Monopauseانقطاع الطمث
|
Introduction
about Menstruation |
|
|
Introduction
and Medical definition of Menopause
|
|
|
Phases of Menopause 1st
phase :Pre-Menopause |
|
|
2nd
phase: Menopause |
|
|
Diagnosis
of Menopause |
|
|
Signs and
Symptoms |
|
|
Clinical
Features |
|
|
Osteoporosis
|
|
|
Prevention |
|
|
Treatment |
|
|
Nursing
care plan and Interventions Menopause |
|
Introduction of Menstruation:
To learn about Menopause
(The main research topic) we have to learn about Menstruation:
Menstruation, or period, is normal vaginal bleeding that
occurs as part of a woman's monthly cycle. Every month, your body prepares for
pregnancy. If no pregnancy occurs, the uterus, or womb, sheds its lining. The
menstrual blood is partly blood and partly tissue from inside the uterus. It
passes out of the body through the vagina.
Periods usually start between age 11 and 14 and continue
until menopause at about age 51. They usually last from three to five days.
Besides bleeding from the vagina, you may have:
o
Abdominal or pelvic cramping pain o
Lower back pain o Bloating and sore breasts o Food cravings o
Mood swings and irritability o
Headache and fatigue The menstrual
cycle:
Regular menstrual periods in the years between puberty and
menopause are usually a sign that your body is working normally. Irregular or
heavy, painful periods are not normal. Many women also get premenstrual
syndrome (PMS) symptoms.
After we Have learnt about
menstruation let’s get to the main topic of the research which is Menopause
Introduction:
Menopause is when a woman permanently stops having menstrual periods, she
has reached the stage of life called menopause. Often called the change of
life, this stage signals the end of a woman's ability to have children. Many
healthcare providers actually use the term menopause to refer to the period of
time when a woman's hormone levels start to change.
Menopause
is said to be complete when menstrual periods have ceased for one continuous
year.
The transition phase before menopause is often referred to as
perimenopause. During this transition time before menopause, the supply of
mature eggs in a woman's ovaries diminishes and ovulation becomes irregular. At
the same time, the production of estrogen and progesterone decreases. It is the
big drop in estrogen levels that causes most of the symptoms of menopause.
Although the average age of menopause is 51, menopause is considered
normal between 40 and 60 years old. Women who smoke and are underweight tend to
have an earlier menopause, while women who are overweight often have a later
menopause.
Generally, a woman tends to have menopause at about the
same age as her mother did.
Menopause can also happen for reasons other than natural
reasons.
Primary ovarian insufficiency and surgical menopause.
Phases of Menopause:
Perimenopause:
- climacteric: It is the phase of the aging process
during which a woman passes from the perimenopause ,also known as the
menopausal transition, refers to the part of the climacteric before the
menopause (2-8 years prior to the fmp) in which there is transition from normal
ovulatory cycles to permanent amenorrhea of menopause .
- The period is characterized by irregular menstrual cycles
together with some of the symptoms associated with the menopause as, hot flushes, night sweats and mood
swings.
- During this period, inhibit-B secretion from granulose cells
fails due to diminished follicular number, and as result FSH levels rise, and
PRG levels become low.
- Ovarian E2 secretion is preserved until late perimenopause.
Menopause:
Definition:
(FMP)
in the absence of any other pathological or physiological cause
- Menopause occurs due to depletion of ovarian primordial
follicles due to their consumption since menarche (the adult ovary at puberty
contains around primordial follicles).
- Natural menopause :occurs due to intrinsic Ovarian failure usually occurs between 44-55 years
with a median age of 51 years .it's characterized by complete, or near complete ,Ovarian follicular depletion, with
subsequent cessation of Ovarian estrogen (E2)secretion .
- Late or delayed
menopause: menopause occurring >55 years of age.
- Early or premature
menopause: menopause occurring
between 40-45 years of age.
- Induced menopause:
menopause can be artificially induced:
- Surgically; as after
bilateral oophorectomy.
- Ablation of Ovarian
function: as pelvic irradiation of systemic chemotherapy medically; during
the use of long acting GnRH agonists in the management of endometriosis.
- Premature menopause:
occurring at an age 40-45 years may be either,
a) Premature ovarian insufficiency
(p o I): due to congenitally deficient number of ovarian follicles at puberty,
leading to their early exhaustion at a relatively young age.
Idiopathic: no
underling etiology.
Gonadal digenesis:
is a causes of mosaic turner syndrome
B. Induced:
Surgical, irritation or chemotherapy before the age of 45 years.
Endocrine change characterize of menopause:
-
Decrease serum inhibin_B
level that started in perimenopause.
-
marked increase in serum
FSH & LH level.
-
Marked and persistent
decrease in ovarian E2 level.
-
Decrease in sex hormone
binding in globulin (SHBG).
-
Increase free testosterone
FT) level.
-
Persistent production of
ovarian testosterone (T)
Changes in body systems Associated with Menopause Aka Signs and
Symptoms:
Change in menopause start in climacteric period, and
continue gradually, and persistently after section of menstruation. There are
almost are related to estrogen deficient and are there for gradual progress and
time related.
