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Menapause

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Menapause * Explore the question of the woman s comfort during sexual intercourse. Then go on to explain that dryness and shrinking of the vagina can be addressed ... – PowerPoint PPT presentation

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Title: Menapause


1
Menapause
2
Introductin
  • The time when menses cease, is a time of
    transition
  • for a woman, marking the end of her
    reproductive
  • abilities.
  • Climacteric, or change of life (often used
    synonymously with menopause), refers to the phase
    of womans reproductive life in which gradual
    cessation in ovarian function results in
    decreased sex steroid producton and its sequelae.

3
  • Today the median age at menopause is 51.3
  • years, and the average life span of a woman
    in the United
  • States is over 80 years.
  • Thus the average woman will live one third of her
    life after menopause.
  • A womans psychologic adaptation to menopause
    and the climacteric is multifactorial.
  • She is influenced by her own expectations and
    knowledge, physical well-being, family views,
    marital stability,
  • and sociocultural expectations.

4
Definition of Menopause
  • The World Health Organization has defined the
    natural menopause as
  • The permanent cessation of menstruation
    resulting from loss of ovarian follicular
    activity.
  • Natural menopause is recognized to have occurred
    after 12 consecutive months of amenorrhea.

4
5
Definitions from WHO
  • Early menopause is menopause that occurs at age
    less than 40 year of womens age.
  • Induced menopause is the cessation of menstrual
    period as a result of surgical removal of ovaries
    or ablation of ovarian functions by chemotherapy
    or radiation

5
6
  • Perimenopause is the term applied to the period
    preceding menopause, usually about 2 to 8 years,
    when ovarian function wanes and hormonal
    deficiencies begin to produce
  • symptoms.

7
Risk factors of Early Menopause
  • Early age at menarche
  • Menstrual irregularity
  • Nulliparity
  • Never use of oral contraceptive
  • Short period of breastfeeding
  • Use of assisted reproductive techniques.
  • Cigarette smoking
  • Marital status
  • Low socioeconomic status
  • Family history
  • Genetic factors

7
8
Women Menopausal Transition
  • Women vary in their experiences of menopausal
    transition, reporting of menopausal symptoms, and
    how they deal with menopausal changes.
  • This also varies from society to another, and
    from culture to another.
  • Some women view menopause as a natural event,
    others adopting the medical view of menopause.
    Whereas others display negative attitudes
    toward menopause, thereby increasing the burden
    on them during menopausal transition

8
9
  • The physical characteristics of menopause are
    linked
  • to the shift from a cyclic to a noncyclic
    hormonal pattern.
  • The age at onset may be influenced by
    nutritional, cultural, or genetic factors.
  • The onset of menopause occurs when estrogen
  • levels become so low that menstruation
    stops.
  • Generally, ovulation ceases 1 to 2 years before
  • menopause, but individual variations exist.

10
  • Atrophy of the ovaries occurs gradually.
    Follicle-stimulating hormone levels rise, and
    less estrogen is produced.
  • Menopausal symptoms are
  • atrophic changes in the vagina, vulva, and
    uretha.
  • vasomotor disturbance commonly known as hot
    flashes, a feeling of heat arising from the chest
    and spreading to the neck and face.
  • sweating and sleep disturbances.
  • dizzy spells, palpitations, and weakness, and
    irritability.

11
  • The uterine endometrium cervical and myometrium ,
    atrophy,
  • The uterine cavity constricts.
  • Vaginal mucosa becomes smooth and thin, and the
    rugae disappear, leading to loss of elasticity
  • painful intercourse

12
  • Dryness of the mucous membrane can lead to
  • burning and itching.
  • The vaginal pH level increases as the
  • number of Döderleins bacilli decreases.
  • decrease in libido at this time.
  • Vulvar atrophy occurs late, and the pubic hair
    thins,
  • Pelvic fascia and muscles atrophy, resulting in
    decreased pelvic support.

13
physical changes
  • Osteoporosis, a decrease in the bony skeletal
    mass.
  • risk of coronary heart disease.
  • Loss of protein from the skin and supportive
    tissues causes wrinkling.
  • Weight gain , which may be due to excessive
    caloric intake or to lower caloric need with
  • the same level of intake.

