Description
Book SynopsisThis book is designed to meet the needs of nurse practitioners, other advanced practice nurses, and allied health professionals working in women’s health, primary care, and other specialties. The multiple roles the clinician embraces in menopause management include that of direct caregiver, manager of therapeutics, educator, and interdisciplinary team member or leader. This book provides updated, evidence based information on the menopause transition from the late reproductive stage to post-menopause to optimize the interaction of the clinician and the individual woman in each of those roles.
Women’s lived experiences of menopause and women’s concerns regarding both the menopause transition and the choice of care options are included as critical components of shared therapy decisions. The review of natural menopause physiology and the variability of menopause symptoms are inclusive of diverse women and diverse trajectories. The impact of menopause on chronic disease, sleep, weight and nutrition, mood and cognition, urogenital health and sexuality, as well as vasomotor symptoms are each developed as individual topics by experts in those fields. Evidence based management using hormonal and non-hormonal options, and life-style and other complementary interventions are discussed with the most updated advantages and disadvantages of each treatment option. Consistent with advanced practice nursing theory, the approach is whole patient focused.
Table of ContentsPreface
Author Patricia Geraghty MSN, FNP-BC, WHNP
· Philosophy of inclusion
· Attention to individuality
Introduction Patricia Geraghty MSN, FNP-BC, WHNP
Author Patricia Geraghty MSN, FNP-BC, WHNP
· Analysis of the cultural view of menopause from that primarily generated through observation, developing into evidence from controlled studies.
· Effect of extended lifespan establishing the common and prolonged role of menopause in a woman’s life.
· Role of advanced practice nurse and allied health professionals through the ages with a focus of current and future role development.
PART 1 PHYSIOLOGY AND WOMEN’S PERSPECTIVE OF THE MENOPAUSE TRANSITION
Chapter 1 Physiology of Menopause Transition
Author Patricia Geraghty MSN, FNP-C, WHNP
· Hypothalamus Pituitary Ovarian Axis and control of the menstrual cycle
· Normal physiological changes from aging oocytes, hormonal and cycle fluctuations
· Time frame of natural transition
· Iatrogenic menopause and primary ovarian insufficiency
· Estrogen receptors in tissue other than the reproductive system
· Menopause symptom profile including individual and ethnic variations in symptom presentation
Chapter 2 Women’s Lived Experience of the Menopause Transition
Author Nina Coslov, Activist. WomenLivingBetter.org
· Women’s surprise about how soon menopause changes begin.
· Impact of menopause on families and partners
· Help seeking behavior - Women’s quotes and voices on their experiences of symptoms and in seeking help.
· Patient resources and support groups - Overview of Online Resources where women find information and support.
o Experts with Products and Programs
o Websites/Blogs
o Telehealth offerings
o Social Media groups/communities
§ Women are grateful to have a place to feel heard and connect.
§ Impact of question/answer format in absence of clinical monitoring
Chapter 3 Menopause and Chronic Disease Interaction
Author Patricia Geraghty MSN, FNP-C, WHNP
· Menopause interaction with leading causes of death and chronic disease: cardiovascular, lung, dementia, kidney, diabetes, arthritis, cancer.
· Influence of ethnicity on menopause and chronic disease interaction
· Contribution of menopause hormone therapy where known.
Chapter 4 Effective Communication with Women in the Menopause Transition
Author Juliette Blount MSN, NP. Health Equity Activist, Women’s Health NP
· Establishing a trusting and supportive relationship
· Gathering information: health history includes race, ethnicity, and culture, lived experience of her menstrual cycles, thoughts and beliefs of the menopause transition, symptoms, thoughts and beliefs of menopause management
· Providing information: Provide detailed information about the options that are in alignment with the information that you gathered, focus on informed and shared decision making
· Open ended leaving room for questions and alterations in management plan
PART 2 MENOPAUSE SYMPTOM MANAGEMENT
Chapter 5 Vaginal Bleeding
Author Patricia Geraghty MSN, FNP-BC, WHNP
· Recap physiology and transition from mid-reproductive stage to perimenopause to post menopause.
· Incidence, management and consequences of heavy bleeding including ethnic variation.
o Co-morbidities of uterine fibroids, coagulation disorders and other etiologies of heavy menstrual bleeding.
· Incidence, management and consequences infrequent bleeding.
o Unintended pregnancy in perimenopause and co-morbidities of PCOS, endometrial hyperplasia and atypia.
· Incidence, management and consequences of post-menopause bleeding.
o Co-morbidities of genital carcinomas.
