NR 566 Week 6 Grand Rounds Presentation Part 1 – MENOPAUSE | Already GRADED A
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NR 566
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Chamberlain College Of Nursing
NR 566 Week 6 Grand Rounds Presentation Part 1 – MENOPAUSE Grand rounds week six menopause When counseling patients who are going through menopause, clinicians should understand the benefits a nd risks of hormone therapy, nonhormonal prescription medications, and alternative treatments, and be fa...
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NR 566 Week 6 Grand Rounds Presentation Part 1 –
MENOPAUSE
Grand rounds week six menopause
When counseling patients who are going through menopause, clinicians should understand the benefits
and risks of hormone therapy, nonhormonal prescription medications, and alternative treatments, and
be familiar with the various delivery methods. Risks and Benefits of Hormone Therapy In 2002, the first
Women’s Health Initiative (WHI) clinical trial was published, causing patients and clinicians to question
the safety of menopausal hormone therapy.1 Before this study, many patients took hormones to
improve overall health, prevent cardiac disease, and treat menopausal symptoms. The large study of
approximately 16,000 women compared a combined oral regimen consisting of conjugated equine
estrogen and medroxyprogesterone with placebo, and found that the combined regimen increased the
risk of coronary artery disease, breast cancer, stroke, and venous thromboembolism (VTE). The study
also found a decreased risk of colorectal cancer, hip fractures, and total fractures with combined
hormone therapy.1 Critics of the study believe it is not appropriate to generalize results to all women
going through menopause, partly because the average age of participants was 63 years. (Hill, et al.,
2016)
• Postmenopausal osteoporosis (also called type I osteoporosis) is a consequence of reduced
estrogen levels, which disrupts the normal cycle of bone cell regeneration such that increased activity
of bone-resorbing osteoclasts compared with activity of bone-forming osteoblasts leads to a net loss
of osteocytes. Postmenopausal osteoporosis primarily affects trabecular bone (i.e., the spongy inner
cavity of the bone). Sites that are most vulnerable to fracture due to decreased bone mass are the
vertebrae (spine), proximal femur (hip), and distal radius (wrist) (Schub, et al., 2018)
Estrogen Medications for the Treatment of Vasomotor Symptoms
Medication Available dosages (mg) Bioidentical? Cost*
Hormone replacement therapy may increase the risk of heart attack, stroke, breast cancer, and blood
clots in the lungs and legs. Tell your doctor if you smoke and if you have or have ever had breast lumps or
cancer; a heart attack; a stroke; blood clots; high blood pressure; high blood levels of cholesterol or fats;
or diabetes. If you are having surgery or will be on bedrest, talk to your doctor about stopping estrogen
and progestin at least 4 to 6 weeks before the surgery or bedrest.(HRT,2019)
Hormone therapy has been the primary treatment for menopausal symptoms. However, because of the
health risks associated with hormone therapy, many women cannot or choose not to use hormone
therapy.9–11 Approximately 51% of women use CAM and more than 60% perceive it be effective for
menopausal symptoms.9 However, the majority of women using CAM do not discuss it with their health
care providers.9 Women often report feeling confused about their options and rely on the internet as
their primary source of information.11,12 It is imperative that physicians engage in shared decision making
with women regarding treatment options, including CAM, for menopausal symptoms. This type of
patient-centered integrated approach can potentially reduce the risk for under treatment and adverse
events.(Johnson et al., 2019)
Hypnosis, a mind-body therapy that involves a deeply relaxed state of focused attention, individualized
mental imagery, and suggestion,17 has been investigated for menopausal symptom management. Two
randomized clinical trials of 5 sessions of hypnotherapy for hot flashes among breast cancer survivors
demonstrated a clinically meaningful (≥69%) reduction in hot flash severity and frequency. 18,19 These
results are comparable to pharmacological intervention.(Johnson et al., 2019)
Hypnosis has been recommended by the North American Menopause Society, and others, for the
treatment of menopausal symptoms and poses little risk.(Johnson et al., 2019)
Cognitive Behavioral Therapy
In CBT, the therapist and the client work together to identify unhelpful patterns of
thinking and behaviour. For example, someone might only notice the negative
things that happen to them and not notice the positive things....... This is sometimes
called a “vicious circle” of thoughts, feelings and behaviours.
CBT is an action-oriented psychological intervention that has been used to treat hot flashes,
depression, and other menopausal symptoms. CBT is a time-limited treatment that focuses on
changing cognitive appraisals and behavior choices to alter symptoms. CBT may include
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