14
Tests Diagnosis
  • Follicle-stimulating hormone (FSH) test
  • Luteinizing hormone (LH) test
  • Serum estradiol test.
  • U\S reveals small ovaries without evidence of
    growing follicles
  • Karyotype

14
15
Management
  • Fertility cannot be restored if the diagnosis is
    made after complete follicular depletion, so
    early diagnosis can be made by genetic
    investigation
  • Estrogen therapy
  • Calcium vitamin supplements

15
16
Management of Menopausal Symptoms
  • Hormonal replacement therapy (HRT) is known as
    the most popular treatment choice to alleviate
    menopausal discomfort for many years.
  • But the intention to use HRT became questionable
    after releasing findings of Womens Health
    Initiative (WHI) study, which concluded that
    risks of HRT overweigh its benefits, and
    recommended not to use the HRT for prevention of
    chronic diseases, and to limit its use for short
    periods.
  • (Writing group for womens health
    initiative investigators. 2002)

16
17
Cont..
  • 2. Complementary and Alternatives Therapies
  • Alternatives therapies like herbs (black
    cohosh), dietary soy, acupuncture, life style
    modifications such as diet and exercise
  • 3. Non- Hormonal Medications
  • Several non-hormonal medications are used
    to relive menopausal symptoms such as
    neuroendocrine agents ( like methyldopa),
    a-adrenergic receptors agonists (such as
    clonidine)

17
18
  • Contraception remains a concern during
    perimenopause.
  • Combined oral contraceptives are becoming
    increasingly
  • popular among healthy nonsmokers because many
    women also benefit from the non contraceptive
    effects including
  • regulation of menses,
  • relief of symptoms of estrogen deficiency,
  • a decreased risk of endometrial and ovarian
  • cancers.

19
Hormone Replacement Therapy
  • Hormone replacement therapy (HRT), usually
    involving estrogen
  • with or without a progestin, had for
    years been the
  • treatment of choice for relieving menopausal
    symptoms,
  • especially hot flashes, night sweats, and
    urogenital symptoms.
  • effective in preventing the development of
    osteoporosis.
  • Nevertheless the risks of HRT outweigh the
    benefits, especially for long-term use, because
    of the slightly increased risk of breast cancer,
    thromboembolic disease, and stroke

20
The beneficial effect of long-term estrogen
  • Reducing the incidence of Alzheimer disease (AD)
  • the most effective short-term (1 to 2 years)
    therapy for women who experience severe
    menopausal symptoms.

21
  • Women taking estrogen should be advised
  • to stop immediately if they develop headaches,
    visual changes, signs of thrombophlebitis, or
    chest pain.

22
risks
  • When estrogen is given alone, it can produce
    endometrial
  • hyperplasia and increase the risk of
    endometrial cancer.
  • Current research focuses on using lower doses of
    estrogen (less than 0.625 mg/day) consideration
  • has also been given to using lower doses or
    less frequent administration of progestins to
    minimize progestin exposure

23
Complementary and Alternative Therapies
  • diet and nutrition, specifically a high-fiber,
    low-fat diet with supplements of vitamins D and
    E. Phytoestrogens (plant substances with estrogen
    properties)
  • herbal remedies such as dong quai and black
    cohosh, which have been used in traditional
    Chinese medicine

24
  • Weight-bearing exercises such as walking,
    jogging,
  • tennis,and low-impact aerobics help increase bone
    mass and
  • decrease the risk of osteoporosis.
  • Exercise also improves cholesterol profiles
  • Stress management and relaxation techniques such
    as biofeedback, meditation, yoga, visualization,
    and massage
  • herbal treatments for symptom relief.

25
Bone mineral density (BMD) testing
  • is useful in identifying individuals who are at
    risk for osteoporosis.
  • ACOG recommends BMD testing for the following
  • All postmenopausal women age 65 or older
  • Postmenopausal women with a fracture
  • Postmenopausal women under age 65 with one or
  • more risk factors

26
  • Prevention of osteoporosis is a primary goal of
    care.
  • Women are advised to maintain an adequate calcium
    intake.
  • Women over age 50 should have a daily calcium
    intake of 1200 mg.