Chapter 6 Vasomotor Symptoms
Author Patricia Geraghty MSN, FNP-BC, WHNP
Recap physiology and extent of problem, including ethnic variations.
· Consequences of failure to treat.
· Pharmacological management and risk/benefit of hormones and non-hormone products, evidence for complementary therapy and lifestyle changes.
Chapter 7 Breast Health
Author Michelle Frankland NP (corresponding), Mariya Rayazantseva NP, Trish Brown MS, CGC
Recap of the physiological effect of menopause on breast health and the effect of hormonal management on breast health
· The role of genetics in breast health
· The woman of average risk, the woman of high risk, and ethnic variations
· The role of breast health screening and modalities of screening in menopause
· Management of menopause for the woman at high risk of breast cancer, including complementary and behavioral therapy.
Chapter 8 Mood and Cognition:
Author Eleanor Bremer PhD, RN, FNP-BC
· History of evidence mood related to the female endocrine events of menstruation, pregnancy, postpartum and menopause.
o Perimenopause prolonged PMS symptoms.
o Depression and anxiety associated with menopause transition as a small subset. Management. Prognosis
· Impact on women, their partners, and families
· Association of dementia with menopause and menopause management options.
· Management including pharmacological, complementary, and behavioural therapy.
Chapter 9 Vaginal and Sexual Health
Author Patricia Geraghty MSN, FNP-BC, WHNP
· Recap physiology and extent of sexual response and genitourinary changes in menopause.
· Impact on women and their partners
· Consequences of genital tissue changes related to pain, incontinence, infection. Management including pharmacological, complementary, and behavioural therapy
· Sexual health: genital and CNS contribution. Diagnostic criteria. Management.
Chapter 10 Skin and Integument
Author Denise Hilliard MD, Medical Director, Internal and Aesthetic Medicine
· Overview of Skin/Hair changes in menopause: Structure of skin and hair follicle, Hormone receptors in skin and hair follicle
o Physiologic changes in skin and hair due to hormone shifts in menopause: hair loss, skin dryness, decrease in skin elasticity, decrease in skin thickness
· Concomitant solar-skin changes (sun damage) affecting skin in menopause: Hyperpigmentation, Fine lines and wrinkles, Pre-cancerous and cancerous skin growths
· Caring for skin and hair during menopause
o UVA/UVB protection
o Skin self-exam and skin cancer screening by clinician
o Treatment of focused skin and hair concerns
§ Dry skin
§ Easy bruising
§ Unwanted facial hair
§ Hair loss/ hair thinning
§ Loss of elasticity/wrinkles/loss of volume
§ Menopausal acne
§ Rashes/Skin Irritation/Rosacea
§ Delayed wound healing
· Role of menopause hormone therapy and complementary and behvioral therapy for skin concerns
Chapter 11 Musculoskeletal: Bone Health, Arthralgia and Myalgia
Author Kathleen Geier DNP, FNP-C, ONC, AJ Benham DNP, FNP-C, ONC
· Recap osteoporosis and menopause: the physiology of bone loss
o Risk factors and the influence of hormones on osteoporosis prevention
o Use of the 10-year fracture risk assessment tool (FRAX) in clinical practice
o What is sarcopenia and how is it related to bone health in menopause
· Common musculoskeletal pain during menopause: myalgia and arthralgia
· Lifestyle and nutritional optimization for bone and joint health related menopause
· Evidence-based clinical treatment guidelines for post-menopausal osteoporosis including complementary and behavioral therapy.
Chapter 12 Nutrition and Weight Management
Author Maya Feller MS, RD, CDN
· Ethnic and cultural dietary patterns and their impact on nutrition-related health outcomes in menopause
· The impact of social determinants of health in the development of positive energy balance, insulin resistance, type II diabetes, elevated lipids and hypertension
· Menopause focused nutrition intervention and management of:
o Positive and negative energy balance / weight management
o Disorders of glucose metabolism: insulin resistance, impaired glucose tolerance & diabetes
o Disorders of lipid metabolism
o Hypertension
· Reducing the risk of nutrient deficiency focused on nutrients of concern as related to bone health, lean body mass preservation, cardiovascular health
Chapter 13 Sleep Disruption and Stress Management
Author Rebecca Berke BCH, Olivia Crowell BSN RN
· Recap physiology and extent of sleep disruption in menopause.
· Consequences inadequate sleep.
· Gold standard Cognitive Behavioral Therapy for insomnia: sleep education and mindfulness.
· Pharmacotherapy and supplements risks/benefits. Complementary therapy.
