Possible Complication Of Menopause And Osteoporosis And Solutions List one possible complication of menopause and some solutions to this complication. Make

Possible Complication Of Menopause And Osteoporosis And Solutions List one possible complication of menopause and some solutions to this complication. Make sure to look in Course Documents for the Turnitin grading rubric

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Menopause, Hormone
Therapy And
Osteoporosis
Part Two
Wendy Bonnar WHNP-BC, MSN
Symptoms of Perimenopause
• Irregular periods
• Hot flashes
• Night sweats
• Alterations in libido
• Insomnia
• Headaches
• ? memory &
concentration
• Tiredness
• Anxiety
• Mood swings
• Breast tenderness
• Palpitations
• Vaginal Dryness
• Itchy vulvar area
• Bladder symptoms
Vasomotor Symptoms
• Definition:
• Recurrent, transient episodes of flushing
accompanied by a sensation of warmth to
intense heat on the upper body and
face/head.
• Commonly referred to as “hot flashes” by day
and “night sweats” by night
• Hot flashes can sometimes involve the whole
body (e.g., inside of elbows, back of knees).
Vasomotor Symptoms
• As many as 75% of perimenopausal
women in US report hot flashes
• Number of episodes vary
• Few to multiple episodes daily
• Highest occurrence during perimenopause
and first 2 years of postmenopausal.
Freeman EW Climacteric 2007;10:197-214
Physiologic Mechanisms
• Not completely understood
• Related to small fluctuations in core body
temperature.
• Triggered when core body temperature rises
above upper (sweating) threshold.
• Shivering occurs when core body temperature
falls from elevated level to a level below the
lower threshold of thermoneutral zone.
Freedman RR Fertil Steril 2002;77487-90; Freedman RR Menopause 2005;12:156-9
Factors Contributing to Hot
Flashes
• Warm environment, hot drinks, spicy food, stress
• Higher BMI, cigarette smoking, alcohol
• Disease conditions including thyroid disease,
infection, leukemia, pancreatic tumors,
autoimmune disorders, anxiety
• Serum estrogen levels are not predictive of hot
flash frequency or severity.
Other Problems
• Midlife sleeplessness:
• Both men and women report an increase in
sleep disturbances at midlife.
• A higher percentage of women than men
report sleep disturbances at all ages.
• Sleep disturbances are associated with fatigue,
irritability, chronic illness (e.g., CVD), mood
disorders (e.g., depression).
Headache
• Abrupt decreases in estradiol, such as those that
occur during menstrual periods and
perimenopause, play a role in the incidence of
headaches.
• During perimenopause, the prevalence or
intensity of headaches often increases,
especially in women with a history of menstrual
headaches.
• Frequency of migraines often decreases
postmenopausally.
Brandes JL JAMA 2006;295:1824-30; Martin VT Headache 2006;46:365-86
Sexual Health
• Libido generally decreases with age.
• Distressing sexual problems peak during midlife
(ages 45-64) and are lowest from age 65 onward.
• Decreased estrogen can result in loss of vaginal
moisture and elasticity.
• Decline in androgens may contribute to a decline
in sexual desire, arousal, and vaginal lubrication
• Vaginal sexual activity and lubricants may help
keep vaginal tissue more moist and elastic.
Basson R J Urol 2000;163:888-93; Gracia CR Menopause 2004;11:144-50; Hartman U Menopause 2004;11:726-40; Shifren JL Obstet Gynecol
2008;112:970-8
Osteoporosis
Osteoporosis
• Osteo means “bones”
• Porosis means porous condition (full of
tiny holes).
• Osteoporosis is a disease that can cause
bones to become thin, brittle and more
likely to break.
• Considered the silent disease
• few warning signs
Definition of Osteoporosis
A disease characterized by low bone mass and microarchitectural
deterioration of bone tissue leading to enhanced bone fragility and a
consequent increase in fracture risk
Normal Bone
Osteoporosis
Pentice A Public Health Nutr 2004;7:227-43; WHO Study Group In Assessement of Facture Risk and Its Application to Screening for Postmenopausal
Osteoporosis. Geneva: WHO, 1994
Osteoporosis – Social Impact
• Osteoporosis causes 1.5 million fractures
each year
• 300,000 of those will be hip fractures
• 700,000 vertebral fractures annually, most common
manifestation of osteoporosis
• 5 – 20% of those women die within the year of that
fracture
• 15-25% become permanently disabled
• Cost of these fractures is $10 Billion annually
• 65% of patients post hip fracture never regain
prefracture level of independence.
A Gender-Related Condition
• Osteoporosis is the most common bone
disorder affecting humans.
• The risk of hip fracture doubles for every
5- to 6-year increase in age from ages 6585.
• Of the 10 million Americans estimated to
have osteoporosis, 8 million are women
(80%).
National Osteoporosis Foundation http://www.nof.org/node/40. Accessed 8/24/2012; Kim SH Arthritis Care Res 2012;64:751-7
Osteoporosis: ethnic-related
National Osteoporosis Foundation http://www.nof.org/node/40. Accessed 8/28/12
BMD Testing
• The Fracture Risk Assessment Tool (FRAX)
• The FRAX tool was developed by the World Health
Organization to help predict the risk of having a
fracture related to osteoporosis in the next 10
years.
• The tool is meant for people who are not already
being treated with medicine for osteoporosis.
• If you are interested in the tool and it’s components
see:
• https://riskcalculator.fore.org/
BMD Testing Recommendations
• All women age 65 and older
• Postmenopausal women younger than age 65
if FRAX score for 10-year risk of major fracture is
?9.3% (average fracture risk for healthy women)
• Postmenopausal women with medical causes of
bone loss.
• Postmenopausal women with history of fragility
fracture.
Pfister AK Ann Intern Med 2011;155:275-6
Other Factors
• For postmenopausal women age 50 and older
with one or more of following:
• Previous fracture after menopause
• Thinness (body weight
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