27
PHYTOESTROGENS
  • Phytoestrogens are naturally occurring plant
    sterols that have an estrogen-like effect.
  • Herbs that contain phytoestrogen include
    ginseng,
  • agnus castus, beth root, black cohosh,
    dong quai, fenugreek, licorice, red sage,
    sarsaparilla, and wild Mexican yam.
  • Phytoestrogens are also found in soy products
    such as soy milk and tofu.

28
gensing
29
agnus castus
30
beth root
31
black cohosh
32
fenugreek
33
Midwife Management
  • Most menopausal women deal well with this
    developmental
  • phase of life, although some women may need
    counseling
  • to adjust successfully.
  • Midwiveses and other health professionals can
    help menopausal women achieve high level
    functioning at this time in life.
  • Of major importance is the midwifes ability to
    understand and provide support for the womans
    views and feelings.
  • Use an empathetic approach in counseling, health
    teaching, and providing physical care.

34
  • Explore the question of the womans comfort
    during sexual intercourse.
  • Then go on to explain that dryness and shrinking
    of the vagina can be addressed by use of a
    water-soluble jelly.
  • Use of estrogen, orally or in vaginal creams, may
    also be indicated.
  • Increased frequency of intercourse will maintain
    some elasticity in the vagina.

35
  • The crucial need of women in the perimenopausal
    period of life is for adequate information about
    the changes taking place in their bodies and
    their lives.

36

VIOLENCE AGAINST WOMEN
37

Domestic violence
37
38
Violence against women
  • Any act of gender- based violence that results
    in/ or is likely to result in physical, sexual
    or mental harm or suffering to women.
  • Domestic Violence (intimate partner violence),
    may involve
  • Physical abuse such as hitting, slapping,
    beating, kicking, threatening her with harmful
    instrument. Suspected with evidence of trauma,
    especially to the head and neck or trunk
    associated with a history of violence, or when an
    explanation of trauma doesnt seem appropriate.

38
39
  • Sexual abuse may involve being physically forced
    to have sexual intercourse against her will.
  • Emotional Psychological abuse involve being
    made to feel bad about oneself, being blamed and
    punished in front of others.
  • Verbal abuse.

Fusco.R,Fantuzzo.J(2008) domestic violence
crimes and children, children and youth services
review.
39
40
Cycle of violence
Honey moon phase
  • Violent phase

Tension building phase
Fusco.R,Fantuzzo.J(2008) domestic violence
crimes and children, children and youth services
review.
40
41
Facts about Domestic violence
  • -Between 15 71 of women around the world have
    suffered physical or sexual violence committed by
    an intimate male partner at some point in their
    life, which has serious consequences for womens
    health. WHO 2007
  • -Intimate partner violence is the most common
    form of violence in womens life, the greatest
    amount of violence was reported by women living
    in rural areas
  • -Domestic Violence continues to be accepted as
    normal within too many societies.

41
42
  • -The greatest challenges found is that abuse
    remain hidden.
  • -The abused women were twice as likely as non-
    abused women to have poor health and physical and
    mental problems which includes suicidal thoughts
    and attempts, mental distress, and physical
    symptoms like pain, dizziness and vaginal
    discharge.
  • -Women who reported physical or sexual domestic
    violence were also more likely to report having
    had at least one induced abortion or miscarriage.
  • WHO- 2005

42
43
  • -Women who are divorced, with no education or
    elementary were more likely to report violence
    during pregnancy.
  • Help seeking behavior
  • - The results of survey indicate that about
    one-fifth of women who had experienced violence
    at least once wanted assistance to deal with
    violence.
  • -Women were almost 3 times as likely to seek help
    if violence had occurred often 40 rather than
    sometimes 15.

43
44
  • -Most of women who asked for help looked to
    relatives for assistance ( 23 from their
    mother).
  • - 7 of women who reported frequent violence
    asked for help from police while 3 from medical
    personnel or lawyer.

