Module 8: Menopause and Hormone Therapy

s/s of arthritis

-Achy, stiff joints -Small bony knobs on fingers (osteoarthritis) Diagnosis of arthritis: No single test can diagnose arthritis. Family history and physical exam to check joints, reflexes, and muscle strength Radiographs Blood tests Joint aspiration

menopause complications

-Cardiovascular disease (most severe) -Osteoporosis (most rapid in first few years of menopause;) -Urinary incontinence -Weight gain -Link with dementia? (probably not)

osteoporosis

A condition in which the body's bones become weak and break easily. aka: silent disease Literally "porous bone" Caused by gradual loss of calcium that weakens bone structure Usually occurs without symptoms Osteoporosis in the vertebra can cause women to lose height and a curving of the spine.

Hypothyroidism

A disorder caused by a thyroid gland that is slower and less productive than normal underactive thyroid—body burns energy too quickly

common chronic diseases affect more women than men

Chronic diseases are responsible for 70% of deaths in the U.S. (men and women). Women have greater rates of arthritis, autoimmune diseases, -Alzheimer's disease, and: -Osteoporosis (4x more common) -Lupus (9x more common) -Hypothyroidism (50x more common) -Fibromyalgia (7x more common) Women are also more likely to be caretakers for other people with chronic diseases.

gestational diabetes

Develops in 2 to 5% of pregnant women; a sometimes-temporary form of insulin resistance similar to type 2

Dx and treatment of AD

Diagnosis of Alzheimer's disease: -Medical and family history; complete physical exam; various laboratory tests; brain scans; tests for measuring memory, language skills, and other brain activities Treatment of Alzheimer's disease: -Controlling symptoms and delaying memory loss with drugs -Maintaining a calm, safe, structured environment

Dx & treating thyroid disease

Diagnosis of thyroid disease -Thyroid-stimulating hormone (TSH) test -Blood tests measuring levels of thyroxine (T4) can confirm presence of disease. Treatment and prevention of thyroid disease -Annual checkups -Thyroxine for Hashimoto's disease -Antithyroid drugs for Graves' disease

modifiable risk factors for osteoporosis

Diet low in calcium and vitamin D Sedentary lifestyle Cigarette smoking Estrogen deficiency Low weight and body mass index Certain medications Glucocorticoids, anticonvulsants Amenorrhea Anorexia nervosa or bulimia

chronic diseases

Diseases that persist for a long time Rarely cured completely Chronic diseases (including heart disease and cancer) cause more than half of deaths around the world. Almost all women will be affected by at least one chronic disease.

s/s & causes of lupus

Exact cause(s) unknown; genetic, hormonal, and environmental factors appear to be involved. Painful, swollen joints or arthritis Skin rash Butterfly-shaped across face Triggered by sun exposure Frequent fevers Prolonged or extreme fatigue Anemia Kidney involvement

symptoms of type 1 diabetes

Frequent urination Unusual thirst Extreme hunger Weight loss Extreme fatigue Blurred vision

bio-identical hormones

Fueled by HT controversy • Products claim to be "identical" to natural female hormones. • Not sanctioned by the FDA • Many products contain estrogen in unregulated amounts or quality. • No credible evidence that product claims are valid

risk factors for diabetes

Having a first-degree relative with diabetes Being overweight Not getting regular exercise Unhealthful diet Having hypertension, abnormal high-density lipoprotein (HDL) or triglyceride levels Racial groups: African Americans, Hispanics, American Indians/Alaska Natives

health effects of menopause

Hot flashes Depression Sleep disturbances Vaginal dryness Vaginal atrophy (thinner lining; less elastic) Decreased libido Weight changes Hair changes Skin changes Urinary tract infections Urinary incontinence

prevention and Tx of arthritis

Maintaining weight through diet and exercise Avoiding contact sports and repetitive joint motion Preventing Lyme disease (vaccine, insect repellent) Treatment may consist of drugs (NSAIDs, topical pain relievers, corticosteroids, immunosuppressants) or surgery.

cultural considerations of menopause

Management options may be confusing. Societal emphasis on youth Stereotypes and myths U.S. "disease" model Information gaps

menopause and mental health

Many conditions have historically been associated with menopause. Most changes in mental health and wellness are not well defined. Most women have few, if any, symptoms.

