The transition to menopause brings about numerous physiological and psychological changes (Alexander & Andrist, 2013). Although the average age at menopause is in the range of 52 years, it is quite normal for a woman to begin experiencing menopausal changes in her early 40s (Alswager & Durler, 2013). For this reason, it is not all women that could experience the same intensity of symptoms. Menopause is an individual process. Menopausal change can range from minor inconveniences to those that affect quality of life (Alexander & Andrist, 2013).
Essentially, these changes are the culmination of heredity, lifestyle and hormonal changes (Burger, 2011). Moreover, changes can be influenced by lifestyle alterations such as a change in diet, physical exercise, and smoking cessation. Furthermore, physiological basis of menopausal changes in women can gives an overview of the psychosocial implications in their life as well. For these reasons, community awareness of a healthy benefits through menopausal and postmenopausal offers women a new viewpoint on aging and empowers them to take greater responsibility for their own health and well-being (Broer et al. 2011).
Primary care physicians are a leading influence on information regarding women health behaviours, risk assessment, and medical interventions that preserve health and that prevent premature death and disability (Shojaelan et al. , 2007). Besides to this point, clinicians can as well help identify therapy goals for short-term relief of menopausal symptoms like amenorrhea, hot flushes, light headed feeling, sleeplessness, night sweat, muscle pains, backache, vaginal dryness and long-term relief and prevention of fractures and osteoporosis (Graziottin, 2010).
In this juncture correctional for her premenopausal or postmenopausal can include the following; lifestyles, exercise, diet, good sleep, fun & be kind to herself and many more. Discuss the possible causes of her symptoms For these reasons, her diagnosis necessitates clinical examination, for example the biochemical assessment and investigation of her cause of premenopausal and postmenopausal (Shojaelan et al. , 2007). Of course, testing of the following hormones; TSH, thyroxine, FSH, LH, oestradiol, prolactin, insulin like growth factor 1 (IGF1) is applicable that a 9 am cortisol form the baseline tests.
Moreover, provocative or dynamic tests are necessary to assess GH secretory and the ACTH-adrenal systematically. In this connection to her diagnosis that premature menopause affects one percentage of women, and her early menopause is about 5-10% of women relevant to her premenopausal (Shojaelan et al. , 2007). Most cases of premature menopause are idiopathic (Alexander & Andrist, 2013). Moreover, a condition can be difficult to diagnose consider in all women with prolonged amenorrhoea (Jafari et al. , 2014).
Diagnostic criteria are an elevated FSH level on two occasions at least one month separately in the setting of amenorrhoea with an exclusion of secondary causes. The diagnosis can be devastating and may require an essential counselling and this can be follow-up over the long term (Jafari et al. , 2014). In the monitoring for her long-term sequelae, mainly osteoporosis and earlier onset of cardiovascular disease (Burger, 2011). Treatment with high-dose HRT is recommended to the expected age of menopause (Alswager & Durler, 2013).
Other possibility is to try non-hormonal therapies or possibly tibolone in women who have had oestrogen dependent tumours. Control of menopausal symptoms related to her symptoms have the followings; She may as well experience the hot flushes, headaches, light headed feeling, night sweats, mood swings, vaginal dryness or dyspareunia and depression. Of course loss of libido and psychosexual issues suggest androgenic replacement is required because it is promoted the decreased in androgen. Persistently deficient sexual fantasies and desire for sexual activity.
The disturbance causes marked distress or much more of her interpersonal difficulty. Very common at the menopause and usually multifactorial in origin and can be difficult to manage. Consideration should be given to treatment of vaginal dryness and any psychosexual problems addressed (Alswager & Durler, 2013). Amenorrhea It is a complicated and common problem encountered by primary care physicians (Alswager & Durler, 2013). Performing a thorough history and physical examination can often narrow the differential diagnosis considerably.
