For this assignment, address the following: (DO NOT ANSWER THIS), (just react to the posts below).
• Discuss the concepts of menopause
• Discuss the misconception of menopause being a medical ailment vs a natural developmental process
• Discuss the clinical presentation and symptoms associated with menopause
• Discuss the risks and benefits of hormone replacement therapies
• Present 3 additional management strategies to assist your patients with management of their menopausal symptoms. Be sure to incorporate the risks/benefits of these management strategies
Post 1
DeHa
Normally, women experience menopause at a mean age of 51; 95% of these women become menopausal between the ages of 45 and 55. Menopause is associated with a marked decrease in ovarian estrogen production. Low estrogen levels in postmenopausal women may trigger vasomotor symptoms (hot flashes) and, in time, the onset of symptoms of vulvovaginal atrophy, including vaginal dryness and dyspareunia (genitourinary syndrome of menopause [GSM]). Estrogen is the most effective treatment available for relief of menopausal symptoms, most importantly, hot flashes, vaginal dryness, and dyspareunia. Menopausal hormone therapy (MHT; estrogen alone or combined with a progestin) is currently recommended for management of menopausal symptoms. Long-term use of MHT for prevention of disease is no longer recommended (Santen & Loprinzi, 2019).
The average life expectation of women in developed countries is 83 years. Women spend more than one-third of their lifetimes post-menopause. The abrupt occurrence of hypoestrogenism causes typical vasomotor, sexual and psychological symptoms, and osteoporosis in 33% of women. Aiming at ‘healthy aging’, postmenopausal women should be safeguarding the quality of life. There is no doubt that hormone replacement therapy (HRT) with estrogen is successful in alleviating menopausal symptoms. A decade ago, the Women’s Health Initiative (WHI) published an alarming report regarding possible health risks of HRT. Although this conclusion has repeatedly been overturned by the re-analysis of the original data and the findings of more recent trials, many women request ‘natural products’ to alleviate their symptoms. Several herbal preparations and over-the-counter nutriceuticals have been recommended because of their phytoestrogenic and alleged health-promoting properties.
Women using HRT benefit from higher qualities of life and more satisfying sexual experiences. Though HRT does not prevent age-related cognitive decline, significant memory improvements were observed when vasomotor symptoms were suppressed. HRT enhances stress tolerance and coping, but does not seem to affect postmenopausal depression; although, it does improves sleep. Randomized trials have shown HRT to reduce joint and muscular pain, to delay aging of the skin and to preserve visual function. HRT also significantly reduced age-related methylation of specific subgroups of gene promoters and may, theoretically, extend life span (Comhaire & Depypere, 2015).
According to UpToDate, the Women's Health Initiative (WHI) combined hormone therapy (HT) trial, risks associated with HRT include CHD events, stroke, venous thromboembolism (VTE), and breast cancer, while benefits include a reduction of fracture and colorectal cancer risk. Results for stroke, VTE, and fracture risk with unopposed conjugated equine estrogen are similar to those in the combined therapy trial.
Non-estrogen treatments for hot flashes are effective in many women. None work as well as estrogen, but they are better than placebos. Not all women need treatments for hot flashes, since the hot flashes are mild in some women .Other options include:
Paroxetine — Paroxetine is the only nonhormonal therapy that is specifically approved for hot flashes (in the United States). This agent has been used for many years for depression but can be taken at a lower dose for hot flashes.
Gabapentin — Gabapentin (sample brand name: Neurontin) is a drug that is primarily used to treat seizures. It also relieves hot flashes in some women, preferably when given as a single bedtime dose or during the daytime.
Antidepressants — Antidepressant medications are recommended as first-line treatments for hot flashes in women who cannot take estrogen. Paroxetine is the only drug approved in the United States for hot flashes of this class, but each of these agents has been used for hot flashes
Progesterone —Injectable progestin birth control hormone medroxyprogesterone acetate (brand name: Depo-Provera) helps to reduce hot flashes, but is not commonly used.
Plant-derived estrogens (phytoestrogens) — Plant-derived estrogens have been marketed as "natural" or "safer" alternatives to hormones for women with menopausal symptoms. Phytoestrogens are found in many foods, including soybeans, chickpeas, lentils, flaxseed, lentils, grains, fruits, vegetables, and red clover. Isoflavone supplements, a type of phytoestrogen, can be purchased in health food stores.