s/s of AD

Memory loss Decline in ability to perform simple tasks Less clear thinking and forgetfulness Affected language and reasoning skills Lack of ability to make judgments Personality changes Emotional outbursts Wandering and agitation

positive aspects of menopause

Normal life change-not to be feared More open discussions No contraceptive concerns Often fewer family obligations Often increased opportunities in workplace

natural menopause

Ovaries begin to fail to respond to the luteinizing and follicle-stimulating hormones. • Ovaries produce lower levels of estrogen and progesterone in response. • Ovulation becomes erratic. -fertility declines but pregnancy can still occur due to ovulation • Menstruation ceases. -2 week cycles; then months of cessation; then consecutive 12 months

modifiable risk factors for arthritis

Overweight/Obesity Joint Injuries Infection Occupation smoking

conditions that may preclude HT

Personal history of breast cancer History of blood clots in legs, lungs, or eyes Undiagnosed or abnormal vaginal bleeding Preexisting cardiovascular conditions, such as blood clots, stroke, or uncontrolled hypertension History of liver, gallbladder, or pancreatic disease; impaired liver function

complications of diabetes

Poorly managed, diabetes can damage many organs in the body, reduce quality of life, and cause early death. Managed well (healthful diet with balanced amounts of carbohydrate, blood sugar monitored regularly, and regular exercise), people with diabetes can live long, healthy lives. heart disease stroke HBP retinopathy end stage renal disase (kidney failure) damage of nervous system lower extremity amputations periodontal disease congenital malformations spontaneous abortions neonatal mortaility macrosomia diabetic ketoacidosis (coma) infections/illness like pneumonia

Dx of diabetes

Routine tests: -Fasting plasma glucose test/oral glucose tolerance test -Normal blood sugar level = 70-110 mg/dL; level above 126 mg/dL on at least two occasions Treatment and prevention of diabetes -Daily insulin injections -Diet control -Physical activity -Home blood glucose testing several times a day

hormone therapy

Standard treatment for decades Designed to replace hormone levels Two primary forms: -Estrogen alone Prescribed for women without a uterus -Estrogen plus progesterone

surgically induced menopause

Surgical removal of both ovaries, usually during a hysterectomy -chemotherapy; radiation therapy partial hysterectomy total hysterectomy -cancer, fibroids total hysterectomy with bilateral salpingo-oophorectomy radical hysterectomy

Dx of lupus

Take note of symptoms -Skin rash, joint pain, chest pain, seizures, photosensitivity, review of history of medications Complete blood count Antinuclear antibody test (ANA) Urinalysis

type 2 diabetes

The most common form of diabetes develops during adulthood and when the body becomes insensitive to insulin

racial/ethnic dimensions chronic disease

White and Asian women have osteoporosis more often than African American women. African American women are more likely than White women to die following a hip fracture. American Indians and Alaska Natives have the highest prevalence rates of diabetes. Blacks and Whites have somewhat equal rates of arthritis, but Blacks have a higher rate of activity limitations due to arthritis and a higher prevalence of severe pain.

screening and Dx for osteoporosis

Women who should be tested: All postmenopausal women younger than age 65 who have one or more additional risk factors for osteoporosis besides menopause All women age 65 and older Women 50 and older with fractures Women with a condition or taking a medication associated with low bone mass or bone loss Women who are considering therapy for osteoporosis or who want to monitor the effectiveness of certain osteoporosis treatments

lupus

a chronic autoimmune disease characterized by inflammation of various parts of the body Immune system forms antibodies that target healthy tissues and organs. Primarily a disease of young women of childbearing age (affects women 10 to 15 times more often than men), more likely to affect African American women -ages 15-44 -200K have lupus (9 of 10 are women) cause unknown Symptoms can go away and then return. Types: -Discoid (cutaneous) lupus -Systemic lupus erythematosus (SLE) -Drug-induced lupus

autoimmune disease

a disease in which the immune system attacks the organism's own cells Diseases in which the body's immune system turns inward rather than outward More than 80 different illnesses, usually occurring among women 4th largest cause of disability among women in the United States

diabetes mellitus

a group of metabolic disorders characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both -type 1 -type 2 -gestational diabetes

radical hysterectomy

a procedure that includes the surgical removal of the ovaries and fallopian tubes, the uterus and cervix, plus nearby lymph nodes; upper part of vagina most commonly performed to treat uterine cancer

factors influence when menopause occurs

age family hx environmental factors personal behaviors genetics

nonmodifiable risk factors for arthritis

age (increases w/age) gender: 60% develop in women genetics: some genes assoc w/rheumatoid arthritis & other types of arthritis

total hysterectomy with bilateral salpingo-oophorectomy

both ovaries, fallopian tubes, uterus, and cervix are removed

menopause

cessation of regular periods once a woman has gone 12 consecutive months w/out menstruating avg age for menopause 51 years late menopause: after age 55yrs -birth control pills -be Japanese -given birth early menopause: before age 40 yrs -personal behaviors

