Menopause

DEFINITION of Menopause

A woman is considered "postmenopausal" once she has gone without menstruation for 12 months. Menopause describes the time after a woman has had her last menstrual period. It is from the Greek word pas is (cessation) and the root men- that we get the phrase "menopause," which signifies "the end of monthly cycles" (month). Menopause is defined as the occurrence of 12 months without menstrual menstruation. When ovarian follicular activity declines, menstruation stops permanently, marking the end of reproductive life. It's the time when your period stops forever. Menopause typically begins between the ages of 45 and 55, with the median age being 50.

PHASES OF MENOPAUSE 

1. Pre-menopause phase 
   In this time frame, a woman's body makes the transition from her menstrual and ovulation cycles to the permanent infertility of menopause. The ovaries' steady reduction of estrogen production during perimenopause can begin 8-10 years before menopause begins. This phase typically begins in one's forties and continues until menopause. More and more symptoms appear as estrogen levels decrease in women. If women still get their periods, it's possible that they could get pregnant. Climacteric refers to the time in a woman's life when she experiences the physiological changes linked with the end of her reproductive potential and which ultimately culminate at the beginning of menopause. Periods of menstruation may become irregular, occurring more frequently, less frequently, lasting longer or shorter than 28 days, and varying in intensity. During this time, many women experience symptoms like as hot flashes, insomnia, and vaginal dryness.

2. Menopausal phase
   When a woman hasn't had a period for 12 months in a row, she is considered to have reached menopause and the perimenopause period is over. When a woman hasn't had her period for more than a year, her ovaries stop putting out eggs. This means she is no longer likely to get pregnant.
3. Post-menopausal phase
   It is the time after which a woman has experienced 12 consecutive month of amenorrhea. During this time, many of the symptoms of menopause ease for most women; she may regain energy and feel emotionally normal once again. But, as a result of a lower level of estrogen, postmenopausal women have an increased risk for a number of health conditions, such as osteoporosis, heart disease, and changes in the vagina and bladder. 

Causes of  Menopause

• Menopause occurs naturally because of a decline in the production of estrogen and progesterone reproductive hormones and ovulation no longer occurs. 
•  Premature menopause or premature ovarian insufficiency may occur before the age of 40 due to natural ovarian functcomingcome to an end due to surgery or total hysterectomy due to the cancer treatment. Menopause is considered "early" when it occurs between 40 and 45 years. 

•  Peri-menopause refers to the time leading up to menopause when a woman may start experiencing changes in her menstrual periods sch as, irregular periods or changes in flow that may become longer or shorter. 

Sign and Symptoms 

 The following sign and symptoms may be caused by fluctuations in the production of hormones from the ovary are as follows:  

• Hot flushes and night sweat formication, unpleasant sensation that feels like ants crawling on the skin are vasomotor symptoms. If the woman smokes then it will add to the severity of vasomotor symptoms and increase the risk of osteoporosis. 
• Aches and pains, 
• Fatigue or irritability as well as premenstrual symptoms such as sore breasts. 
• Vaginal dryness because of less moisture production and loss of elasticity can cause discomfort and slight bleeding during sexual intercourse may reduce the desire for sexual activity (libido) 

 POSTMENOPAUSE 

 After menopause, the risk of certain medical conditions increases due to changes in the body's hormone levels. Such as cardiovascular disease and osteoporosis, prone to recurrent UTI and urinary incontinence due to loss of elasticity of the vaginal and urethral tissues. 

Diagnosis 

• Based on the symptoms of menopause after 45 years in healthy women perimenopause and menopause can be diagnosed: 
• Perimenopause-vasomotor symptoms and irregular periods .
• Menopause in women who have not had a period for at least 12 months and not using hormonal contraception 
• FSH test can be done to women whose age is less than 40 years and in women with change in their menstrual cycle.
• Mammography, pelvic exams and lipid screening can be done. 

 Management 

Symptomatic treatment for the menopause is often works. Such as: 

• Hormone replacement therapy (HRT), which here refers to the use of estrogen and progestin in menopausal women. And it may be helpful for the treatment of menopausal symptoms such as hot flashes and prevention of osteoporosis and osteoporotic fracture. 
• Selective estrogen receptor modulators (SERMS) SERMS are a category of drugs that act selectively as agonists or antagonists (depending on the target issue) on the estrogen receptors throughout the body. SERMS are either synthetically produced or derived from a botanical source called phytoserms. It is especially used to prevent occurrence of postmenopausal osteoporosis and many have been associated with an increase in hot flashes. 
• Control your blood pressure, cholesterol, and other risk factors for heart disease is essential. 
• Proper education and lifestyle modification is effective management of menopause. These includes:
  a. Cessation of smoking is helpful because smoking increases the severity of vasomotor symptoms and risk of osteoporosis.
  b. Diet such as herbal supplements are natural approach to manage menopause.
  c. Soy, chickpeas, lentils and flaxseed helps to prevent vasomotor symptoms. 
• Vaginal estrogen therapy in particular provides excellent relief of genitourinary symptoms  
• Exercising regularly and involving relaxation techniques in daily life and self-management strategies such as carrying a fan, dressing in layers, always having a cool drink and a facial water spray can be helpful. 
•  Avoiding spicy foods, caffeine and alcohol will also reduce flushing.  
• Vitamin E found naturally in nuts, vegetable oils, and green leafy vegetables needs to be preferred more which is an alternative treatment for menopause. 

Nursing management 

•  Assess the phase of the patient, and interest in the diagnosis and then inform clearly to the client about the symptoms and diagnosis of it. 
• Help the patient to modify health habits and lifestyle to prevent further complications of menopause. 
• Explain both the benefit and adverse effects of treatment modalities of menopause. 
• Clearly tell the patient about the vasomotor symptoms, low mood, vaginal dryness, and low sexual desire associated with menopause.
• Give clear information about menopause and fertility 
• Advice for regular moisturizer and lubricant can be used with vaginal estrogen. 
•  Encourage modifying the diet as mentioned above in treatment.