Perimenopause - Management of Normal and Altered Female Physiologic Processes

PERIMENOPAUSE

Perimenopause is the period extending from the first signs ofmenopause—usually hot flashes, vaginal dryness, and irregular menses—to beyond the complete cessation of menses. It has also been defined as the period around menopause, lasting to 1 year after the last menstrual period. Women often have varied beliefs about aging, and these must be considered by the nurse caring for or educating perimenopausal patients.

Nursing Management

Perimenopausal women often benefit from information about the subtle physiologic changes they are experiencing. Perimenopause has been described as an opportune time for teaching women about health promotion and disease prevention strategies. When discussing health-related concerns with midlife women, nurses should consider the following issues:

·      Sexuality, fertility, contraception, STDs

·      Unintended pregnancy (this is possible if contraception is not used)

·       Oral contraceptive use. Oral contraceptives provide peri-menopausal women with protection against uterine cancer, ovarian cancer, anemia, pregnancy, and fibrocystic breast changes as well as relief from perimenopausal symptoms. This option should be discussed with perimenopausal women. (Women who smoke and who are 35 or older should not take oral contraceptives because of an increased risk for cardiovascular disease.)

·       Breast health. About 16% of cases of breast cancer occur in this group of women, so breast self-examination, routine physical examinations, and mammograms are essential.

Women need to be aware that diet and exercise are crucial to their health. The Women’s Health Initiative study has found that the risks of long-term use of hormone replacement therapy (HRT) outweigh the benefits. Although HRT decreases hot flashes and reduces the risk for osteoporotic fractures and col-orectal cancer, it increases the risk for breast cancer, heart at-tack, stroke, and blood clots (Writing Group for Women’s Health Initiative Investigators, 2002). (It has been suggested that the term “menopausal hormone therapy” be used in place of HRT.)