Each Woman’s Menopause: An Evidence Based Resource: For Nurse Practitioners, Advanced Practice Nurses and Allied Health Professionals

Preface
Contents
Part I: Women’s Perspective and Physiology of the Menopause Transition
1: History and Overview of the Menopause Experience
1.1 Evolutionary Theories of Menopause
1.2 History of Menopause
1.2.1 Antiquity
1.2.2 Rituals as a Window to Menopause History
1.2.3 Early Concepts of Menopause
1.2.4 Menopause in the Twentieth and Twenty-First Centuries
1.3 The Stages of Menopause
1.4 Age at Natural Menopause
1.4.1 Genetic Control of Age of Menopause
1.4.2 Lifestyle, Socioeconomic, and Health Influences on Age of Menopause
1.5 Menopause Transition Symptom Profile
1.5.1 Cultural Influence on the Menopause Transition Experience
1.5.2 Symptom Cluster Patterns
1.6 Trajectory and Duration of Menopause Symptoms
1.7 Concept of Symptom Management
1.8 The Clinician and the Woman in the Menopause Transition
References
2: Women’s Voices: The Lived Experience of the Path to Menopause
2.1 Author Perspective and Chapter Context
2.2 Lack of Education Leads to Misattribution, Confusion, and Fear
2.3 A Broader Range of Symptoms Than Commonly Recognized
2.4 Seeking to Determine the Source of New Experiences Is Hit or Miss
2.5 Confusing Messages About Research
2.6 Online Support
2.6.1 Shirley’s Story
2.6.2 Emily’s Story
2.6.3 The Challenges of Monitoring Online Support
2.6.4 Benefits of Online Support; Shared Experience Is Key
2.7 Dissatisfaction with Healthcare Interactions
2.7.1 Confusion over the Value of Testing Hormone Levels
2.7.2 The Challenge for Healthcare Providers Who Care for Midlife Women
2.8 Cycle Tracking Yields Information About the Beginning of Hormonal Changes and Is a Source of Empowerment
2.9 Optimizing the Healthcare Visit
2.10 A Later Symptom: Largely Undiscussed and Yet Treatable
2.11 Impact of Symptoms on Relationships and Work
2.12 What Would Be Game Changing in Menopausal Care: Recognition of the LRS
2.13 Conclusion
References
3: Communication with Women in the Menopause Transition
3.1 Introduction
3.2 Cultural Competence vs. Cultural Humility
3.2.1 Cultural Competence
3.2.2 Humility
3.2.3 Cultural Humility
3.3 Patient-Centered Care and Communication
3.4 The QIAN Healthcare Curriculum Model
3.5 Communicating Effectively with Cultural Humility
3.5.1 Establishing a Trusting and Supportive Relationship
3.5.2 Gathering Information
3.5.3 Providing Information
3.5.4 Communicating Treatment Decisions
3.5.5 Open Door Policy
References
4: Physiology of Menopause
4.1 Hypothalamic Pituitary Ovarian Axis and Control of the Menstrual Cycle
4.1.1 Influence of Aging on the HPO
4.1.1.1 Late Reproductive Stage (STRAW + 10 Stages −3b, −3a)
4.1.1.2 Early to Late Menopause Transition (STRAW + 10 Stages − 2, −1)
4.1.1.3 Postmenopause (STRAW + 10 Stages +1a, +1b, +1c, +2)
4.2 Physiology of Menstrual Changes Prior to FMP
4.2.1 Physiological Profiles in Race/Ethnicity, Body Morphology, and Lifestyle Variations
4.3 Physiology of Fertility Decline
4.4 Role of Hormone Testing and Predicting FMP
4.5 Intracrinology
4.6 Menopause Physiology with Reproductive Endocrine Pathologies
4.6.1 Primary Ovarian Insufficiency
4.6.2 Polycystic Ovarian Syndrome
4.6.3 Functional Hypothalamic Amenorrhea
4.6.4 Induced Menopause
4.7 Physiology of Menopause Symptom Profile
References
5: The Interaction of Menopause and Chronic Disease
5.1 Chronic Disease Overview
5.2 Cardiovascular Disease
5.2.1 Summary
5.3 Thromboembolism
5.3.1 Summary
5.4 Stroke
5.4.1 Summary
5.5 Diabetes and Metabolic Syndrome
5.5.1 Summary
5.6 Chronic Lung Disease
5.6.1 Summary
5.7 Chronic Kidney Disease
5.7.1 Summary
5.8 Gallbladder Disease