44
45
The cultural Meaning of Violence Against Women
Jordanian womens perspective. Gharaibaha. M Al
Maaitah. R. (2002)
  • Descriptive qualitative study to explore the
    cultural meaning of violence from a theoretical
    and practical perspective focusing on the
    perception of Jordanian women.
  • Convenience samples of 42 Jordanian married
    women participated in-depth unstructured
    interviews.
  • The study findings indicated that Jordanian women
    viewed the meaning of violence to be composed of
    5 components physical abuse, sexual, emotional,
    social and economic abuse.

45
46
  • -The cultural meaning of violence perceived
    continuity and intensity of physical abuse,
    sexual desertion, marrying another woman, and no
    rights for ownership and financial independence.
  • -Despite the fact that the woman perceived
    violence to be a multi-dimensional, about 50 of
    them believed that men have the right to
    physically hurt and sexually desert the woman.

46
47
  • Implications for nursing practice include
  • (a) identifying abused women.
  • (b) empowering them with knowledge to change
    their sociocultural perceptions of marital
    relationships. (c) designing interventions that
    address their needs.
  • (d) educating health care providers to take a
    role in addressing spousal abuse.

47
48
Risk factors for injury to married women from
domestic violence in Hong Kong
  • -Case control study in Regional public hospital,
    Hong Kong for All married women aged 18 to 60
    years
  • The results showed that the risk factor for
    domestic violence are
  • -Woman who is a new immigrant
  • -Woman with no job
  • - Husband with low educational level
  • -Presence of extramarital relationships
  • -Husbands unemployment
  • -Husbands alcohol abuse
  • -Husbands illegal drug abuse
  • -Husbands mental illness.
  • Tsui K etal. Risk factors for injury to married
    women from domestic violence in Hong Kong.Hong
    Kong Med J (2006)

48
49
Impact of domestic violence on women
  • NON-FATAL OUTCOMES
  • Physical health outcomes
  • Injury (from lacerations to fractures
  • and internal organs injury)
  • Unwanted pregnancy
  • Gynecological problems
  • Miscarriage
  • Headache
  • Permanent disabilities
  • Irritable bowel syndrome
  • Self-injurious behaviors

49
50
  • Mental health outcomes
  • Depression
  • Fear
  • Anxiety
  • Low self-esteem
  • Sexual dysfunction
  • Eating problems
  • Obsessive-compulsive disorder
  • Post traumatic stress disorder
  • FATAL OUTCOMES
  • Suicide
  • Homicide
  • Maternal mortality
  • Fusco.R,Fantuzzo.J(2008) domestic violence
    crimes and children, children and youth services
    review.

50
51
The  objectives of the strategy and action plan 
to control domestic violence against women
  • Prevention and Earlier Intervention in cases of do
    mestic 
  • Violence, looking at ways to change attitudes
    particularly looking at ways to change attitudes,
    particularly those of  young people, and ensuring
  • that victims receive the information they need
    to improve  their safety.
  • Protection and Justice for those affected by domes
    tic violence Providing a focus on the role of the 
    criminal 
  • justice agencies and  how partnerships
    can work closely together.
  • Domestic violence strategy 2006-2008,
    Nottinghamshire County Council

51
52
The  objectives of the strategy and action plan 
to control domestic violence against women
  • Prevention and Earlier Intervention in cases of do
    mestic 
  • Violence, looking at ways to change attitudes
    particularly looking at ways to change attitudes,
    particularly those of  young people, and ensuring
  • that victims receive the information they need
    to improve  their safety.
  • Protection and Justice for those affected by domes
    tic violence Providing a focus on the role of the 
    criminal 
  • justice agencies and  how partnerships
    can work closely together.
  • Domestic violence strategy 2006-2008,
    Nottinghamshire County Council

52
53
Strategy Objectives
  • The strategy has four main objectives
  • 1.To promote the effective coordination,
  • delivery and evaluation of multiagency
    responses to domestic violence
  • 2.To promote the prevention of and earlier
    intervention into cases of domestic violence  
  • 3.To improve the protection and justice offered to
    victims of domestic violence 
  • 4.To increase and improve the support 
  • available to victims of domestic violence
  • Domestic violence strategy 2006-2008,
    Nottinghamshire County Council  

53
54

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