-
The Vagina become
smaller, thinner, with gradual loose of it is rogue. Decrease vascularity, and
increased vaginal PH. Vaginal smears become atrophic.
-
The pelvic ligaments become weaker predisposing to
pelvic organ prolapse.
-
The uterus become
smaller in size. If myoms is present they undergo atrophy.
-
The endometrium become
thin and atrophic (<5mm thickness).
-
The cervix become
flushed with vaginal fornices and the squmo_columnar junction migrates higher
end cervical canal.
-
The urethra and bladder mucosa show loss of elasticity, bladder dysfunction, and stress
incontinence (due to relaxation in the weak pelvic ligaments).
-
The breast become gradually smaller, flabby with progressive fatty
replacement of breast tissue and atrophy of active glandular elements. - The skin shows gradual decrease in
thickness and collagen content.
-
Increased facial hair and androgenic alopecia in response to increased
androgens
-
Gradual changes in
cognitive function and mood swings.
-
Decreased mineral bone
density leading to osteoporosis (see later)
-
Nervous and psychological
changes
Clinical Features of the Menopause (signs &
symptoms):
Most menopausal manifestation are secondary to the chronic
low serum E2 levels characteristic of the menopause.
Symptoms usually start gradually in the perimenopause.
Increase atrophy after FMP, and extend years into the menopause.
In almost 50% of woman menopausal symptoms will be severe
enough to call for gynecologic consultation and or treatment.
Menstruation may stop abruptly, however the FMP is more
commonly preceded by a period of oligomenorrhoea in the late perimenopause
period.
1. Vasomotor symptoms
(VMS): Hot flushes & Cold sweating
Hot flushes: are recurrent waves of heat over the chest,
neck, and face, followed by cold sweating. A flush may last for 1-5 minutes,
and may be associated by palpitation, dizziness or headaches.
Flushes affect at least 50% of menopausal woman but with
variable grades of severity.
Flushes start in the perimenopause and become more
aggressive in the menopause.
Flushes result from inappropriate stimulation of the
thermoregulatory centers in the hypothalamus with vasodilation of the skin over
the head, neck and chest, causing a skin temperature rise although care body
temperature does not change.
2. Nervous and psychological symptoms: anxiety, irritability, mood changes,
insomnia and lack of concentration, are common although with variable degrees
3. GIT Symptoms: constipation, abdominal
distension and tendency to weight gain.
4. Dyspareunia: due to
vaginal atrophy, dryness and senile vaginitis.
5. Urinary symptoms: as frequency, dysuria and stress urinary
incontinence, may occur alone or in
association with pelvic relaxation and genital prolapse.
6. Tendency towards pelvic
organ prolapse (POP) : uterine , vaginal prolapse occur more frequently y
due to weakness and atrophy of pelvic and cervical ligaments.
7. Androgenic manifestation: increased facial hair
and baldness affect woman variably.
8. Symptoms related to osteopenia and osteoporosis (see
later).
Diagnosis of menopause:
-
Amenorrhea for 1 after the
EMP in premenopausal woman.
-
Elevated serum fsh levels
(>30 mlU /ml).
-
Low E2 levels (< 25mlU
/ml).
-
Menopausal symptoms as
flushes, cold sweating, irritability, insomnia and weight gain.
Management of Menopause:
-Reassurance about the physiological nature of the
menopausal symptoms
-Education for healthy life style, Calcium rich diet,
suitable exercise, and avoid smoking
-Symptomatic
treatment for some menopausal symptoms Sedatives, tranquilizers;
antidepressants on individual basis whenever needed. -Periodic tests for early detection of premalignant
and malignant lesions including; Mammography, TVS. Rap smear cytology, and
colposcopy.
-Diagnosis, prevention, and treatment of osteoporosis (see
later).
-Hormone therapy (HT) in selected cases with severe
menopausal symptoms (see later).
REMOTE HEALTH HAZARDS RELATED TO MENOPAUSE:
CARDIOVASCULAR SYSTEM CHANGES (CVS)
•
Pathogenesis: Oestrogen deficiency may lead to hypercholesterolemia
with increased LDL and decreased HDL (reversed LDL/HDL ratio)
•
Clinical manifestations:
reversed LDL/HDL ratio may predispose ta ischemic coronary heart disease (ICHD),
myocardial infarction (MI), atherosclerosis, hypertension (HTN), and
cerebrovascular strokes.
OSTEOPOROSIS:
- Definition:
Osteoporosis is a disorder characterized by decreased bone mineral density
leading to compromised bone strength with increased risk of bone
fractures.
- Pathogenesis:
Oestrogen deficiency results in accelerated bone mineral calcium loss, and
increased activity of osteoclasts (bone destroying cells), affecting mainly the
vertebrae, femoral neck, distal radium, and the calcaneus
- Clinical manifestations:
o
bone demineralization is usually a silent disease that manifests years
after menopause with; decreased height, increased curvature of the spine,
silent fractures of the vertebrae, or fractures of the hip and long bones on
exposure to mild trauma.
