The 3 "M"s of Menopause
Published
Learn more about myths/misinformation, misdiagnosis, and management of menopause.
By Karla Rodriguez & Theresa Bucco
Most women know that at some point, they will transition to a natural stage of their lives called menopause. Menopause occurs when a woman no longer ovulates and menstruation has stopped for at least one year. Women can also undergo surgical menopause, where their ovaries, which secrete estrogen, are removed. Peacock et al reported that 1.3 million women are affected by menopause and that their average age is 51 years. Coincidentally, the American Association of Colleges of Nursing reports that the median age of RNs is 46 years, and 89% of these nurses are female. So it’s affecting us as nurses, in large numbers, as well!
KARLA’S STORY
“From personal experience, at 54 years old, I had non-specific symptoms initially. Examples include brain fog, headache, hot flashes, palpitations, and increased weight, especially abdominal fat. Even though I have a family history of cardiac disease, I had never visited a cardiologist before. However, since I was experiencing palpitations, I had a cardiac workup done. My echocardiogram was above 65%, which is normal. The physician ordered a Holter monitor for me to wear for two weeks. After analyzing the monitor recordings, the cardiologist stated I had periods of “minor hiccups,” but nothing to be worried about. However, I was worried! I experienced sleepless nights because of the palpitations; I felt like my heart was coming out of my chest at times. The cardiologist prescribed propranolol which is a beta-adrenergic blocker. Not only does it curb my palpitations, but it also helps with anxiety. Since I have a history of Ductal Carcinoma in Situ which is a Grade 0 breast cancer, my gynecologist prescribed a selective serotonin reuptake inhibitor, escitalopram, which I had concerns about due to undesirable side effects. My gynecologist was adamant about not prescribing estrogen, as it has been known to contribute to cancer. Hence, I still have palpitations from time to time but not as severe as before. I also sought holistic approaches such as meditation and taking black cohosh (a holistic supplement). [Editor’s note: Speak with your health care provider before taking any holistic or complementary health supplements. NIH’s National Center for Compelementary and Integrative Health notes that black cohosh does have side effects, its efficacy shows mixed results in studies, it may interact with certain medications, rare liver damage has been reported with its use, and certain health conditions may contraindicate its use.]
My colleague has also been on the menopause continuum and by now she is probably at the end. However, she still experiences night sweats and difficulty sleeping. Her endocrinologist told her it is because she still has hormones. So where do we stand?”
MYTHS/MISINFORMATION
MISDIAGNOSIS
There are certain conditions that can mimic menopause symptoms from psychological conditions, metabolic problems, and cardiac disease. There is no standardized approach to treatment as management varies and it is contingent on the severity of the symptoms as well as patient history. Unfortunately, a knowledge gaps exists among providers because they may lack the appropriate training about menopause. Many obstetrics-gynecological residents rarely see women during their menopause years. That is, in part, because 80% of those covered by Medicaid are aged 45 years old or younger and Medicare coverage starts at age 65. This often leaves American women between the ages of 40-64 years old without coverage and without incentive (like childbirth and birth control) to visit their ob/gyns during these crucial perimenopausal and menopausal years.
According to researcher Arthur A. Mirin, there is a considerable gender gap in healthcare with only a staggering 4% of all healthcare research dedicated to women and most of that research was focused on reproductive issues. Needless to say, most medical treatments are designed for the male counterpart. Women respond differently to medications than men do. This has led to a disproportionate number of women’s care issues being underestimated leading to negative health outcomes.
Although there is no diagnostic test to diagnose menopause, women need to know that there are resources available to guide them through this phase of their lives. This has many implications for the working woman as she could continue to experience signs and symptoms for up to 5-10 years after starting menopause.
MANAGEMENT
More importantly, nurses need a platform of navigating life at work with these symptoms since most of the symptoms described can impact their caregiving abilities: fatigue, mood swings, vasomotor symptoms, et cetera. This can also cause disruptions in their workflow where some nurses have been known to change their practice in clinical skills or leave nursing altogether due to “burnout”. Garnering support from their employer and colleagues is key.
Women do not have to face this disproportionate burden alone. It is time that women spend the last third of their lives without suffering in silence.
Healthy Nurse, Healthy Nation is a community of support for nurses. Let us know how you or someone you know is positively coping with problematic menopause symptoms.
Karla Rodriguez, DNP, CNE, DipACLM, NC-BC, FNYAM, is a Clinical Assistant Professor of Nursing at Rory Meyers NYU College of Nursing, teaching in the undergraduate program.
Theresa Bucco, PhD, RN, NPD- BC, FNYAM, is a Clinical Assistant Professor of Nursing at Rory Meyers NYU College of Nursing, teaching in the undergraduate program.
Not a member of Healthy Nurse, Healthy Nation (HNHN) yet? Join today!
Sign up for our monthly challenges!
Most women know that at some point, they will transition to a natural stage of their lives called menopause. Menopause occurs when a woman no longer ovulates and menstruation has stopped for at least one year. Women can also undergo surgical menopause, where their ovaries, which secrete estrogen, are removed. Peacock et al reported that 1.3 million women are affected by menopause and that their average age is 51 years. Coincidentally, the American Association of Colleges of Nursing reports that the median age of RNs is 46 years, and 89% of these nurses are female. So it’s affecting us as nurses, in large numbers, as well!