5.8.1 Summary
5.9 Cancer
5.9.1 Endometrial Cancer
5.9.1.1 Summary
5.9.2 Breast Cancer
5.9.3 Ovarian Cancer
5.9.3.1 Summary
5.9.4 Colorectal Cancer
5.9.4.1 Summary
5.9.5 Lung Cancer
5.9.5.1 Summary
References
6: Menopause Hormone Therapy
6.1 Introduction
6.2 Estrogen
6.2.1 Type and Delivery Methods of Estrogen Therapy
6.3 Progesterone
6.3.1 Clinical Use of Progesterone in the Menopause Transition
6.3.2 Type and Delivery Methods of Progesterone and Progestins
6.4 Combined Estrogen and Progestogen in Women with a Uterus
6.4.1 Endometrial Suppression
6.4.2 Combined Hormone Regimens
6.5 Bioidentical Estrogen and Progesterone
6.5.1 Compounded Bioidentical Hormone Therapy
6.6 Risks in Estrogen Only and Estrogen with Progestogen Menopause Hormone Therapy
6.6.1 Venous Thromboembolism
6.6.2 Gallbladder Disease
6.6.3 Stroke and Cardiovascular Disease
6.6.4 Breast Cancer
6.6.4.1 Effect of Progestogen Formation on Breast Cancer Risk
6.6.5 Dementia
6.7 Discontinuation of Menopause Hormone Therapy
6.8 Tibolone
6.9 Tissue Selective Estrogen Complex: Conjugated Estrogen and Bazedoxifene
6.10 Conclusion
References
Part II: Menopause Symptom Management
7: Abnormal Uterine Bleeding
7.1 Normal Menstrual Parameters and Abnormal Uterine Bleeding (AUB) Overview
7.1.1 Epidemiology of AUB
7.2 Management of Acute Heavy Bleeding
7.2.1 Combined Estrogen and Progestin in Acute HMB
7.2.2 Progestin Only in Acute HMB
7.2.3 Antifibrinolytics in Acute HMB
7.3 Chronic Heavy Menstrual Bleeding Presentations in Midlife
7.3.1 AUB-O: Ovulatory Dysfunction
7.3.2 AUB-A: Adenomyosis
7.3.3 AUB-L: Leiomyoma/Uterine Fibroids
7.3.4 AUB-I: Iatrogenic
7.3.5 AUB-C: Coagulopathy
7.3.6 AUB-E: Endometrial
7.4 Approach to the Assessment of Chronic Heavy Menstrual Bleeding
7.4.1 Medical Management of Chronic Heavy Menstrual Bleeding
7.4.1.1 Estrogen and Progestogen or Progestogen Alone in Chronic HMB
7.4.1.2 Nonsteroidal Anti-inflammatory in Chronic HMB (NSAID)
7.4.1.3 Levonorgestrel Intrauterine System (LNG-IUS) in Chronic HMB
7.4.1.4 Antifibrinolytics in Chronic HMB
7.4.1.5 GnRH Modulation for HMB
7.4.1.6 Selective Progesterone Receptor Modulation for HMB in Uterine Leiomyoma
7.4.2 Minimally Invasive Procedural and Surgical Options in Chronic HMB
7.5 Infrequent Bleeding
7.6 Postmenopause Bleeding
References
8: Vasomotor Symptoms
8.1 Epidemiology of Vasomotor Symptoms (VMS)
8.2 Duration and Trajectory of Vasomotor Symptoms
8.3 Vasomotor Symptoms Impact on Women’s Lives
8.4 Physiology of VMS
8.5 Assessing Vasomotor Symptoms
8.6 Management of Vasomotor Symptoms
8.6.1 Hormonal Products
8.6.2 Management of VMS with Nonhormonal Methods
8.6.2.1 Nonhormonal Medications
Antidepressant Protocols
Gabapentinoids
Clonidine
8.6.2.2 Management with Non-prescription Botanicals and Supplements
Regulation of Supplements
Botanicals
Soy Foods and Soy Extracts
8.6.2.3 Acupuncture
8.6.2.4 Lifestyle Management
Weight Loss
Exercise
Mind-Body Therapies
8.7 Emerging Vasomotor Symptom Management
8.7.1 Neurokinin 3 Receptor Antagonist
8.7.2 Estetrol
References
9: Sleep Disruption
9.1 Introduction
9.2 Mental and Physical Consequences of Disrupted Sleep
9.3 Characteristics of Sleep During the Menopause Transition
9.4 Sleep Disorders in the Menopause Transition
9.4.1 Insomnia
9.4.2 Sleep-Disordered Breathing
9.5 Biopsychosocial Etiology and Context for Sleep Disruption During the Menopause Transition
9.5.1 Biological Factors
9.5.1.1 Vasomotor Symptoms
9.5.1.2 Reproductive Hormones and Menopause Hormone Therapy
9.5.2 Psychological Factors
9.5.2.1 Mood/Mood Disorders
9.5.2.2 Stress Reactivity
9.5.3 Social Factors Influencing Sleep in the Menopause Transition
