FNP Perspective Peer Assessment
Please respond to your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:
- Do you agree with your peers’ assessment?
- Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
- Share your thoughts on how you support their opinion and explain why.
- Present new references that support your opinions.
Please be sure to validate your opinions and ideas with in text-citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. Be respectful and thoughtful.This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Minimum of 100 words.
List the clinical signs and describe the clinical implications of perimenopause including family planning needs.
The transition from the reproductive period to the first year of post menopause, termed perimenopause, occurs over several years and is characterized by substantial biological change. perimenopause encompasses three stages: early menopausal transition (also known as early perimenopause), characterized by persistent irregularity of the menstrual cycle; late menopausal transition (also known as late perimenopause), characterized by an interval of amenorrhea of ≥60 days in the prior 12 months; and early post menopause, which is the first year following the final menstrual period (FMP)
Signs of perimenopause are
CNS-related symptoms arising as a consequence of the neuro-biochemical changes that occur after ovarian failure, such as vasomotor symptoms, sleep disturbances, anxiety and depression, migraine and changes in cognitive performance.
Vasomotor symptoms are the hallmark of menopause and are defined as hot flashes and sweating, sometimes followed by trembling and a feeling of coldness. These are typically the most frequent and bothersome symptoms associated with menopause due to their sudden and seemingly random onset during the day and even at night. Although vasomotor symptoms influence the quality of life of women during daytime, they also greatly alter the quality of sleep. Indeed, women with nocturnal vasomotor symptoms have greater motor restlessness in bed, less efficient sleep and a reduced feeling of being rested in the morning compared to women without night-time symptoms. Nocturnal hot flashes are more common during the first 4 hours of sleep and are associated with a greater number of episodes of waking after the onset of sleep, whereas later rapid-eye-movement (REM) sleep suppresses hot flashes, arousals and awakenings.
Sleep difficulties, particularly nocturnal awakenings, are major complaints and are reported by 40–60% of menopausal women.
Depression and anxiety. The menopausal transition is a vulnerable period for the onset of depressive symptoms.
Women with a personal history of major depression are at risk of relapse during perimenopause and in the first 2 years of post-menopause but not beyond. However, it is unclear whether women who have never experienced major depression in their premenopausal years are at increased risk during or after menopausal transition.
Cognitive changes. Perimenopausal women often report a decline in memory and concentration, which might be distressing and is clinically relevant.
Migraine, Weight and metabolic changes, Cardiovascular changes, Urogenital symptoms, Sexual dysfunction, Musculoskeletal symptoms, Skin, mucosal and hair changes, Personal and social impact.
An emerging concept is that some menopausal symptoms might be predictive of future health complications. Indeed, severe vasomotor symptoms and poor quality of sleep are associated with an increased risk of CVD and postmenopausal depression. Furthermore, depressive symptoms, vasomotor symptoms and sleep disorders might increase the susceptibility to developing cognitive dysfunction. Severe hot flashes have also been associated with an increased risk of osteoporosis and bone fracture. Finally, as menopause seems to accelerate the ageing process, it is conceivable that, in addition to loss of ovarian function, the manifestation of menopausal symptoms might be in part due to ageing changes in health-care practice should start before the menopausal transition to counteract the emergent cardiovascular risk factors and possibly reduce bothersome symptoms. (Monteleone,et al.,2018)
Monteleone, P., Mascagni, G., Giannini, A., Genazzani, A. R., & Simoncini, T. (2018). Symptoms of menopause — global prevalence, physiology and implications.Nature Reviews.Endocrinology, 14(4), 199-215. doi:http://dx.doi.org/10.1038/nrendo.2017.180
Clinical Implications of Perimenopause
Menopause is a subject that many women dread, but it is something that all women will experience at some point in their life. Symptoms of perimenpause or the menopausal transition can be different for all women. This transition averages out to be about four years before the final menstrual period and can include many different symptoms (Casper, 2019). It is important to know when menopause will occur as there is an increase in cardiovascular risk factors and accelerated bone loss during the year leading up to the final menstrual period (Casper, 2019). Knowing the signs and symptoms of perimenopause can help prevent complications for women in this stage.
One of the most common symptoms that women complain of are hot flashes. They are referred to as vasomotor symptoms and occur in up to 80 percent of women (Casper, 2019). Although this is a common complaint, many women do not seek medical treatment for this symptom alone. Hot flashes are reported to be more common at night and are often referred to as “night sweats” (Casper, 2019). As hot flashes tend to occur more often at night, this then begins to affect sleep. Sleep disturbances are another common symptoms reported during this perimenopausal transition period. Studies have shown that women with sleep disturbance also deal with anxiety and depression (Casper, 2019). Along with depression and anxiety, many women report a loss of concentration and memory loss during this transition period.
As estrogen begins to decrease, the epithelial lining of the vagina and urethra that are dependent on estrogen start to become thin causing vaginal atrophy (Casper, 2019). This starts to cause symptoms such as vaginal dryness, itching, irritations, and pain with intercourse. This can not only affect women during intercourse, but in their everyday activities with activity. If the vagina is dry, irritated, and painful then the likeliness of a women to continue having sexual intercourse will decrease. This can be very depressing and life changing for women and their relationships.
The depletion of estrogen has long term effects on the body as well. Bone loss leading to osteoperosis and cardiovascular disease occur at a higher risk during this transition period. Getting bone density scans, checking lipid panel and basic labs to monitor these changes is important for providers to monitor.
Casper, R. (2019). Clinical manifestation and diagnosis of menopause. UpToDate. Retrieved from https://www.uptodate.com/contents/clinical-manifes…