Menopause is the permanent cessation of menstruation that occurs naturally as part of aging when the ovaries stop producing estrogen and progesterone, and a woman can no longer get pregnant. Counseling women about menopause aims to address questions/concerns, provide education, facilitate informed decision making, and enhance confidence. The counseling process involves building rapport, exploring issues, and committing to actions. A survey found that over 75% of postmenopausal women received counseling on hormone replacement therapy, with no differences found between managed care and other insurance types. More efforts are needed to educate underserved women.

1. Ms. Kanchan Mehra
M.Sc. (N) I yr
PCNMS

2. Menopause is the end of menstruation .The word menopause
came from the Greek word ` mens ’ meaning ``monthly’’ and `
pausis ’ meaning ``cessation ‘’. Menopause is a part of a
women’s natural ageing process when her ovaries produce
lower level of the estrogen and progesterone and when she no
longer able to become pregnant.

3. Menopause is the permanent cessation of menstruation at the
end of reproductive life due to loss of ovarian follicular activity

4. Face-to-face contact between a patient and clinician may be
what most commonly comes to mind when one thinks of
"patient counseling." However, there are many methods of
providing information to patients, such as classes or support
groups, print materials, audio and videotape, telephone
resource lines, and Internet tools.

5. The objectives of counseling include-
• Addressing women's questions and concerns, providing patient
education, facilitating informed decision making, and
enhancing the patient's confidence in the decision made and in
her ability to carry it out or modify it over time.
• A partnership between clinician and patient characterized by
mutual respect and trust enhances counseling.

6. • If a therapy is chosen, the patient and clinician should agree on
the goals, whether they are short term (menopause symptom
relief), long-term (primary or secondary prevention of diseases
associated with aging), or both.
• The clinician should re-visit decisions about menopause
management with the patient at subsequent visits, as new
research is published and the woman's health status and
preferences may change over time.
• For instance, a woman who begins taking ERT/HRT to help
with the symptoms of menopause will later need to evaluate the
risks and benefits of long-term continuation.

7. • As a woman approaches the age of menopause,
experiencing her first hot flush can be a watershed. It is a sign
of the beginning of the menopause, and with it, there can be a
sense of huge loss – of youth, attractiveness, femininity, and
some woman may consciously or unconsciously assess where
she is in her life and the future.
• This may be with a sense of renewal of the beginning of a new
chapter or a sense of failure
• For a woman who has not had children, it is the final step in
the realization that motherhood is no longer possible.

8. • Even for others who have had children, there may be grief and
loss around the end of that part of their lives – the ability to
bear and bring life into the world.
• A loss of libido may signal a loss of a sense of, femininity and
put a certain amount of pressure on the relationship with her
partner.
• Having a growing daughter who is becoming a beautiful
woman can be difficult if we feel that our own attractiveness is
declining.

9. 1) INITIAL DISCLOSURE:-
– Relationship Building - Relationship building is the first
important step in the counseling process
• The counselor establish rapport with the counselee based on
trust, respect and mutual purpose.
• One central task of the counselor in the first stage is to allay
the client’s fears and encourage self disclosure.
• To let the counselor know what has been occurring in the
client’s life and how the client thinks and feels about those
events.
• To encourage the client to gain some feeling of relief through
the process of talking about her or his problems

10. - Interaction A Counselee -
• “Tell me more about...”
• “Help me understand more fully…”
• “Tell me what happened when…”
• “Help me understand what you are thinking about…”
• The Counselor’s Verbal Encouragement to Disclose Follow-
up invitations that encourage

11. 2) IN-DEPTH EXPLORATION –
- Problem Assessment:- • It is the time for in-depth exploration
of themes and issues related to the clients concerns
• The counselor’s task becomes that of helping the client develop
new awareness and perspective that can lead to growth, more
effective coping and clarification of goals.
• As the client continues to disclose his or her intimate thoughts
and feelings, the counselee and the counselor become more
aware of following-
Interpersonal relationships with significant other’s in the
client’s life.
Feelings about self and others

12. • Significant events that have shaped the counselee’s present
personality and circumstance.
• Deficiencies in the counselee’s ability to cope with life
circumstances
• Strengths that the counselee has available but may not be
applying to resolve his or her problems.

13. • 3) COMMITMENT TO ACTION –
• Selective Response-
• When a counselor uses selective reflection, he or she chooses
to respond more fully to the part of a client’s statement that
shows yearning for change
• The counselor reflected back affective content to the client, but
the counselor’s statement were centered on that portion of the
feeling associated with readiness to change.
• Selective reflection is used effectively when the client has
progressed to the point of insight into him- or herself

14. - Readiness for Termination-
• When the counselee has achieved what she wants
• Positive and identifiable changes in the counselee’s behavior,
positive and pervasive changes in the clients mood.
• Consistent reports of improved ability to cope with stress of
menopausal symptoms
• Clear expressions of commitment to verbalized plans for the
future

15. • Reassurance the client and teach her coping measure.
• Explain her about the estrogen therapy along with this tell her
that the excessive use of ORT increase the risk of endometrial
cancer. Hence it should be taken along a with course of
synthetic progesterone with the prescription of the doctor.
• In case of hot flushes the client is advised to avoid alcohol,
smoking, spicy food, caffeine, hot coffee to have cold liquid.

16. • To try sleep in a room which is ventilated and cool, a fan can
also be used, the client can wear light clothes instead of
excessive clothes.
• Insomnia is deal with exercises, yoga, and medication.
• Dryness of vagina are treated with the help of vaginal
moisturizer or lubricant, vaginal estrogen products are used in
dyspareunia.
• For osteoporosis supplementary vitamin D and calcium is
given.

17. • Advice the client to keep a damp cloth in order to cool oneself
in case of night sweat.
• Avoid heavy bleeding.
• Get a regular check up including blood pressure, blood sugar
level, cholesterol, weight and mammograms etc.
• Follow aerobic exercise for heart and follow weight bearing
exercises for bones.
• Accept it as a new phase of life and be positive.
• To have frequent and light and light meals.
• Antidepressants are given to unlift mood.

18. Ettinger B, Woods NF, Barrett-Connor E, Pressman A. The North American
Menopause Society 1998 conducted a menopause survey: Part II. That is
Counseling about hormone replacement therapy: association with
socioeconomic status and access to medical care. During May-July 1998, by
means of random-digit telephone dialing, 749 postmenopausal women who
were living in the United States and aged 50-65 years were interviewed. Of
these 749 women, 75.4% reported that they had received counseling about
post-menopausal HRT from health care providers. No differences were
observed in prevalence of counseling between women in managed care
settings and those with other types of health insurance. The findings suggest
that special efforts are necessary to provide menopause education and
counseling to underserved women.