This document discusses various topics related to menopause, including: - Perimenopause is the transition period leading up to menopause where estrogen levels gradually decline, causing irregular periods and symptoms like hot flashes and mood swings. It typically lasts 6-10 years. - Menopause is confirmed after 12 months without periods and is a natural process where fertility ends, occurring on average at age 51. - Hot flashes, sleep issues, headaches, memory problems and mood changes are common menopause symptoms that can usually be managed through lifestyle changes or over-the-counter remedies. - Supplements are not proven as effective as FDA-approved medications for treating menopause symptoms

1. Lauren Dansereau NP
Western New England College Health Services

2. Menopause.. The Big “M”
With Ease !
Lauren Dansereau NP
Western New England College Health Services

3. Peri menopause

4. Peri menopause
• Menopause transition (peri-menopause)

5. Peri menopause
• Menopause transition (peri-menopause)
• The physical signs of menopause begin

6. Peri menopause
• Menopause transition (peri-menopause)
• The physical signs of menopause begin
• Estrogen gradually decline

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. 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. 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. 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. Confirming Menopause

12. Confirming Menopause
• Menopause is a normal, natural life event.

13. Confirming Menopause
• Menopause is a normal, natural life event.
• End of fertility

14. Confirming Menopause
• Menopause is a normal, natural life event.
• End of fertility
• Average at age 51

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. 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. 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 aren't able to tolerate other treatments or
aren't benefitting from other treatments

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 aren't able to tolerate other treatments or
aren't 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. Induced and Premature Menopause

20. Induced and Premature Menopause
• Induced: At any age, no menstrual periods due to a medical intervention

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. 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. 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. Hot Flashes

25. Hot Flashes
• The most common discomfort is the “hot flash/hot flush”

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. 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. 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. What About Supplements?

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. 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. 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. Sleeping?

34. Sleeping?
• Perimenopausal insomnia is often occurs due to hot flashes during the night
as well as mid life stressors.

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. 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. Headaches

38. Headaches
• Women are at increased risk for hormonal headaches during peri-menopause
if they have had menstrual headaches in the past

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. 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. Memory

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. 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. 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. Moody?

46. Moody?
• Few scientific studies prove that menopause contributes to true clinical
depression, severe anxiety, or erratic behavior.

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. 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. Dryness etc...

50. Dryness etc...
• At least one-third of all women will experience some troubling symptoms in
the vulvo-vaginal area

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. 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. Libido

54. Libido
• Libido (sex drive) generally decreases with age in both sexes, but varies
individually.

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. 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. Leaking?

58. Leaking?
• Urinary symptoms, including incontinence (persistent, involuntary leaking of
urine), become more common with aging.

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. 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. 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. Weight

63. Weight
• Age 40s and 50s, women often gain weight, and sometimes attribute this gain
to menopause??

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. 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. Skin

67. Skin
• Aging skin undergoes normal loss of collagen and elasticity, which creates
slight sags, wrinkles and increase dryness

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. 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. 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. Hair

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. 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. 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. 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. Eyes

77. Eyes
• chronic dry eye: dry, scratchy eyes, often with light sensitivity, blurred vision,
increased tearing, or swollen or reddened eyelids

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. 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. Health Concerns

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. 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. 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. 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. Hormone Therapy

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. 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. 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. 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. Who Should Consider Hormone Therapy?

91. Who Should Consider Hormone Therapy?
• Experience moderate to severe hot flashes or other menopausal symptoms

92. Who Should Consider Hormone Therapy?
• Experience moderate to severe hot flashes or other menopausal symptoms
• Have lost bone mass and either aren't able to tolerate other treatments or
aren't benefitting from other treatments

93. Who Should Consider Hormone Therapy?
• Experience moderate to severe hot flashes or other menopausal symptoms
• Have lost bone mass and either aren't able to tolerate other treatments or
aren't 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. Who should not take Hormone Therapy?

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. 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. Hormone Therapy Benefits

98. Hormone Therapy Benefits
• Hormone therapy can alleviate hot flashes, ease vaginal symptoms such as
dryness, itching, burning and discomfort with intercourse

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. 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. Risks of Hormone Therapy

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. 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. 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. 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. Hormone Therapy

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. 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. 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. Compounded Hormones

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. 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. Optimal Health

114. Optimal Health

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. 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. 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