KARLA’S STORY
“From personal experience, at 54 years old, I had non-specific symptoms initially. Examples include brain fog, headache, hot flashes, palpitations, and increased weight, especially abdominal fat. Even though I have a family history of cardiac disease, I had never visited a cardiologist before. However, since I was experiencing palpitations, I had a cardiac workup done. My echocardiogram was above 65%, which is normal. The physician ordered a Holter monitor for me to wear for two weeks. After analyzing the monitor recordings, the cardiologist stated I had periods of “minor hiccups,” but nothing to be worried about. However, I was worried! I experienced sleepless nights because of the palpitations; I felt like my heart was coming out of my chest at times. The cardiologist prescribed propranolol which is a beta-adrenergic blocker. Not only does it curb my palpitations, but it also helps with anxiety. Since I have a history of Ductal Carcinoma in Situ which is a Grade 0 breast cancer, my gynecologist prescribed a selective serotonin reuptake inhibitor, escitalopram, which I had concerns about due to undesirable side effects. My gynecologist was adamant about not prescribing estrogen, as it has been known to contribute to cancer. Hence, I still have palpitations from time to time but not as severe as before. I also sought holistic approaches such as meditation and taking black cohosh (a holistic supplement). [Editor’s note: Speak with your health care provider before taking any holistic or complementary health supplements. NIH’s National Center for Compelementary and Integrative Health notes that black cohosh does have side effects, its efficacy shows mixed results in studies, it may interact with certain medications, rare liver damage has been reported with its use, and certain health conditions may contraindicate its use.]
My colleague has also been on the menopause continuum and by now she is probably at the end. However, she still experiences night sweats and difficulty sleeping. Her endocrinologist told her it is because she still has hormones. So where do we stand?”
MYTHS/MISINFORMATION
- Hot flashes are the only symptoms of menopause. In fact, there are at least 34 symptoms of menopause. There is a constellation of symptoms, from night sweats, anxiety, palpitations, migraines, brain fog, vaginal atrophy, frozen shoulder, stress incontinence and dysuria, to name a few. Almost half of all women experience anger, irritability, depression and social withdrawal.
- Menopause occurs after the age of 50. Menopause can occur before the age of 50 and may be dependent on race and ethnicity of the women. There is no specific timeline addressing the start and end of menopause. In addition, perimenopause can last 7-10 years before the onset of menopause and can harbor its own set of shortcomings.
- All estrogen therapy is too dangerous. The North American Menopause Society recommends women and their healthcare providers thoughtfully consider the benefits and risks of hormone therapy for the individual woman, taking into consideration symptoms, history, health status, age, and other factors.
MISDIAGNOSIS
There are certain conditions that can mimic menopause symptoms from psychological conditions, metabolic problems, and cardiac disease. There is no standardized approach to treatment as management varies and it is contingent on the severity of the symptoms as well as patient history. Unfortunately, a knowledge gaps exists among providers because they may lack the appropriate training about menopause. Many obstetrics-gynecological residents rarely see women during their menopause years. That is, in part, because 80% of those covered by Medicaid are aged 45 years old or younger and Medicare coverage starts at age 65. This often leaves American women between the ages of 40-64 years old without coverage and without incentive (like childbirth and birth control) to visit their ob/gyns during these crucial perimenopausal and menopausal years.
According to researcher Arthur A. Mirin, there is a considerable gender gap in healthcare with only a staggering 4% of all healthcare research dedicated to women and most of that research was focused on reproductive issues. Needless to say, most medical treatments are designed for the male counterpart. Women respond differently to medications than men do. This has led to a disproportionate number of women’s care issues being underestimated leading to negative health outcomes.
Although there is no diagnostic test to diagnose menopause, women need to know that there are resources available to guide them through this phase of their lives. This has many implications for the working woman as she could continue to experience signs and symptoms for up to 5-10 years after starting menopause.
MANAGEMENT
- Discuss your symptoms and potential treatments with your healthcare provider. This could be your ob/gyn, general practitioner, psychiatrist, or other licensed healthcare professional.
- Various drug treatments may be prescribed for individual symptoms depending upon the woman’s age, medical and familial history, pre-existing conditions, and many other factors. These medications may be oral, vaginal, and/or other topicals. Any herbs or other supplements should be discussed with your healthcare provider as well, since these can interfere with certain drugs and be contraindicated in specific health conditions.
- Vaginal atrophy may improve with lubricants, vaginal creams, and sexual activity.
- Holistic regimens such as yoga, breathing exercises, and physical activity can help improve sleep and mood.
- For some women, specific foods and drinks exacerbate hot flashes. Common trigger items include caffeine, alcohol, and spicy foods.
More importantly, nurses need a platform of navigating life at work with these symptoms since most of the symptoms described can impact their caregiving abilities: fatigue, mood swings, vasomotor symptoms, et cetera. This can also cause disruptions in their workflow where some nurses have been known to change their practice in clinical skills or leave nursing altogether due to “burnout”. Garnering support from their employer and colleagues is key.
Women do not have to face this disproportionate burden alone. It is time that women spend the last third of their lives without suffering in silence.
Healthy Nurse, Healthy Nation is a community of support for nurses. Let us know how you or someone you know is positively coping with problematic menopause symptoms.
Karla Rodriguez, DNP, CNE, DipACLM, NC-BC, FNYAM, is a Clinical Assistant Professor of Nursing at Rory Meyers NYU College of Nursing, teaching in the undergraduate program.
Theresa Bucco, PhD, RN, NPD- BC, FNYAM, is a Clinical Assistant Professor of Nursing at Rory Meyers NYU College of Nursing, teaching in the undergraduate program.
Not a member of Healthy Nurse, Healthy Nation (HNHN) yet? Join today!
Sign up for our monthly challenges!
Blog Quality of Life
08/05/2024 2:26pm CDT
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