9.6 Assessment and Interventions for Sleep Disruption During the Menopause Transition
9.6.1 Assessment
9.6.2 Cognitive Behavioral Therapy for Insomnia
9.6.3 Mindfulness
9.6.4 Pharmacotherapy
9.6.5 Alternative and Complementary Treatment Approaches
9.7 Conclusion
References
10: Mood and Cognition
10.1 Introduction
10.2 History of Mood Disturbance Related to the Female Endocrine Events
10.2.1 Menstruation
10.2.2 Pregnancy/Postpartum
10.2.3 Perimenopause/Menopause
10.3 Timeline of Menopause Transition
10.4 Depression
10.5 Evaluation and Treatment
10.6 Evaluation
10.7 Treatment Options
10.7.1 Antidepressants
10.7.2 Menopause Hormone Therapy (MHT)
10.8 Anxiety
10.9 Symptom Description
10.10 Impact on Women, Their Partners and Families
10.11 Spousal Support
10.12 Treatment
10.12.1 Anxiolytics
10.12.2 Menopause Hormone Therapy (MHT)
10.13 Psychotherapy for Depression and Anxiety
10.13.1 Cognitive Behavioral Therapy (CBT)
10.13.2 Mindfulness-Based Stress Reduction
10.14 Complementary and Alternative Medicine for Menopausal Mood Symptoms
10.14.1 Acupuncture
10.14.2 Yoga
10.14.3 Daily Exercise
10.14.4 Herbs, Vitamins, and Supplements
10.15 Association of Cognitive Changes and Dementia with Menopause
10.16 Evaluation
10.17 Treatment
10.18 Role of the Healthcare Provider
10.19 Summary
References
11: Genitourinary and Sexual Health
11.1 Introduction
11.2 Common Urogenital and Sexual Health Concerns in Menopause
11.2.1 Vulvovaginal Symptoms
11.2.2 Urinary Symptoms
11.2.3 Pelvic Organ Prolapse
11.2.4 Low Sexual Desire
11.3 Impact of Genitourinary and Sexual Health Concerns Internationally
11.4 Effects of Hormonal Changes in the Menopause Transition
11.5 Medical Evaluation
11.5.1 Medical History
11.5.2 Physical Examination
11.5.3 Laboratory Testing
11.6 A Multidisciplinary Treatment Approach
11.6.1 Non-hormonal Options
11.6.2 Hormonal Options
11.6.2.1 Systemic Estrogen Therapy
11.6.2.2 Local Estrogen
11.6.2.3 Hormone Modulators
11.6.2.4 Dehydroepiandrosterone (DHEA)
11.6.2.5 Local Androgen Therapy
11.6.3 Pelvic Floor Physical Therapy
11.6.4 Behavioral Modifications
11.6.4.1 Dietary Management
11.6.4.2 Cardiovascular Exercise
11.6.4.3 Bladder Management
11.6.4.4 Bowel Management
11.6.4.5 Weight Management and Smoking Cessation
11.6.5 External Support for Pelvic Organ Prolapse
11.6.6 Hypoactive Sexual Desire Disorder (HSDD) Treatment
11.6.7 Vaginal RenewalTM Program
11.6.8 “OtherCourse”
11.6.9 Energy-Based Treatments
11.7 Interventional Therapies
11.8 Surgery
11.9 Conclusion
References
12: Nutrition and Weight Management in Midlife
12.1 Introduction
12.2 Sociocultural Factors and Symptom Reporting
12.2.1 Social Determinants of Health and Their Impact on Menopausal Experience
12.3 Health Impacts of Aging vs. Menopause Transition
12.4 Energy Balance and Weight Management in the Menopause Transition
12.4.1 Metabolic Alterations in the Menopause Transition
12.4.2 Energy Balance
12.4.3 Glucose Metabolism
12.4.3.1 Body Composition and Glucose Metabolism
12.4.3.2 Microbiome and Glucose Metabolism
12.5 Carbohydrate Literacy
12.6 Nutrient Recommendations
12.7 Fluid Recommendations
12.8 Eating Patterns and Menopause Symptoms
12.9 Mindful Weight Management
12.10 Implementing Recommendations in Glucose Metabolism
12.11 Lipid Metabolism
12.11.1 Implementing Recommendations for Heart Health
12.12 Hypertension
12.13 Implementing Recommendations for Heart Health and Blood Pressure
12.14 Bone Health
12.14.1 Implementing Recommendations for Bone Health
12.15 Lean Body Mass
12.16 Physical Activity
12.17 Conclusion: Menopause Is a Natural Transition, Not a Disease
References
13: Musculoskeletal Health in Menopause
13.1 Bone Physiology
13.1.1 Introduction
13.1.2 Calcium