Alxheimer's disease

characterized by early impairment of short-term memory. as disease progresses, there is confusion, disorientation and personality changes. commonly accompanied by irritability and emotional outbursts. eventually loses ability to read, write, speech, language ability, unable to do ADL's. they may die in a severely debilitated state 4-12 years after onset results in memory loss, personality changes, decline in cognitive abilities

Fibromyalgia

chronic condition with widespread aching and pain in the muscles and fibrous soft tissue Disease characterized by constant, widespread pain Still poorly understood Treatment focuses on improving quality of life and reducing symptoms (regular exercise, therapy to cope with pain and adjust, antidepressants). Most likely to appear in women and during middle age (7xs in women than men)

type 1 diabetes mellitus (autoimmune disease)

diabetes caused by a total lack of insulin production; body can't produce insulin usually develops in childhood, and patients require insulin replacement therapy to control the disorder

comparison of hormone tx for menopause

estrogen plus progestin -increased risk of heart attack, stroke, blood clots, breast cancer -reduced risk of colorectal cancer, fractures, no protection against dementia estrogen alone -no difference in risk for heart attack -increased risk of stroke, blood clots -uncertain effect for breast cancer -no difference in risk for colorectal cancer -reduced risk for fractures

hyperthyroidism

excessive activity of the thyroid gland overactive thyroid—body burns energy too slowly

current medical options for menopause

hormone therapy (HT) -helps reduce severity of menopause symptoms -absolute low risk of heart disease or breast cancer approved medical options: -pills -patches -creams -gels -sprays

arthritis

inflammation of a joint affects an estimated 50 million Americans (1 in 5 adults). Osteoarthritis: degenerative joint disease Rheumatoid: chronic inflammatory disease Gout: excess uric acid in the body affects at least 1 in 6 adults in every state.

thyroid disease

inflammation of the thyroid, the gland controlling the body's metabolism Two forms -Hypothyroidism -Hyperthyroidism

medicalization

is a process in which societies or individuals define and treat basic human conditions as medical conditions to be solved or cured. can create harmful effects

post-menopause

life after the final menstrual period

Non-medical menopause management

lifestyle options -regular exercise -weight bearing exercise -aerobic exercise avoid smoking balanced diet

partial hysterectomy

only the uterus is removed

3 stages of menopause

perimenopause menopause postmenopause

total hysterectomy

removal of the uterus and the cervix -ovaries, fallopian tube may/may not be removed

perimenopause

stage immediately before menopause where physical changes begin to occur

hysterectomy

surgical removal of the uterus Performed for cancers and other conditions Results in more severe menopause symptoms Women who have both ovaries removed before 50 years of age are at increased risk for later CVD, CHD, and stroke.

special population for HT

women experience premature menopause (<40) women who have lost normal ovarian function (<40) HIT seems to reduce risk for CHD

symptoms of Hashimoto's Disease (hypothyroidism)

wt gain fatigue/listlessness difficulty concentrating dry skin sensitivity to cold constipation goiter

symptoms of Grave's Disease (Hyperthyroidism)

wt loss increased energy expenditure nervousness/irritability sweating more than normal heat intolerance diarrhea bulging of the eyes

non modifiable risk factors for osteoporosis

Being female Increased age/postmenopausal Small frame and thin-boned White or Asian ethnicity Family history of osteoporosis or fractures

symptoms of type 2 diabetes

Any type 1 symptoms Frequent infections Cuts/bruises that are hard to heal

Tx of lupus

Avoid sun exposure and use sunscreen Exercise Nonsteroidal anti-inflammatory drugs (NSAIDs) Corticosteroids Antimalarial agents Immunosuppressant drugs

aging population experiencing menopause

About 13 % of the total female population—are currently between the ages of 45 and 54, the age group at which menopause most often begins. By 2060, about half the women in the United States will be experiencing, or will have experienced, menopause.

Tx and prevention of osteoporosis

Adequate supply of calcium (ideally from food) Vitamin D Participate in weight-bearing and muscle-strengthening exercises Estrogen replacement therapy Drugs: alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), teriparatide (Forteo), nasal calcitonin spray Fall-prevention strategies

risk factors for AD

Age Female gender (related to women living longer?) Genetic background -Familial Alzheimer's disease (FAD) Other possible factors -Lifestyle -Severe or repeated head injuries -Lower education levels -Environmental agents

risk factors of thyroid disease

Age and gender (women older than age 20) Family history of a family member with thyroid disease Previous thyroid concerns or conditions