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27 Cards in this Set

  • Front
  • Back
how we view menopause influences how we experience it
definition of menopause as metamorphosis
atrophy and dysfunction or transformation. (womans genetial shrivel up) a transition to elder position some cultural
Menopause definition
retrospectively, one year w/o menses
avg. age is 50
perimenopause: 5 to 10 y surrounding menoupause starts at 40/45
Surgical menopause
any time ovaries are removed
acute menopause body can't ajdust so quickly if ovaries out dramatic change. put on HRT for short period of time.
Physiologic changes
change in hormones
ovaries decrease amt of estrogen
TSH&LH increase to try and get ovaries to produce estrogen. Hot flashes-due to irratic changes in levels of hormones
Physical changes
cessesation of menses
increased hair growth-due to unopposed testosterone
hot flashes
vaginal dryness
thinning of estrogen sensitive tissues
infertility
Menses changes
no normal
quick sudden end-have normal periods then stop-very unususal
gradual tapering off-gradual decrease or further apart q3mo to 11mo to 3mo-can be heavy or scant bleeding
may go almost a year then resume for awhile.
Menopausal symptoms timeline
5 year block
hot flashes have these before anything else. then vaginal discomfort, then cardiac disese, then bladder discomfort, then osteoporosis
Hot Flashes patho
unstable vasospastic response to fluctuatuing estrogen levels r/t noreepimetabolism in brain can last 2-5y or whole life
hot flashes manifestations
mild flush to intensely hot, several seconds to several minutes, rare to cluster can be accompained by perspiration, tension, anxiety, heart palpatations, nausea. nighttime is most bothersome
Hot flash triggers
ETOH
caffeine
hot drinks
stress/tension
hot humid weather
high acid foods bother them
triggers are very individual some may have none at all
changes to estrogen sensitive tissue
thinning of tissues:vaginal mucosa become thinner due to lack of estrogen
increase in UTI, monilia infections
dysparunia-result of lack of use
Loss of bone with menopause
starts before menopause gradual decline after 20's. Once menopause there is sharp decrease. men lose but not as fast.
Hormone Replacement Therapy
started in 30's with estrogen. if give estrogen w/o progesterone, >risk of endometrial CA.
START BEFORE MENOPAUSE
suppossed < in CVD, Osteoporosis and hot flashes after PEMI study in 95
PREMARIN 4th most common rx in US
New thoughts on HRT
2002 study showed > in CVD, Breast CA, FX, Colon CA, CVA, thromoembolic events
So what have we learned about HRT
don't use for prevention of CVD
tx duration and dose should be as short and low as poss.
altenative rx for osteoporosis
give only if reason if menopausal symptoms
Menses changes
no normal
quick sudden end-have normal periods then stop-very unususal
gradual tapering off-gradual decrease or further apart q3mo to 11mo to 3mo-can be heavy or scant bleeding
may go almost a year then resume for awhile.
Menopausal symptoms timeline
5 year block
hot flashes have these before anything else. then vaginal discomfort, then cardiac disese, then bladder discomfort, then osteoporosis
Hot Flashes patho
unstable vasospastic response to fluctuatuing estrogen levels r/t noreepimetabolism in brain can last 2-5y or whole life
hot flashes manifestations
mild flush to intensely hot, several seconds to several minutes, rare to cluster can be accompained by perspiration, tension, anxiety, heart palpatations, nausea. nighttime is most bothersome
Hot flash triggers
ETOH
caffeine
hot drinks
stress/tension
hot humid weather
high acid foods bother them
triggers are very individual some may have none at all
what have we learned
HRT should not be used for prevention of CVD
treatment and duration and dose should be as short and low as possible
alternative rx for osteoporosis
HERS and WHI data can't be extraploated to perimenopause or premature menopause woman
USE HRT ONLY FOR MENOPAUSAL SX
Know your risk Factors
killers of woman over 50
CVD-esp if strong family hx
osteoporosis
breast CA
Colon CA
risk/benefits of HRT
know alternative rx choices
Self Care Choices
EXERCISE: >endorphins, <bone loss, >HDL, < hot flashes
DIET-wt stabilization,<fat&animal protein,>fiber&CA vit D, E and C, <phosphates
<ETOH
<SMK
<CAFFEINE
>sex to help prevent dyspurnia
stress reduction
visulaization
yoga
tai chi
therapeutic touch/massage
acupunture
elderly wt bearing exercise
what causes increase in number of falls in the elderly
the change in center of gravity
Alternative Rx
herbs
Herbs:dong quai,ginseng and black cohosh tea all help body produce estrogen
Alternative Rx
Pharmacologic
megace-
catapres
prozac
effexor
paxil
SSRI