Reproductive health Menopause. Definition of Menopause WHO 2004 defined natural menopause (the...
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Transcript of Reproductive health Menopause. Definition of Menopause WHO 2004 defined natural menopause (the...
Definition of Menopause
WHO 2004 defined natural menopause (the permanent cessation of menstruation resulting from loss of ovarian follicular activity which occurred after 12 consecutive months of amenorrhea).
Climacteric is defined as (the phase in the aging
women which marks the transition from reproductive state to non reproductive state).
Definitions Related to Menopause
Perimenopause :(1-2 year immediately before menopause or it is the whole reproductive period prior menopause ,it is characterized by menstrual irregularities )
Post menopause :(dating from the menstrual period regardless of wither the menopause was induced or spontaneous)
Importance of Topic
Menopausal women at more risk to develop cardiovascular diseases and osteoporosis on the long term effect, which affect the quality of life.
Menopausal women complaining from morbidity including urinary incontinence , urinary tract infections , reproductive infections and genital prolap.
Importance of Topic
little attention is provided to the menopausal women ,here in Jordan there isn’t available services to the menopausal women, because most of the health care focuses on the pregnant women during childbearing years, as the essential role of the woman is childbearing(Mahadeen, et al., 2008).
Age of Menopause
Worldwide the average age of menopause is 50yeras with a range of 45-55yeras.
The median age of menopause in Jordan is 50-51years, Jordanian women are living longer than their male counterparts with a life expectancy of 71 years (Jordan Department of Statistics 2005).
Menopause is affected by the woman's health , weight ,nutrition, life style ,culture and genetic factors.
Factors Affecting Menopause
Self concept Physical health Marital stability Relationship with others Cultural values Education
Research finding Among Jordanian Women
In a qualitative research done by(Mahadeen, et al., 2008) of 25 peri menopausal Jordanian women to study their perception of menopausal transition , they found that Jordanian women considered menopause as a life transition with no reproduction leading to a stage of freedom, relief and rest, Jordanian women valued the menopausal stage and consider it as a stage of wisdom ,so their perception was positive(Mahadeen, et al., 2008).
Becoming menopausal decreased women worries about pregnancy and gave them time to pray regularly and fast all the month of Ramadan without any interruption, therefore Jordanian women tended to have positive attitude toward menopause (Gharaibeh, et al., 2010).
Menopausal Symptoms
Vasomotor symptoms Vaginal symptoms Urinary symptoms Physical symptoms Psychological symptoms
Remember
Menopause is highly individualized and each women dealing with it in different way, although the biological changes are same , the symptoms vary in intensity ,frequency and severity from one women to another. There is short term symptoms and long term symptoms.
Vasomotor Symptoms
Hot flashes Night sweats Sweating Palpitations Insomnia, sleeping disturbances Shivering Increased pulse Feeling faint and nausea
Vaginal and Urinary Symptoms
Vaginal infection Post_ coital bleeding Painful sex Itching or irritation Decreased libido Decrease lubrication Urinary frequency /urgency Stress and urge incontinence
Physical Symptoms
Decreased fitness and flexibility
Changes in distribution of body fat
Changes in sleep patterns
Psychological Symptoms
Nervousness Anxiety Moody changes Irritability, confusion Depression Forget fullness Poor self esteem Deterioration in memory Psychosexual dysfunction
Long Term Symptoms
Cardiovascular symptoms which is considered as the leading cause of death in women and its incidence increased after menopause, increased risk for coronary heart diseases(CHD) hypertension and strokes.
Risk Factors for CHD
Family history of heart diseases Advancing age Overweight and obesity Cigarette smoking Hypertension Diabetes Elevated cholesterol
Osteoporosis
One in three of all
women develops
Osteoporosis The incidence increases
in post menopause
due to the reduction
in estrogen levels
Risk Factors for Osteoporosis
Personal history of fracture Current low bone mass Advanced age Family history of osteoporosis Low intake of calcium Vitamin D deficiency Cigarette smoking Inactive life style
Remember
Negative attitudes toward menopause affect the severity of menopausal symptoms, therefore nurses need to reassure the women about normalcy of menopause to make coping and adaptation.
life Style Changes
Regular exercises to prevent coronary heart diseases
lowering weight to increase bone density Avoidance of stress and stressful situation Decrease in caffeine and alcohol intake Smoking cessation Proper nutrition Being in the sun light taking vitamins and calcium
life Style Changes
To use appropriate moisture
to manage any vaginal dryness
Keep cool patches and sprays under
pillows at night to help manage hot flushes and night sweats
Complementary Therapy
Acupuncture Homeopathy Aromatherapy Massage Use of herbs Cognitive behavior therapy Group therapy
Hormonal Replacement Therapy (HRT)
It is effective to relieve vasomotor
urogenital and psychological
symptoms . It is available in many forms and
a variety of routes , including oral
transdermal and intrauterine.
Remember
• Estrogen alone is given to women who
undergone hysterectomy , it increased the
risk of endometrial cancer.
• Progesterone and estrogen given to
women with intact uterus.
Hormonal Replacement Therapy (HRT)
The current advice is to use the lowest dose for the shortest possible time ,many women who stop HRT find that symptoms return again.
Before Starting HRT
Pap smearMeasurement of cholesterol,
lipids ,liver enzymesBase line mammogramEndometrial biopsy
Hormonal Replacement Therapy (HRT)
HRT is contraindicated in women with recent thromoemboilitic disease or sever liver disease, in special forms and in certain circumstances , it will increase the risk of breast cancer in women aged above 50 years , and also older patients who are taking certain types of HRT may also be at increased risk of ischemic stroke.
References
Agnew, Y. (2010). Dealing with menopause -- Go with the flow. Sister Namibia, 22(2), 11-11. Brockie, J. (2008). Physiology and effects of the menopause. Nurse Prescribing, 6(5), 202-207. Gharaibeh, M., Al-Obeisat, S., & Hattab, J. (2010). Severity of menopausal symptoms of Jordanian
women. [Article]. Climacteric, 13(4), 385-394. doi: 10.3109/13697130903050009 Holloway, D. (2011). An overview of the menopause: assessment and management. Nursing Standard,
25(30), 47-58. Mahadeen, A. I., Halabi, J. O., & Callister, L. C. (2008). Menopause: a qualitative study of Jordanian
women's perceptions. [Article]. International Nursing Review, 55(4), 427-433. doi: 10.1111/j.1466-7657.2008.00662.x
Pitkin, J. (2010). Cultural issues and the menopause. Menopause International, 16(4), 156-161. doi: 10.1258/mi.2010.010032
Senba, N., & Matsuo, H. (2010). Effect of a health education program on climacteric women. Climacteric: The Journal Of The International Menopause Society, 13(6), 561-569.
Strauss, J. R. (2011). Contextual Influences on Women's Health Concerns and Attitudes toward Menopause. Health & Social Work, 36(2), 121-127.
Yangin, H. B., Kukulu, K., & Sozer, G. A. (2010). The Perception of Menopause Among Turkish Women. [Article]. Journal of Women & Aging, 22(4), 290-305. doi: 10.1080/08952841.2010.518880