The addition of basic determinations of serum FSH and LH or other tests as indicated by abnormalities on the history or examination can then make the diagnosis more clear (Faucher & Schuiling, 2013). In all cases of primary amenorrhea, treatment is directed by the diagnosis (Faucher & Schuiling, 2013). The primary goal of treatment is to facilitate the normal sexual development through gentle coaxing into puberty (Faucher & Schuiling, 2013). In secondary amenorrhea, there is a greater focus on fertility and prevention of complications from the associated abnormal hormone levels.
Probability of conception is dictated by the reversibility of the cause of the amenorrhea. It is the lack of a menstrual period for six months or longer. In fact, menopause is one of the most common causes of amenorrhea in the middle-aged woman (Hansen et al. , 2011). A woman in midlife who has stopped having menses after years of normal cycles is experiencing what is called secondary amenorrhea. A young girl who has yet to experience her first period has primary amenorrhea. Even though menopause is the most common cause of amenorrhea during midlife, other causes should be considered, and a thorough history should be conducted.
First, pregnancy must be excluded. Other indications for amenorrhea could be related to lifestyle factors such as loss of body fat or physical stress. Tests for prolactin level and thyroid stimulating hormone (TSH) level may be considered. Testing the FSH level may also be considered; however, this level is variable during the menopause transition, making it an unreliable diagnostic marker (Jafari et al. , 2014). Discuss what biochemical tests you would undertake to confirm your diagnosis and why you would undertake those tests. Laboratory tests are only tools to be used in conjunction with the patient history and physical examination.
However, certain tests can be used to help rule out medical and gynaecological conditions that mimic menopause, and some important serum markers for this age-group can help evaluate overall health status. Overall of these biochemical tests have the following diagnosis to be undertaken: Follicle -stimulation hormone (FSH), Estradiol/ estrone, luteinising hormnone (LH), thyroid-stimulating hormone (TSH) and cardiovascular evaluation. All of these can be discussed as followings: Follicle-stimulating hormone (FSH) level is a common serum evaluation utilized by healthcare providers.
Rising levels are a hallmark of the perimenopausal/menopausal period. However, it must be remembered that FSH levels normally fluctuate during the menstrual cycle, especially during times of irregularity. Moreover, an FSH test should not be ordered for women taking hormonal contraceptives or hormone therapy, as the level will be inaccurate. Although there is no laboratory test recommended to confirm menopause, tests for ovarian function (LH and estradiol, as well as FSH) can be used to differentiate the cause of amenorrhea. Estradiol and estrone are most commonly used to evaluate fertility in women.
Because of their variability, however, these tests are used only in conjunction with other assessment techniques to evaluate menopause. These serum markers are helpful in diagnosing poor response to estrogen therapy and can be used to guide the route and dosage of exogenous estrogens. The evaluation of luteinizing hormone (LH) is of limited value in diagnosing menopause. LH levels rise considerably later than FSH levels, and the overall clinical picture is much more important than this particular value. Thyroid disorders are another major concern for women.
Approximately 3% of the women population is affected by thyroid disease. Primarily, the thyroid gland is intricately involved with hormonal functioning, lipid metabolism, carbohydrate and absorption of natural vitamins and nutrients evaluation is indicated during the perimenopausal/menopausal transition. Furthermore, many of the symptoms associated with menopause, including hair changes, fatigue, night sweat, weight gain, and vasomotor instability, are also implicated in thyroid conditions. Screening tests for differentiating thyroid disorders include a TSH level.
Heart disease is known to affect many women as they age. Evaluation of cholesterol, lipids, and triglycerides is crucial during the perimenopausal/menopausal transition. It is mainly initiation of hormone therapy in women with a pre-existing heart disease has been challenged by professionals, perimenopausal/menopausal women must be assessed for cardiovascular risk and the presence of heart disease before treatment begins (Mosca et al. , 2011). Discuss what typical results you would obtain for the biochemical tests you have suggested that would confirm your diagnosis.
