.• Evaluate the cause before determining if treatment is needed.
  57. 57. Leaking?
  58. 58. Leaking?• Urinary symptoms, including incontinence (persistent, involuntary leaking of urine), become more common with aging.
  59. 59. Leaking?• Urinary symptoms, including incontinence (persistent, involuntary leaking of urine), become more common with aging.• Women are much more prone to the occasional episode of urine leakage than men. These symptoms may be partially affected by menopause.
  60. 60. Leaking?• Urinary symptoms, including incontinence (persistent, involuntary leaking of urine), become more common with aging.• Women are much more prone to the occasional episode of urine leakage than men. These symptoms may be partially affected by menopause.• Aging may cause surrounding pelvic muscles to weaken.
  61. 61. Leaking?• Urinary symptoms, including incontinence (persistent, involuntary leaking of urine), become more common with aging.• Women are much more prone to the occasional episode of urine leakage than men. These symptoms may be partially affected by menopause.• Aging may cause surrounding pelvic muscles to weaken.• Lack of estrogen can cause thinning of the lining of the urethra, the outlet for the bladder.
  62. 62. Weight
  63. 63. Weight• Age 40s and 50s, women often gain weight, and sometimes attribute this gain to menopause??
  64. 64. Weight• Age 40s and 50s, women often gain weight, and sometimes attribute this gain to menopause??• In general, fewer calories are needed after midlife because less energy is expended.
  65. 65. Weight• Age 40s and 50s, women often gain weight, and sometimes attribute this gain to menopause??• In general, fewer calories are needed after midlife because less energy is expended.• Whether weight gain is linked to menopause itself and/or age, the important thing is that studies shows that weight gain around menopause years can be prevented by exercise and diet—by minimizing fat gain and maintaining muscle, thereby reducing body size and burning more calories!
  66. 66. Skin
  67. 67. Skin• Aging skin undergoes normal loss of collagen and elasticity, which creates slight sags, wrinkles and increase dryness
  68. 68. Skin• Aging skin undergoes normal loss of collagen and elasticity, which creates slight sags, wrinkles and increase dryness• Decrease estrogen at menopause contribute to a decline in skin collagen and thickness, which is more rapid in the years immediately after menopause
  69. 69. Skin• Aging skin undergoes normal loss of collagen and elasticity, which creates slight sags, wrinkles and increase dryness• Decrease estrogen at menopause contribute to a decline in skin collagen and thickness, which is more rapid in the years immediately after menopause• Estrogen therapy may have benefit on skin, but it cannot reverse genetic aging or sun damage, or change any risk of skin cancer
  70. 70. Skin• Aging skin undergoes normal loss of collagen and elasticity, which creates slight sags, wrinkles and increase dryness• Decrease estrogen at menopause contribute to a decline in skin collagen and thickness, which is more rapid in the years immediately after menopause• Estrogen therapy may have benefit on skin, but it cannot reverse genetic aging or sun damage, or change any risk of skin cancer• Estrogen should never be used solely to improve skin
  71. 71. Hair
  72. 72. Hair• Aging - hair will become gray and more brittle. Excessive hair growth (hirsutism) may occur in areas that are androgen-sensitive, such as the chin, upper lip, and cheeks.
  73. 73. Hair• Aging - hair will become gray and more brittle. Excessive hair growth (hirsutism) may occur in areas that are androgen-sensitive, such as the chin, upper lip, and cheeks.• Menopause-related shift in the balance between androgen and estrogen can also result in the opposite effect—hair loss.
  74. 74. Hair• Aging - hair will become gray and more brittle. Excessive hair growth (hirsutism) may occur in areas that are androgen-sensitive, such as the chin, upper lip, and cheeks.• Menopause-related shift in the balance between androgen and estrogen can also result in the opposite effect—hair loss.• Recommendation: Eating a healthy diet, adding a daily multivitamin, avoiding harsh chemicals and sunlight that dry hair.
  75. 75. Hair• Aging - hair will become gray and more brittle. Excessive hair growth (hirsutism) may occur in areas that are androgen-sensitive, such as the chin, upper lip, and cheeks.• Menopause-related shift in the balance between androgen and estrogen can also result in the opposite effect—hair loss.• Recommendation: Eating a healthy diet, adding a daily multivitamin, avoiding harsh chemicals and sunlight that dry hair.• Mild Hirsutism: plucking, waxing, shaving, bleaching, electrolysis, and laser treatment. Laser is recommended for large areas.
  76. 76. Eyes
  77. 77. Eyes• chronic dry eye: dry, scratchy eyes, often with light sensitivity, blurred vision, increased tearing, or swollen or reddened eyelids
  78. 78. Eyes• chronic dry eye: dry, scratchy eyes, often with light sensitivity, blurred vision, increased tearing, or swollen or reddened eyelids• Condition may be worse in climates with dry air, or from certain diseases and with the use of some drugs
  79. 79. Eyes• chronic dry eye: dry, scratchy eyes, often with light sensitivity, blurred vision, increased tearing, or swollen or reddened eyelids• Condition may be worse in climates with dry air, or from certain diseases and with the use of some drugs• Try: Increasing water intake, good diet include vitamin A, C,E,. Eye protection with glasses and prevention of eye strain and prescription or over the counter eye drops to help provide relief.