However, it is uncertain whether phytoestrogens help to reduce hot flashes or night sweats; most studies have not reported benefits. In addition, some phytoestrogens might act like estrogen in some tissues of the body. Many experts suggest that women who have a history of breast cancer should avoid phytoestrogens.
Herbal treatments — Several herbal treatments have been promoted as a "natural" remedy for hot flashes. In fact, many postmenopausal women use black cohosh for hot flashes, but clinical trials have shown that it is not more effective than placebo. There have been concerns that black cohosh could stimulate breast tissue like estrogen, increasing the risk of recurrence in women who have had breast cancer. Currently, there is no evidence that it is harmful, even in women with breast cancer. Still, some experts suggest that women with breast cancer avoid black cohosh until its effects have been studied more extensively. Herbal treatments are not recommended for hot flashes or other menopausal symptoms.
Cognitive behavioral and other treatments — Stress management, relaxation, deep breathing, and yoga might be helpful for some women, but study results have been inconsistent. Other approaches such as hypnosis, stellate ganglion blockade (numbing of a nerve in the neck with an injection), and acupuncture reduce hot flashes, but they might work at least in part due to a placebo effect.
Post 2
BrCa
Menopause is the last phase of the reproductive cycle. The Stages of Reproductive Aging Workshop (STRAW) separate the perimenopause, menopause and postmenopausal periods into seven stages (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017). Menopause transition is typically marked when there are menstrual cycle changes. It is difficult to be accurate because there is not actually a serum marker that can pinpoint menopause (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017). Therefore, menopause is defined by a decrease in gonadal hormone levels that is proven by an absence of a period for 12 months. This could be a natural event or a surgically induced event by removing the ovaries and uterus (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017).
Menopause is a natural part of life that occurs in an unpredictable cycle. The age of naturally occurring menopause is between 40-58 with the average age being 52. Although some of the symptoms can be harsh to a female, it is not a disease or sickness that is occurring. A woman may still seek healthcare for their symptoms, especially when they interfere with her life or become unbearable(Schiiling, 2017).
Symptoms that are often reported by women are hot flashes, irregular menstrual bleeding, changes in the vagina and vulva that are due to fluctuating hormone levels. A woman may report changes in her mood such as depression or trouble sleeping. She may also have a decrease in sexual activity due to vaginal dryness or decreased libido (Buttaro et al., 2017).
A woman may choose to start taking hormone replacement medications. One of these is estrogen. Estrogen is usually easy to use and is not expensive and is helpful for cholesterol levels. However, it does increase the risk for stroke. It can increase triglycerides, C-reactive protein and hepatic proteins. A woman may have a decrease in their sex drive while taking oral estrogen (Buttaro et al., 2017).
She may choose to use transdermal or topical estrogens instead. Compared to the oral route, the risks are decreased. The cost is higher, and patches may not stick to the skin well and are visible (Buttaro et al., 2017). Vaginal estrogen can increase vaginal discharge, are not convenient and have not been studied efficiently for safety (Buttaro et al., 2017).
For a woman that takes progesterone, there will be less harmful effects on the endometrium. Taking this medication at night can help with insomnia. However, they can cause bloating, and dysphoria and decrease estrogen’s benefit on HDL. Some progesterone can increase a women’s risk for breast cancer (Buttaro et al., 2017).
A patient can try taking herbal products to reduce their symptoms. Some of these products are Black cohosh and relizen. These products are thought to reduce vasomotor symptoms. The problem with using these products is that they are not FDA approved so there are questions about their safety, purity and side effects (Buttaro et al., 2017).
They may choose to use vaginal moisturizers or lubricants for vaginal dryness. This would help with irritation and dyspareunia. The downfall to these products is that they only give the woman short term relief and they can be messy (Buttaro et al., 2017).
To help cope with or reduce the menopausal symptoms, a woman should dress in layers, wear clothes with wicking material, avoid smoking, alcohol, caffeine, spicy foods and maintain a healthy weight. Using a fan at night could also help her to cope with night sweats (Buttaro et al., 2017). The downfall of doing these things is that she will most likely still have the VMS although they may decrease at times.