Menopause and ED

Menopause

  • Definition: Permanent cessation of menses; a normal physiological process, INC in FSH levels

  • Risks: Increases risk of physical disorders, affecting various aspects of women's health

  • Phases:

    • Climacteric: Time during which reproductive function gradually ceases.

    • Perimenopausal: Can last 7 to 14 years before periods stop.

    • Postmenopausal: One year after the final menstrual period.

  • Average Age: In the US, menopause typically occurs between ages 45 and 55.

  • Factors Influencing Earlier Menopause: Genetics, smoking, high altitude, undernutrition.

  • Health Risks Associated with Menopause: Increased risk of heart disease, osteoporosis, macular degeneration, cognitive changes, breast cancer.

Physiology of Menopause

  • Hormonal Changes:

    • Cessation of ovum development and ovarian hormone response.

    • Decrease in estrogen and progestin levels, especially low levels after menopause.

  • Surgical Menopause: Ovaries removed surgically can lead to immediate cessation of hormonal response.

  • Hormonal Dynamics: Increased FSH levels due to decreased ovarian function and less response to LH, estrogen drops to very low level

Clinical Manifestations

  • Health Experiences: Varies greatly from woman to woman; some may experience significant discomfort.

  • Physiological Effects:

    • As estrogen decrease

    • Decrease in breast tissue, body hair, skin elasticity, and subcutaneous fat.

    • Atrophy of ovaries, uterus, cervix, vagina leading to symptoms such as:

      • Vaginal dryness, dyspareunia.

      • Urinary issues including stress incontinence and UTIs.

      • Atrophic vaginitis (urogenital infection, ulceration, painful sex).

      • Vasomotor instability (hot flashes, night sweats, palpitations, dizziness, headaches, insomnia)

      • Hormonal changes: irritability, anxiety, depression, brain fog

      • Long-term estrogen deprivation: imbalance bone romdeling causes osteoporosis

  • Psychological Symptoms: Include irritability, anxiety, and depression; may feel forgetful or experience brain fog, moody, inability to concentrate

  • Menstrual Changes: Erratic cycles, vaginal changes, decreased lubrication, vaginal ph rises (casues dryness)

  • Vasomotor Symptoms: Hot flashes, night sweats, mood swings, insomnia, anxiety, difficulty concentrating, and depression.

Collaboration in Care

  • Focus Areas:

    • Relieving symptoms.

    • Minimizing postmenopausal health risks.

  • Team Involvement: May include physicians, gynecologists, nurse practitioners, nurses, and community support groups.

  • Patient Needs: Reassurance, education, and support during the transitional phase.

Diagnostic Tests

  • Menopause Indicators:

    • Decreased estradiol level.

    • Increased FSH level; not routinely measured unless diagnosis is unclear.

Pharmacologic Therapy

  • Hormone Replacement Therapy (HRT):

    • increased health risks: CHF, breast cancer, Pulm embolism stroke and DVT

    • Recent studies support lower-dose estrogen/progestin as beneficial when used shortly after menopause: dec risk for CV disease

    • Current recommendations for healthy women up to age 59 or within 10 years of menopause involve HRT to alleviate hot flashes and vaginal dryness.

    • Increased risk for blood clots, though rare in this age group.

  • Selective Estrogen Receptor Modifiers (SERMs):

    • Include Duavee for hot flashes and reduce risk of boen fractures

    • Osphema for dyspareunia

    • potential risk for endometrial cancer and DVT.

  • Antidepressants: SSRIs and SNRIs may alleviate hot flashes and night sweats.

Nonpharmacologic Therapy

  • Complementary Approaches:

    • Massage, meditation

    • plant estrogens found in soybeans, chickpeas, lentils, flaxseed, grains, beans, fruits, red clover, dark green, leafy vegetables yams, tofu

    • Ginseng, but with conflicting research outcomes.

    • Black cohosh shows lack of evidence for efficacy.

Lifespan Considerations

  • Surgical Menopause:

  • Oophorectomy leads to sudden changes, and symptoms can be exacerbated.

  • Discussion of Options Pre-Surgery: Important for patients seeking to preserve fertility.

Nursing Process

  • Focus Areas:

    • Symptoms management, cardiovascular disease reduction, cancer prevention, osteoporosis awareness.

    • Education on lifestyle changes including healthy diet, weight-bearing exercises, and mental health support.

Assessment**

  • Observational and patient interview:

    • Sexual history

      ● Dyspareunia or changes in arousal

      ● Menstrual history

      ● Changes in bleeding patterns, cycle

      ● Past pregnancies, childbirth, gynecologic surgeries

      ● Urinary problems

      ● Sleep patterns

      ● Vasomotor symptoms

      ● Changes in emotional responses

      ● Alcohol, nicotine, drug use

      ● Diet, vitamin or supplement use

      ● Exercise

  • Physical Assessment:

    • Vital signs, body measurements

    • Breast examination: irregularities, do 1/month in shower

      • report: changes in shape, skin, nipple, massess or swelling of lymph nodes

    • Abdominal: percussion and palpation

    • Pelvic exam: apperance of external genitalia, vagina, cervix

    • Assessment of overall health including sexual function and emotional responses.

Common Patient Problems**

  • Problems related to menopause may include lack of knowledge, sexuality concerns, symptoms and psychological impacts

  • Goals Setting for Patients: Understanding menopause and learning coping strategies.

Implementation**

  • Patient Education: Discuss the physiological and psychological impacts of menopause and the importance of support.

  • Promote Healthy Self-Image: Encourage open discussions about body image and emotional health, and provide referrals if necessary

  • Encourage a body image that includes a realistic view of physical characteristics

    ● Referrals to address to promote wellness and a positive self- concept

    ● Weight issues how long , what do they want to incoperate

    ● Multiple and overlapping social roles

    ● Specific professional needs (i.e., aesthetician consult for facial hair, etc.)

Evaluation**

  • Expected Outcomes: Patient to verbalize feelings about changes, demonstrate self-acceptance, and describe health maintenance strategies.

  • Re-assessment: If goals aren't met, additional education and support may be needed.