  80. 80. Health Concerns
  81. 81. Health Concerns• Cardiovascular diseases - the number one killer of women in North America. After age 55, more than half of all deaths in women are caused by cardiovascular disease. Risk for this disease increases after menopause.
  82. 82. Health Concerns• Cardiovascular diseases - the number one killer of women in North America. After age 55, more than half of all deaths in women are caused by cardiovascular disease. Risk for this disease increases after menopause.• Diabetes- Increased risk when weight gain occurs.
  83. 83. Health Concerns• Cardiovascular diseases - the number one killer of women in North America. After age 55, more than half of all deaths in women are caused by cardiovascular disease. Risk for this disease increases after menopause.• Diabetes- Increased risk when weight gain occurs.• Osteoporosis - a skeletal disorder in which bone strength has weakened to a point where the bone is fragile and at higher risk for fractures.
  84. 84. Health Concerns• Cardiovascular diseases - the number one killer of women in North America. After age 55, more than half of all deaths in women are caused by cardiovascular disease. Risk for this disease increases after menopause.• Diabetes- Increased risk when weight gain occurs.• Osteoporosis - a skeletal disorder in which bone strength has weakened to a point where the bone is fragile and at higher risk for fractures.• Cancer- Menopause is not associated with increased cancer risk.
  85. 85. Hormone Therapy
  86. 86. Hormone Therapy• Several prescription drugs are available to help relieve menopause-related symptoms and decrease long-term health risks across the menopause transition and beyond.
  87. 87. Hormone Therapy• Several prescription drugs are available to help relieve menopause-related symptoms and decrease long-term health risks across the menopause transition and beyond.• Hormone therapies are the prescription drugs used most often when treating menopause symptoms.
  88. 88. Hormone Therapy• Several prescription drugs are available to help relieve menopause-related symptoms and decrease long-term health risks across the menopause transition and beyond.• Hormone therapies are the prescription drugs used most often when treating menopause symptoms.• Estrogen therapy (ET) has been widely studied and used for more than 50 years by millions of women. Gold Standard.
  89. 89. Hormone Therapy• Several prescription drugs are available to help relieve menopause-related symptoms and decrease long-term health risks across the menopause transition and beyond.• Hormone therapies are the prescription drugs used most often when treating menopause symptoms.• Estrogen therapy (ET) has been widely studied and used for more than 50 years by millions of women. Gold Standard.• Many kinds of estrogen therapies are available to treat menopause-related symptoms. A variety of estrogen types, delivery systems, and dosage strengths give each woman a better chance to find an option which is best.
  90. 90. Who Should Consider Hormone Therapy?
  91. 91. Who Should Consider Hormone Therapy?• Experience moderate to severe hot flashes or other menopausal symptoms
  92. 92. Who Should Consider Hormone Therapy?• Experience moderate to severe hot flashes or other menopausal symptoms• Have lost bone mass and either arent able to tolerate other treatments or arent benefitting from other treatments
  93. 93. Who Should Consider Hormone Therapy?• Experience moderate to severe hot flashes or other menopausal symptoms• Have lost bone mass and either arent able to tolerate other treatments or arent benefitting from other treatments• Stopped having periods before age 40 (premature menopause) or lost normal function of your ovaries before age 40 (premature ovarian failure) As you are
  94. 94. Who should not take Hormone Therapy?
  95. 95. Who should not take Hormone Therapy?• Women with breast cancer, heart disease or a history of blood clots should not take hormone therapy for relief of menopause symptoms.
  96. 96. Who should not take Hormone Therapy?• Women with breast cancer, heart disease or a history of blood clots should not take hormone therapy for relief of menopause symptoms.• Women who aren’t bothered by menopause symptoms
  97. 97. Hormone Therapy Benefits
  98. 98. Hormone Therapy Benefits• Hormone therapy can alleviate hot flashes, ease vaginal symptoms such as dryness, itching, burning and discomfort with intercourse
  99. 99. Hormone Therapy Benefits• Hormone therapy can alleviate hot flashes, ease vaginal symptoms such as dryness, itching, burning and discomfort with intercourse• Long-term HRT for the prevention of postmenopausal conditions is no longer routinely recommended. But women who take estrogen for short-term relief of menopausal symptoms may gain some protection against Osteoporosis, Colon Cancer and Cardiovascular Diseases.
  100. 100. Hormone Therapy Benefits• Hormone therapy can alleviate hot flashes, ease vaginal symptoms such as dryness, itching, burning and discomfort with intercourse• Long-term HRT for the prevention of postmenopausal conditions is no longer routinely recommended. But women who take estrogen for short-term relief of menopausal symptoms may gain some protection against Osteoporosis, Colon Cancer and Cardiovascular Diseases.• ERT or HRT (estrogen and progesterone) what’s the difference?
