Menopause ADH3 Wk1

Menopause Clinical Definition

the permanent cessation of menstruation resulting from the loss of ovarian follicular activity

typically occurs between ages 45 and 55, with the average age being around 51 in developed countries. This timing can vary significantly based on genetic, environmental, and lifestyle factors, which we'll discuss shortly

Menopause Diagnosis

retrospective diagnosis - we can only confirm menopause after a woman has experienced 12 consecutive months of amenorrhea without any other identifiable cause

Perimenopause Definition

the transitional, often 3-to-10-year, period before menopause when hormone levels (estrogen) become erratic and menstrual cycles become irregular

Postmenopausal Definition

the phase occurring after a woman has experienced 12 consecutive months of amenorrhea (no menstrual periods)

Surgical Menopause Definition

the immediate onset of menopause caused by the surgical removal of both ovaries (bilateral oophorectomy), leading to an abrupt stop in hormone production (estrogen & progesterone) rather than the gradual decline of natural menopause

Premature Menopause

when a woman's menstrual periods stop, and her ovaries cease functioning (releasing eggs, producing hormones like estrogen) before the age of 40, occurring earlier than the typical age range of 45-55

Menopause Causes

•Natural aging (most common)                             

•Surgical removal of ovaries

•Chemotherapy or pelvic radiation

Early Menopause Risk Factors

•Family history of early menopause

•Smoking

Autoimmune disorders affecting ovaries

Menopause S/S

Before menstruation stops completely, women often experience irregular menstrual cycles - periods may become heavier, lighter, more frequent, or less frequent

Vasomotor symptoms - Most Common symptoms (Night sweats and Hot Flashes)

Sleep disturbances are common and may be related to night sweats, but can also occur independently

Mood changes are frequently reported and can include irritability, depression, and anxiety.

painful intercourse and decreased libido - due to declining estrogen, which leads to vaginal dryness and thinning of vaginal tissues

Urinary Symptoms- increased frequency, urgency, incontinence

Integumentary Symptoms - skin thinning, decreased elasticity, and changes in hair texture or distribution

Metabolic Symptoms -- Slow metabolism, weight gain

Increased Risk of Osteoporosis - Estrogen plays a crucial role in bone metabolism, and its decline accelerates bone loss, significantly increasing fracture risk over time

Menopause Long-term Health Risks

•Osteoporosis

•Metabolic Changes

•Cardiovascular Disease

•Other considerations

Menopause Diagnostic Tests if cause Uncertain or Premature

•FSH: Elevated (>30–40 IU/L)

•Estradiol: Low levels

•Thyroid function tests: Rule out other causes

Menopause Long-term Health Screenings

•DEXA scan: Bone mineral density for osteoporosis risk

•Lipid profile: Cardiovascular risk screening

Menopausal Hormone Therapy (MHT)

All forms of estrogen treat vasomotor symptoms (hot flashes) and vaginal dryness/atrophy associated with menopause. They should be used at the lowest effective dose for the shortest duration (typically <5 years)

17β-Estradiol (Plant-Derived)

• Routes: Transdermal patches, topical gels/sprays, vaginal rings, vaginal tablets

• Advantages: Avoids first-pass liver metabolism, reducing nausea and hepatic effects

• Dosing:

  • Patches: Changed twice weekly or weekly

  • Gels: Applied daily to one arm (shoulder to wrist)

  • Vaginal rings: Replaced every 3 months

  • Vaginal tablets: 10 mcg daily for 2 weeks, then twice weekly

Conjugated Estrogens (Premarin/CEE)

• Routes: Oral tablets, vaginal cream

• Dosing:

  • Oral: Daily dosing

  • Vaginal cream: 0.5-2 g/day for 2 weeks, then twice weekly for 3 weeks/month

• Note: Oral route increases HDL but has greater effect on liver proteins

Estrone

Main estrogen source postmenopause, formed from androstenedione conversion in body tissues

Estriol

Weaker estrogen; less commonly used in standard HT

Progestogen/Progestin

Required in women with an intact uterus when using systemic estrogen (oral, transdermal patches, higher-dose vaginal rings) to protect the endometrium.

Common Forms

• Medroxyprogesterone acetate (MPA) - most common

• Norethindrone acetate

• Micronized progesterone

Exception

Low-dose vaginal estrogen creams don't require progestin as they minimally affect the endometrium.

Estrogen Contraindications

• Pregnancy

• Personal history of breast cancer

• History of endometrial cancer (during active treatment)

• Thromboembolic disorders

• Acute liver disease or chronic impaired liver function

• Active gallbladder/pancreatic disease

• Coronary artery disease (CAD)

• Undiagnosed vaginal bleeding

• Endometriosis

• Special Considerations

  • Smoking: Increases thromboembolism risk

  • Fibroid tumors: Wait 1 year after last menstruation before starting HT

  • Fibrocystic breast disease or diabetes: Use extra caution

Menopause Hormone Replacement Therapy Key Pt Education

Patient education about risks vs. benefits is essential. HT is not recommended for preventing cardiovascular disease, osteoporosis, or dementia.

Menopause Nursing Assessment Characteristics

Menstrual pattern and symptom onset

Impact on sleep, mood, and daily activities

Sexual health and vaginal symptoms

Bone health history and fracture risk

Cardiovascular risk factors

Emotional support systems and coping strategies

Cultural beliefs and expectations regarding menopause

Menopause Nursing Diagnoses

•Readiness for Enhanced Knowledge: Menopause

•Disturbed Sleep Pattern

•Sexual Dysfunction

•Risk for Osteoporosis

•Ineffective Coping

•Situational Low Self-Esteem

•Deficient Knowledge

Menopause Nonpharmacologic Interventions

Layered clothing, fans, cool environment

Regular weight-bearing exercise

Diet rich in calcium and vitamin D

Stress reduction (yoga, meditation)

Pelvic floor (Kegel) exercises

Vaginal moisturizers and lubricants

Menopause Pharmacologic Therapy

•Hormone Therapy (HT): estrogen ± progestin

•Fezolinetant (Veozah)-NK3 Antagonist

•Non-hormonal: SSRIs, SNRIs, gabapentin, clonidine

•Bisphosphonates or SERMs for osteoporosis

•Topical estrogen for vaginal atrophy

Menopause Pt Education

•Normalize experience: Menopause is a normal life stage, not a disease

•Treatment options: Benefits and risks of hormone therapy—individualized approach

•Lifestyle measures: For symptom relief

•Bone health: Importance of calcium/vitamin D, exercise

•Heart health: Maintain healthy weight, BP, cholesterol

•Sexual health: Use of lubricants, open communication with partners

•When to seek care: Abnormal bleeding, severe symptoms