A literature cites beliefs, values, and expectations as influencing libido (Graziottin, 2010). An ethnicity, culture, religion and generational aspects are equally important considerations. Additionally, dysfunction of her partner is a major factor in her biochemical tests. One of the best predictors of her postmenopausal sexual functioning is premenopausal function. Libido tends to decline with age, but every person is different. For this reason, many more women stay sexually active throughout their postmenopausal years (Shojaelan et al. , 2007).
In this connection her physiological factors that contribute to sexual functioning are hormone related tested in her biochemical results as of FSH, estradiol or estrone, LH, TSH and her cardiovascular evaluation contributed heavily in her premenopausal. As a matter of facts, declining estrogen levels decrease lubrication, led to a critical part of sexual arousal. Meanwhile, her decreased in the blood flow and vascularization reduce sexual sensations and engorgement. On the other hand, androgens levels are known to affect sexual desire in both men and women.
Perimenopause is a time of decreased androgen production as well as decreased conversion of androstenedione to testosterone (Fritz & Speroff, 2011). Yet, her loss of vaginal elasticity, which is directly associated with decreased estrogen levels, interferes with her sexual satisfaction. In order to decrease vaginal dryness and dyspareunia that a medical approved used of a vaginal lubricants primarily over-the-counter preparations can be used (Bita & Karim, 2016). In this juncture a vaginal moisturizers can be used when women experience daily discomfort.
It is important to sexual functioning to realize that numerous factors are responsible for libido (Graziottin, 2010). As with other symptoms of menopause, doctors must take into account physiology, psychology, and any other issues presenting at this time. Providing the menopausal woman and her partner with a proper education may be helpful. An ideas of encouraging the woman to openly communicate with her partner about what she is experiencing may lead to changes in both partners’ sexual lives that can be mutually fulfilling.
Yet, a literature is divided about whether menopause actually causes depression (Khoshbooii, 2011). However, the literature has substantiated menopause as the cause of irritability, tearfulness and transient fatigue. Furthermore, these conditions affect the day-to-day women functioning and, as a result, are common concerns voiced to healthcare providers. A genuinely circular relationship exists between the symptoms of menopause and mood and depression (Khoshbooii, 2011). For example, amenorrhea, hot flush leads to fatigue.
Fatigue leads to irritability. Irritability interferes with sleep patterns and, as a result, the cycle continues whereby the ability of concentration and cognition are then affected. Consequently, with the addition of the physiological interactions of estrogen deficiency and serotonin alteration, depression can be a natural result in her premenopausal (Khoshbooii, 2011). Furthermore, temporal life passages, such as a relationship changes and an occupational decisions are common during the years of premenopausal.
For these reasons, such conditions contribute to the psychological effects of aging and menopause (Roger et al. , 2005). In this connection, amenorrhea, hot flush, nigh sweat and depression are a common multifactorial phenomenon during perimenopause and the menopausal period. An impact of depression from amenorrhea, hot flush and many more of her symptoms can be severe (Jafari et al. , 2014). If no proper approach from the doctors then all leads to morbidity and mortality which includes comorbid medical illness, suicide attempts, and increased accidents (Khoshbooii, 2011).
All in all, it is medically approved that lifestyles, exercise, diet, good sleep, fun and be kind to herself and many more are the relief management of women who are being observed in their premenopausal and postmenopausal (Burger, 2011, & Shojaelan et al. , 2007). Conclusion Treatment with a hormone therapy and serotonin selective reuptake inhibitor can often help alleviate the symptoms of depression while also decreasing the number of hot flushes, light headed feeling and improving her sleeping status.
Even though menopause is the most common cause of amenorrhea during mid-life, other causes should be considered, and a thorough history should be conducted and pregnancy must be excluded at this point in time. Other indications for amenorrhea could be related to lifestyle factors such as loss of body fat or physical stress. Finally, some other tests for prolactin level and mainly thyroid stimulating hormone level may be considered in addition to those of FSH, and LH.