  101. 101. Risks of Hormone Therapy
  102. 102. Risks of Hormone Therapy• In the largest clinical trial to date, combination estrogen-progestin (Prempro) increased the risk of the following serious health conditions.
  103. 103. Risks of Hormone Therapy• In the largest clinical trial to date, combination estrogen-progestin (Prempro) increased the risk of the following serious health conditions.• Over one year, 10,000 women taking estrogen plus progestin might experience: 7 > cases of heart disease than placebo, 8 >cases of breast cancer than placebo 8 > cases of stroke than placebo. 18 more cases of blood clots than placebo. An increase in abnormal mammograms, particularly false positives
  104. 104. Risks of Hormone Therapy• In the largest clinical trial to date, combination estrogen-progestin (Prempro) increased the risk of the following serious health conditions.• Over one year, 10,000 women taking estrogen plus progestin might experience: 7 > cases of heart disease than placebo, 8 >cases of breast cancer than placebo 8 > cases of stroke than placebo. 18 more cases of blood clots than placebo. An increase in abnormal mammograms, particularly false positives• In cases of estrogen without progestin: The study found no increased risk of breast cancer or heart disease.12> cases of stroke than placebo 6> cases of blood clots in the legs than women taking a placebo. An increase in mammography abnormalities.
  105. 105. Risks of Hormone Therapy• In the largest clinical trial to date, combination estrogen-progestin (Prempro) increased the risk of the following serious health conditions.• Over one year, 10,000 women taking estrogen plus progestin might experience: 7 > cases of heart disease than placebo, 8 >cases of breast cancer than placebo 8 > cases of stroke than placebo. 18 more cases of blood clots than placebo. An increase in abnormal mammograms, particularly false positives• In cases of estrogen without progestin: The study found no increased risk of breast cancer or heart disease.12> cases of stroke than placebo 6> cases of blood clots in the legs than women taking a placebo. An increase in mammography abnormalities.• The effect of hormone therapy on mammograms * important. Suggests women on hormone therapy may need more frequent mammograms and additional testing.
  106. 106. Hormone Therapy
  107. 107. Hormone Therapy• Progestogen: to treat symptoms such as hot flashes, to manage abnormal uterine bleeding, or to counter “estrogen dominance” that can occur in some women as estrogen levels fluctuate to high levels.
  108. 108. Hormone Therapy• Progestogen: to treat symptoms such as hot flashes, to manage abnormal uterine bleeding, or to counter “estrogen dominance” that can occur in some women as estrogen levels fluctuate to high levels.• Combined estrogen-progestogen therapy (EPT) with various dosing schedules (often called “regimens”): Estrogen and progestogen separately or through convenient combination EPT products.
  109. 109. Hormone Therapy• Progestogen: to treat symptoms such as hot flashes, to manage abnormal uterine bleeding, or to counter “estrogen dominance” that can occur in some women as estrogen levels fluctuate to high levels.• Combined estrogen-progestogen therapy (EPT) with various dosing schedules (often called “regimens”): Estrogen and progestogen separately or through convenient combination EPT products.• Each woman should feel comfortable exploring options with her clinician to determine which is best for her.
  110. 110. Compounded Hormones
  111. 111. Compounded Hormones• (“Custom-compounded”) hormone products—containing one or more of various hormones in varied amounts, depending on the individual prescriber’s order. Mixed in other ingredients that hold everything together, suppository, under tongue tablet, under skin pellet, cream, gel, liquid, nasal spray.
  112. 112. Compounded Hormones• (“Custom-compounded”) hormone products—containing one or more of various hormones in varied amounts, depending on the individual prescriber’s order. Mixed in other ingredients that hold everything together, suppository, under tongue tablet, under skin pellet, cream, gel, liquid, nasal spray.• Risks- although the “active ingredients” are government approved, mixtures are not, because they have not been studied to confirm that they are absorbed appropriately or provide predictable levels in blood and tissue. Thus, little or no scientific evidence about the effects of these hormones on the body, either good or bad.
  113. 113. Optimal Health
  114. 114. Optimal Health
  115. 115. Optimal Health• There is no universal menopause experience. Menopause can mark the beginning of an exciting new time of life (no periods/no pregnancy)
  116. 116. Optimal Health• There is no universal menopause experience. Menopause can mark the beginning of an exciting new time of life (no periods/no pregnancy)• Regular clinical checkups will help a woman achieve optimal health and identify health conditions
  117. 117. Optimal Health• There is no universal menopause experience. Menopause can mark the beginning of an exciting new time of life (no periods/no pregnancy)• Regular clinical checkups will help a woman achieve optimal health and identify health conditions• Regular mammograms over 40 every 2 years and every year after 50. Pap tests every 1-3 years. Bone density per history. Colonoscopy at 50 or earlier with history

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