managing menopause beverly m. vaughn, m.d. clinical assist. prof. ob/gyn thomas jefferson university
TRANSCRIPT
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Managing Menopause
Beverly M. Vaughn, M.D.
Clinical Assist. Prof. Ob/Gyn
Thomas Jefferson University
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Some Definitions
Perimenopause: The time before the final menstrual period characterized by irregular periods. Some women experience hot flashes, difficulty sleeping, and/or changes in mood.
Menopause: Begins 12 months after the final period
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How do I know if I’m menopausal?
Are hormonal levels useful?
Will I become menopausal after chemo and/or radiation therapy?
What happens if I have my ovaries removed?
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Every woman’s perimenopause and menopause is unique.
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Healthcare Provider Concerns
Cardiovascular disease
Cancer prevention
Osteoporosis
Obesity
Symptoms of menopause
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Patient Concerns
Hot flashesVaginal drynessLibidoPoor sleepMood changesWeight gainMemory problemsOsteoporosisCancer prevention
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What’s happening to my body?
Cardiovascular changes: Shifts in HDL and LDL, decreased elasticity of blood vessels, increased formation of plaqueMusculoskeletal: Muscle converts to fat, decrease muscle strength, decrease in calcium absorption from the intestine, increase bone turnover resulting in decrease bone densityWeight gain: hormonal influence, caloric requirements decrease
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What’s happening to my body?
Skin: increased dryness, thinner skin, decreased collagenGenitourinary: decreased blood flow, elasticity, and ability to retain moisture, thinner tissue, shorter vaginal canal, painful intercourse, possible increased susceptibility to bladder infections, increased incontinence
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What’s happening to my body?
Sexuality: Diminished perception of touch, changes in body image, prolonged arousal time, less intense orgasms, changes in libido
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What’s happening to my body?
Mood: Increased depression and moodiness occurs in the perimenopausal period
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Who manages my menopause symptoms?
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Hot flashes
Can occur with natural, surgical or chemotherapy induced menopause
Removal of the ovaries will cause immediate menopause but not necessarily immediate symptoms
Tamoxifen™, Arimidex™, Femara™ all cause hot flashes
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What about estrogen therapy?
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Controversial
Does the hormone receptor status matter?
Does the length of time since diagnosis matter?
Does age matter?
* Will it effect my risk of recurrence?*
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What about progesterone/progestin?
Synthetic progestins were used very effectively in the past. Their use is currently controversial.
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Bioidenticals
Bioidenticals are exogenous hormones biochemically similar to those produced endogenously by the body or ovaries
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Lifestyle changes
Avoid common triggers: alcohol, caffeine, cigarettes, hot and/or spicy foods, stress
Eat well, eat less and exercise
Dress in layers
Use natural fibers
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Non pharmaceutical therapies
Paced breathing
Relaxation therapy
Soy
Herbs ( i.e. black cohosh, red clover, flaxseed)
Vitamin E
Acupuncture
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Selective Serotonin Reuptake Inhibitors (SSRI’s)
Paxil ™, Prozac™, Effexor™, Celexa™, Lexapro™
Works at the thermoregulatory center of the brain
Effective
Relief occurs quickly
Side effects
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Other pharmacologic options
Gabapentin ™ , Clonidine™
Effectiveness
Side effects
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Vaginal dryness
Over the counter lubricants such as, K-Y™, Astroglide™, Slippery Stuff™, silicone products
Over the counter moisturizers like Replens™
Almond oil
Vaginal estrogen ring, tablet or cream
Dilators
Patience, non intercourse intimacy
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Libido
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Libido
Vulnerability
Body image
Painful sex
Fatigue
Duration of relationship
Effect of hormones
Difficulty with arousal and achieving orgasm
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Libido
Look at all of the factors
Testosterone??????????
Viagra™??????????
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Resources
www.soulsource.com
www.vaginismus.com
www.passionparties.com
www.middlesexmd.com
www.menopause.org
www.mainlinehealth.org/whs