[Woman] Menopause

Pathophysciology

1. Ovarian function declines -> estrogen levels decrease -> ovulation suppressed -> menses cease

2. Occurs in clients age >45

3. Retrospectively diagnosed : Menses absent for >12months 

 

Menopausal changes due to decreased estrogen.

CNS	Vasomotor symptoms, Cognitive changes, Demensia
	Sleep disturbance(excessive perspiration while sleeping), Depression
Systemic changes	decreased skin thickness & elasticity, hair loss
	Weight gain
Urogenital system	Amenorrhea, Vulvovaginal atrophy, Dyspareunia(pain during sexual intercourse), decreased Libido
Musculoskeletal system	Bone loss(decreased bone density), Joint pain

 

 

* Combined estrogen/progesterone hormone therapy -> hysterectomy 했으면 estrogen monotherapy 해도 돼.

-increase risk for blood clot formation

-Contraindications: History of deep vein thrombosis, hormone-driven cancers.

-Nonhormonal alternative = selective serotinin reuptake inhibitors (SSRI)

*Vitamin D with a calcium supplement

-promote and maintain bone health

*complementary and alternative medicine

 

Nursing interventions

*Client teaching

-Avoid excessive alcohol, tobacco, caffeine, spicy foods

-Water-based lubricant during intercourse

-Weight-bearing exercises (eg. yoga, walking) - d/t risk for osteoporosis -

-Calcium-rich foods.

 

Breast tenderness 는 임신때도 있고, 폐경 떄도 있다. 에스트로겐이 상승하거나 하강할 때 둘다 breast tenderness 생김. 

 

 

1. Taking a calsium supplement to help prevent loss of bone density (eg. osteopenia, osteoporosis) associated with decreasing estrogen levels

2. Avoiding spicy foods to decrease vasomotor symptoms (eg. hot flashes, night sweats). Vasomotor symptoms are the result of estrogen withdrawal in the hypothalamus, affecting the themoregulatory system and causing paradoxical peripheral vasodilation, heat loss, and perspiration.

3. Using water-based lubricants during intercourse to decrease pain.

 

X) Estrogen monotherapy is not expected. clients with an intact uterus (ie. no history of hysterectomy) are prescribed combined estrogen/progesterone to decrease the risk for endometrial hyperplasia or carcinoma due to unopposed estrogen. Clients ieth a previous hysterectomy (ie. no uterus) can be prescribed estrogen-only therapy.

 

X) Preparing the client for removal of the Copper intrauterine device is not expected at this time b/c spontaneous ovulation and pregnancy can still occur due to fluctuating estrogen levels during perimenopause. (저기요 초기폐경기는 아직 완전한 폐경이 아니라서 임신 할수도 있어요)

 

 

[ Modifiable ]

* Hormone replacement therapy

* Nulliparity

* Increased age at first live birth

* Alcohol consumption

[Nonmodifiable]

* Genetic mutation or breast cancer in first-degree relatives

* White race

* increasing age

* Early menarche or later menopause

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On PE, bilateral breasts are noted to be mildy tender with a rope-like texture.

-> Fibrocystic breast changes occur when glandular tissue proliferation leads to diffusely nodular breasts and breast tenderness. On examination, bilateral breasts typically have multiple nodulocystic masses (eg. rope-like texture). Fibrocystiv breast changes are benign and do not require follow-up.