This document discusses menopause and perimenopause, including common symptoms and treatments. It notes that perimenopause lasts 1-10 years as hormone levels fluctuate. Menopause is defined as 12 months without periods as hormone levels decline. Biological and cultural factors can impact self-esteem during this time. The document outlines various symptoms and their potential treatments, including night sweats, sleep issues, vaginal dryness, and urinary changes. It stresses the importance of exercise, diet, and lifestyle habits in prevention conditions like osteoporosis. The risks of hormone therapy are discussed. The document calls for more unbiased research on safe treatment options and support for women during this stage of life.

1. Chapter 20 Teach back
By: Kendra Woudenberg

2.  Perimenopause- “The one-to-ten-year stretch
during which ovaries function erratically and
hormonal fluctuations may bring a range of
changes, such as hot flashes, night sweats,
sleep disturbances, and heavy menstrual
bleeding” (506).
 Menopause- “marked by the final menstrual
period, known to be final after twelve
months with no periods…the ovaries settle
down and the reproductive hormones—
estrogen and progesterone…have declined to
low, steady levels” (506).

3.  Culture values youth and beauty-lower
feeling of self-worth
 Lose the sense of womanhood
 Depression over the end of childbearing
opportunities
 Many biological changes include wrinkles,
thinned hair, lower sex drive, and vision loss.
This can lead to low self-esteem.
 Happiness over a sense of control in later
years of life
 Dealing with sexism and ageism in society

4.  Signs for beginning this stage
 “New-onset heavy and/or longer flow”
 “Shorter menstrual cycles (less than twenty-five
days)”
 Swollen or lumpy breasts
 Poor sleep cycle
 “Increased migraine headaches”
 Unexpected weight gain
 “Increased cramps”
 “New or increased premenstrual mood swings”
 Vaginal dryness
 Overactive bladder
 “Memory gaps or lowered ability to concentrate”

5.  Night sweats: stay active; reduce caffeine,
alcohol, spicy foods, etc.; avoid stress, use air
conditioning, drink lots of water, take low dose
of antidepressants, clonidine-an
antihypertensive medication, estrogen
 Sleep disturbances: cut out caffeine, exercise,
take valerian-an herbal sleep aid, melatonin,
antihistamines, limit alcohol consumption
 Vaginal dryness: Lubricants, regular sexual
activity, wait for arousal before sex, drink more
fluids, low-dose local (vaginal) estrogens,
hormone therapy

6.  Urinary changes: “Kegel exercises, Bladder
training, Medications, Vaginal estrogen in the
form of tablets, cream or rings, surgery”
General Care-taking
-exercise to prevent heart disease, osteoporosis
and help depression, bowl movements, sleep,
and hot flashes
-eat well by consuming calcium, vitamin D,
phosphorus, and magnesium to prevent bone
loss. Adequate amount of protein and low
amounts of carbonated drinks will help prevent
osteoporosis.

7.  “a condition of significantly low bone density”
 Body naturally replaces bone but women begin
to lose bone in mid-thirties and again in their
70’s
 Weight-lifting builds bone density and muscle
mass
 Avoid smoking, drinking alcohol excessively, and
an oophorectomy (removal of ovaries)
 Medical treatments include hormone treatments
with estrogen and progestin, bisphosphonates
(nonhormonal drug), raloxifene (estrogen
receptor modulators)

8.  Lack of health care insurance for women
under the age of 65 and not poor enough for
Medicaid.
 For those unemployed, they do not have easy
access to health insurance
 “The United States is the only industrialized
country in the world that does not provide
access to basic health care for all” (534).

9.  Long history of trying to find the risks associated
with hormone therapy.
 Notably in 2002, a trial conducted pointed to
women sixty-five and older not having
“protection against mild cognitive impairments”
and dementia (536).
 There is still uncertainty about the risks
associated with hormone therapy regimens and
women should be cautious about unauthorized
claims.
 Research and “an assessment of potential harms
and benefits” should be conducted for every
woman.

10.  Estradiol- “predominant estrone during the
pre- and perimenopausal years”
 Estriol- “ found in greater amounts during
pregnancy”
 Estrone- “ found after menopause”

11.  The Pill- should be used with caution. When taken
orally needs to be processed through the liver and
“this stimulates the liver to make clotting proteins,
which increases the chances of blood clots” (538).
 Estrogen through the skin- may bypass the liver,
carries the same risk for breast cancer as oral
estrogen.
 Estrogen Vaginal Ring— “releases estradiol into the
vagina” reducing dryness.
 Progestogens– progestogen is used to treat the
discomforts caused by the low levels of progesterone
in perimenopause. Use alone without estrogen for a
sleep aid and to reduce hot flashes.
 Caution: “The WHI showed an increase in breast
cancer for estrogen and progesterone used together,
though not for estrogen used alone…”

12.  More testing needs to be done on hormone
therapy!
 More attention is needed in medical
researching for peri and post menopausal
women.
 Many studies have been founded to help
improve peri and post menopausal women’s
lives. Including The Black Women’s Health
Study, The Study of Women’s Health Across
the Nation, and The Kronos Early Estrogen
Prevention Study

13.  “What we currently have is outdated
language about women that reinforces our
‘deficiencies’ as women. Why not, as
women, start making language that fits our
experiences and isn’t disease-oriented? Why
subject ourselves to those physicians who
want to give us routine estrogen treatment in
perimenopause and beyond, treatment we
may not need at all” (544)?
 ~ Jerilynn Prior M.D., “a key contributor to
recent research exploring the significance of
higher estrogen and declining progesterone levels
in perimenopause”

14.  How can we advocate for women in finding
more research funding and policies to
support finding safe ways to treat peri and
post menopause?
 Perhaps start a community support organization?
Why is this topic of research treated as a last
priority in the medical world?

15.  Boston Womens Health Collective. Our
Bodies, Ourselves. 2011