13.1.3 Magnesium and Phosphorus
13.1.4 Vitamin D
13.1.5 Parathyroid Hormone
13.1.6 Calcitonin
13.1.7 Estrogen
13.2 Osteoporosis
13.2.1 Epidemiology and Physiology
13.2.1.1 Incidence and Burden of Osteoporosis Fractures
13.2.1.2 Physiology of Osteoporosis and Menopause
13.2.2 Screening, Diagnosis, and Management: Osteoporosis vs. Fracture Risk
13.2.2.1 Fracture Risk Assessment
13.2.2.2 Prevention and Management Guidelines
Integrative and Behavioral Interventions
Nutrition
Exercise
Soy Isoflavones
Pharmacologic Treatments
Bisphosphonates
Safety of Bisphosphonates in Osteoporosis Treatment
Estrogen
13.3 Sarcopenia
13.3.1 Epidemiology
13.3.2 Physiology
13.3.3 Screening, Diagnosis, and Management
13.3.3.1 Treatment
13.4 Arthralgia and Myalgia
13.4.1 Epidemiology and Physiology
13.4.2 Screening, Diagnosis, and Management
13.4.2.1 Treatment: The Role of Exercise
13.4.2.2 General Treatment
13.4.2.3 Summary
13.5 Conclusion
References
14: Breast Health
14.1 Introduction: Incidence of Breast Cancer
14.2 Racial/Ethnic Disparities in Breast Cancer Diagnosis, Treatment, and Survival
14.2.1 Race/Ethnicity and Breast Cancer Survival
14.2.2 Race/Ethnicity, Genetics, and Breast Cancer
14.2.3 Race/Ethnicity and Incidence by Age
14.2.4 Race/Ethnicity and Stage of Cancer at Diagnosis and Mortality
14.2.5 Race/Ethnicity and Biological Differences in Tumors
14.3 Barriers to Breast Cancer Screening, Diagnosis, and Care
14.3.1 Clinical Barriers to Screening
14.3.2 Socioeconomic Barriers to Screening and Care
14.3.2.1 Poverty
14.3.2.2 Social Injustice
14.3.2.3 Healthcare System Distrust
14.3.3 Barriers to Use of Chemoprevention
14.4 Breast Health Screening
14.4.1 History of Breast Health Screening
14.4.2 Modalities: Mammography, Ultrasound, Breast MRI
14.4.2.1 Mammography: Two Dimensional Versus Three Dimensional
14.4.2.2 Ultrasound
14.4.2.3 Magnetic Resonance Imaging (MRI)
14.5 Breast Density
14.5.1 Breast Imaging Reporting and Data System (BIRAD)
14.5.2 Breast Density on Mammography
14.6 Defining the Woman of High Risk for Breast Cancer
14.6.1 Family History
14.6.2 Personal Medical History
14.7 Risk Assessment Tools
14.7.1 National Cancer Institute Gail Model (https://bcrisktool.cancer.gov)
14.7.2 Breast Cancer Surveillance Consortium Model (BCSC) (https://tools.bcsc-scc.org/BC5yearrisk/calculator.htm)
14.7.3 Tyrer-Cuzick Version 8 (http://www.ems-trials.org/riskevaluator/)
14.8 Genetics
14.8.1 The Role of Genetics in Breast Health
14.8.2 Cancer Genetics
14.8.3 Acquired Breast Cancer
14.8.3.1 ERBB2 (HER2) [72, 73]
14.8.3.2 PI3K/AKT/MTOR [72, 75]
14.8.3.3 FGFR Gene Family [72]
14.8.3.4 NTRK [72]
14.8.3.5 ESR1 [72, 76, 77]
14.8.3.6 BRCA [78]
14.9 Inherited Breast Cancer
14.9.1 Determining Inherited Breast Cancer Risk
14.10 Genetic Counseling and Testing
14.10.1 When to Consider Genetic Testing
14.10.2 Pretest Genetic Counseling
14.10.3 Interpreting a Genetic Test
14.10.4 Posttest Genetic Counseling
14.11 Chemoprevention in High-Risk Women and Treatment of Hormone Receptor-Positive Early Stage Breast Cancer
14.11.1 Early Stage Hormone Receptor-Positive Breast Cancer
14.11.2 Chemoprevention in High-Risk Women
14.11.2.1 Raloxifene
14.11.2.2 Tamoxifen
14.11.2.3 Aromatase Inhibitors
14.11.3 Treatment of Early Stage Hormone Receptor-Positive Breast Cancer
14.11.3.1 Tamoxifen
14.11.3.2 Aromatase Inhibitors
14.11.3.3 Leuprolide
14.11.4 Additional Clinical Considerations When Prescribing Endocrine Therapy
14.12 Iatrogenic Menopause Post Chemotherapy
14.13 Management of Menopausal Symptoms in Breast Cancer Patients
14.13.1 Vaginal Estrogen and Testosterone
14.13.2 Summary of Menopausal Symptom Management in the Breast Cancer Patient
References
Index