Risk factors
Premature menopause. Heavy smoking, lack of exercise, low body
weight, together with heradtiatory and genetic factors.
Diagnosis.
X-ray bone densitometry (DEXA)
Prevention of osteoporosis
v Balanced diet with rich of calcium intake of 1500mg daily
v Vitamins D600_800Iu/day
Treatment of osteoporosis
Drugs the slow bone break down during bone remodeling:
v Bisphosphonates
orally once per week decreases non vertebral fractures
v Calcitonin nasal
spray increase the vertebral bone mass and reduce fractures
v Drugs that have an anabolic effect that stimulate bone
remodeling: Tripartite IM injections over a period up to 18_24 months. It
decreases vertebral and non-vertebral fractures. Hormone therapy
(HT). Although effective in prevention and management of
osteoporosis is rarely used as primary therapy except in
case of needing HT for control of menopause flushes or in cases of premature
menopause.
v Selective Oestrogen receptor modulation (SERM). E. G. Raloxifene
60mg/day has a combined and oestrogens affection bone and anti oestrogen tissue
on Breast and uterus. It is approved for prevention of osteoporosis but may
induce hot flushes.
v Phytoestrogen plant substitutes that have a weak estrogen
action.
Hormone therapy in menopause
Types
of HT:
A.
Oestrogen and progesterone therapy combined HT where Progestin is
added to avoid osteoporosis, induced endometrial hyperplasia, and possible
endometrial carcinoma.
B.
Oestrogen only therapy suitable for women who have undergone
hysterectomy.
No risk for oestrogen induced endometrial hyperplasia and
carcinoma.
Benefits of oestrogen in menopause:
1-
It reduce menopause
symptoms as: hot flashes, sleepiness, and mood disorders
2-
Treat vaginal dryness and
atrophy which may cause dyspareunia and senile vaginitis.
Prevents the risk of osteoporosis during the period of the
therapy.
Risk of hormone therapy:
o Small but significant increase for CVS diseases, stroke. And
venous thromboembolism.
o Small but significant increase in the risk of Breast cancer,
endometrial cancer risk: with oestrogen and progesterone only therapy more than
5 years
Indications of HT in menopause:
-
Menopausal symptoms
affecting the patient's. Life style and psychological condition
-
Premature menopause
(idiopathic or surgically induced) till age of natural menopause.
-
Prevention of osteoporosis
in high risk cases. The effect is limited to the period of HT.
Contraindication to the use of HT
a. Undiagnosed abnormal bleeding from the genital tract
b. Known or suspected breast cancer, or estrogen dependent
neoplasia
c. History of DVT stroke, or thromboembolic disease
d. Active liver disease
Commonly used schedules for HT
- Continuous
Combined E/ PRG therapy: daily oral tablets throughout duration of therapy
(1-
2 years). No withdrawal bleeding expected.
-
Cyclic Combined E/PRG therapy: daily oral estrogen tablets for 3
weeks PRG added last12
Days. Treatment stopped for one week in which withdrawal
bleeding is expected,
-
Oestrogen only therapy (E T): daily oral doses? sub dermal
implants, or transdermal Patches are used for patients with absent uterus
(after hysterectomy).
-
Oestrogen vaginal cream preparations: for local application in
cases of vaginal atrophy
Types of Hormones used:
-
Natural oestrogens are
preferred over synthetic ones e.g.; conjugated equine Oestrogen 0.625 rn€/day
or oestradiol valerate IQ rng/day.
-
Synthetic Gestagens are
preferred being more effective in smaller doses. Side effects include
mastalgia, mood changes, PMS like symptoms, weight gain, etc...
Nursing care Plans of MENOPAUSE:
Nursing management of menopause is symptomatic.
Estrogen replacement therapy is the most advantageous
treatment for symptoms .but it's not suitable for all patients as it has some
adverse effects and risks.
Here are six nursing care Plans and nursing diagnosis for
patients with menopause:-
1.
disturbed sleep
pattern 4. stress urinary
incontinence
2.
sexual dysfunction 5. risk for
infection
3.
risk for injury 6. situational low self
esteem
Nursing INTERVENTIONS:
v Assess type of medications, effect of medications, and number of
medications being taken.
v Assess patient’s accident proneness, presence of agitation,
ambulatory status, and interference with thinking, balance, and gait.
v Reduce unsafe activities and behaviors, or modify, if
appropriate.
v Assess patient’s pulses distal for fracture, presence of edema,
or color changes.
v Tell patient to immediately report vaginal bleeding or spotting
after menstruation has ceased.
v Assessing presence of impotence, dyspareunia, feelings of
inadequacy, or fear of sexual function and failure.
v Assessing patient’s sexual interest, desire, effect of health
status on sexuality, and psychosocial factors affecting sexual function
v Discussing past sexual experiences and practices, interests, and
satisfaction, and medications taken for control of chronic diseases that affect
sexual function.
v If patient is sexually active, tell her to remain sexually
active v Instructing
patient to perform Kegel exercises daily.
v Encourage to vary positions during intercourse.
تعليقات
إرسال تعليق