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Women's Health: Climacteric/Menopause

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The Process of aging. Includes perimenopause, menopause, and beyond.
What is climacteric?
May onset as early as age 35.
When does perimenopause begin?
Cycles become anovulatory and increasingly irregular. As a result of anovulatory cylces, proliferative (follicular) phase is longer.

Estrogen load is higher, FSH is elevated, and progeterone load is lower.
What happens in perimenopause hormonally?
• Increasing vaginal dryness
• Acne
• Generalized fatigue/Symptoms of adrenal
fatigue
• Increasing blood pressure
• Symptoms of sympathetic dominance
• Sleep disturbances
What are the signs and symptoms of perimenopause?
Hypothyroidism. They can come in with fatigue, cold hands, etc.
Estrogen dominance can look like what condition?
1. Exercise (low to medium intensity)
2. Coping mechanisms like biofeedback, yoga, and meditation.
3. Decreasing stress, developing, and nurturing support systems, and recognizing that perimenopause is a phase of transition that can be managed.
4. Dietary management. Legumes, phytoestrogens, and filtered water.
How do we manage perimenopause?
Estrogen
Excess insulin results in excess ______________ (hormone)
It can hinder T4 and T3 conversion.
Why can estrogen cause a hypothyroid state?
Gently. They are usually more sensitive to force and pressure.
How should we adjust a perimenopausal female?
51
What is the average age for menopause?
Six to twelve months of amenorrhea.
When is someone considered to be menopausal?
Low estrogen and low progesterone.
What do your hormones look like in menopause?
Estrone (Not estradiol, but estrone can be converted to estradiol).
In menopause, the principle circulating hormone is now....
5% via ovary, 95% via adrenal glands.
What produces estrone?
Conversion of stress hormones in body fat with help of enzyme aromatase (which facilitates conversion of androstenedione or testosterone to estrone)
In menopause, most estrogen and progesterone is being produced by....
because its a hormonal issue and steroid hormone receptors have been found on virtually every type o cell in the body.
Why do perimenopausal and menopausal women experience system-wide symptoms?
1. Fight or flight.
2. Increases brain activity by speeding up neuronal transmission, facilitating neurotransmitter production, and increasing nerve connections.
3. Inhibit thyroid function - false negative hypothyroidism
What are the effects of estrogen?
• Osteoporosis
• Genitourinary atrophy/changes
• Cardiovascular Disease
• Depression (Psychosocial/Psychological)
What are the conditions that can arise from menopause?
Increased Hypothalamus and Pituitary activity
Estrogen facilitates heat loss at the level of the
Capillaries and Venules. Declining levels cause heat
loss at the level of the Arterioles
What is the proposed etiology of hot flashes?
• Dress in layers
• Exercise
• Fiber in the diet - SHBG
• Cruciferous vegetables I3C
• Isoflavones/lignans
• BLACK COHOSH (Important. Also, should combine with other herbs)
• Vit E
• Progesterone cream
• Avoid hot flash triggers
How do we manage menopause?
Caffeine, stress, heat, citrus fruits, tomatoes, berries in some women
What are the most common triggers for hot flashes?
Progesterone. It balances estrogenic effects and promotes bone formation. However, it may result in increased estrogen load and insulin resistance so be careful.
What should we do for a women with osteoporosis and estrogen dominance?
▫ Component of Isoflavones, Lignans and Fiber
▫ Transport estrogen and other sex hormones
▫ Decrease the availability of estrogen to tissues
What are sex hormone binding globulins?
▫ Converts to Testosterone
▫ Increases Estrogen load
▫ Recommendations range from 5-100mg/day
▫ Monitor with salivary tests

It is used for people who are "totally zapped", depressed, and loss of libido.
What are the benefits of DHEA? Why should we use it with caution?
• Eliminate Meds. that cause mucosal dryness (Antihistamines, decongestants)
• Lubricants - Vit E oil, KY jelly, Flaxseed oil
• Kegel Exercise
• Increased sexual activity ( increase foreplay)
• Chaste Berry 150-500mg/day
• Black Cohosh
• Zinc 15 - 20mg/day and high zinc foods
• Estrogen cream
What things can we do to treat genitourinary conditions?
▫ Feeling of fullness or lump in Vagina
▫ Dragging sensation in abdomen or lower back
▫ Vaginal discharge
▫ Difficulty with coitus
▫ Cystitis, Inability to empty quickly, incontinence,
stress urgency
What are the signs and symptoms of a prolapse?
▫ Kegel Exercises
▫ Postnatal exercise
▫ Control associated factors such as obesity,chronic
cough
How can we prevent prolapses?
▫ Manipulation - correct leg length deficiency
▫ Muscle techniques - adductor stripping, psoas
balance
▫ Kegels
▫ Slant board (knee/chest pulls)
▫ Physiotherapy 0-15ma 15 mins. Low volt
▫ Nutrition - manganese for ligaments, Vit. C for
collagen structures ,
How can we treat Prolaps?
...
Read this awesome list
Decreased hot flashes and osteoporosis

Side Effects: Nausea, breast tenderness, fluid retention, depression, loss of hair, hair growth, skin rash, etc.
What are the two main benefits of estrogen supplementation?

What are the side effects?
History of blood clots, history of breast and uterine cancer, unexplained abnormal vaginal bleeding, liver disease.
What are the contraindications to ERT?
• NATURAL ESTROGENS - SYNTHESIZED FROM PLANTS OR ANIMALS: ESTRONE, ESTRADIOL, ESTRIOL
• CONJUGATED ESTROGENS - MIXTURE OF SEVERAL FORMS OF ESTROGEN, SOME NATURAL TO ANIMALS BUT NOT TO HUMANS e.g. Prempro
• COMPOUNDED ESTROGENS - PRESCRIPTION COMBINATIONS OF NATURAL ESTROGENS PREPARED BY COMPOUNDING PHARMACIES: BIEST (Estrone & estradiol) TRIEST: (Estrone, estradiol and Estriol)
Define natural, conjugated, and compounded estrogens.
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