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Rubric for Turitin Assignments
Grammar/spelling/punctuation/paragraph structure: 3 points
Correct citation: Correct citation with in the paragraph and correct reference citation:2
Reference w/in 5 years from a professional journal, website, or textbook:2 points
Must be at least 300 words: 3 points
Less than 150 words
1. Your word count should be 300 points, without headings, references etc. In
other words, the paper itself needs to be 300 words minimum.
2. When handing in an assignment you do not need a cover page. Type your response
in the space provided.
3. We need to be able to verify references. If there is an error message or a log in page
points will be taken off. Do not cite a URL for the library for a particular article. It will only
show a log in page when accessed. If your reference is from a library you need to
download the article and attach it to the post.
Be careful copying and pasting URL’s and DOI’s. Make sure you have done so
4. When you are citing your textbook with in the paper you need to cite it completely.
Saying “the text” or “our text” is unacceptable. The year of publication needs to be
stated after the authors regardless of the source you are using, in other words any book
not just your text.
5. Use your APA resources in course documents, and look at Guidelines for Written
Work in your syllabus.
6. These are some UNACCEPTABLE references: Forb’s Magazine, Time Magazine,
Men or Women’s fitness, Newsweek, New York Times, any other lay newspaper or
magazine, in print or online. Television stations and T.V. news outlets. ANY Blog, any
source that is used for advertising.
If you are unsure email the instructor.
Wendy Bonnar WHNP-BC, MSN
Symptoms of Perimenopause
• Irregular periods
• Hot flashes
• Night sweats
• Alterations in libido
• memory &
• Mood swings
• Breast tenderness
• Vaginal Dryness
• Itchy vulvar area
• Bladder symptoms
• Recurrent, transient episodes of flushing
accompanied by a sensation of warmth to
intense heat on the upper body and
• Commonly referred to as “hot flashes” by day
and “night sweats” by night
• Hot flashes can sometimes involve the whole
body (e.g., inside of elbows, back of knees).
• As many as 75% of perimenopausal
women in US report hot flashes
• Number of episodes vary
• Few to multiple episodes daily
• Highest occurrence during perimenopause
and first 2 years of postmenopausal.
Freeman EW Climacteric 2007;10:197-214
• Not completely understood
• Related to small fluctuations in core body
• Triggered when core body temperature rises
above upper (sweating) threshold.
• Shivering occurs when core body temperature
falls from elevated level to a level below the
lower threshold of thermoneutral zone.
Freedman RR Fertil Steril 2002;77487-90; Freedman RR Menopause 2005;12:156-9
Factors Contributing to Hot
• Warm environment, hot drinks, spicy food, stress
• Higher BMI, cigarette smoking, alcohol
• Disease conditions including thyroid disease,
infection, leukemia, pancreatic tumors,
autoimmune disorders, anxiety
• Serum estrogen levels are not predictive of hot
flash frequency or severity.
• Midlife sleeplessness:
• Both men and women report an increase in
sleep disturbances at midlife.
• A higher percentage of women than men
report sleep disturbances at all ages.
• Sleep disturbances are associated with fatigue,
irritability, chronic illness (e.g., CVD), mood
disorders (e.g., depression).
• Abrupt decreases in estradiol, such as those that
occur during menstrual periods and
perimenopause, play a role in the incidence of
• During perimenopause, the prevalence or
intensity of headaches often increases,
especially in women with a history of menstrual
• Frequency of migraines often decreases
Brandes JL JAMA 2006;295:1824-30; Martin VT Headache 2006;46:365-86
• Libido generally decreases with age.
• Distressing sexual problems peak during midlife
(ages 45-64) and are lowest from age 65 onward.
• Decreased estrogen can result in loss of vaginal
moisture and elasticity.
• Decline in androgens may contribute to a decline
in sexual desire, arousal, and vaginal lubrication
• Vaginal sexual activity and lubricants may help
keep vaginal tissue more moist and elastic.
Basson R J Urol 2000;163:888-93; Gracia CR Menopause 2004;11:144-50; Hartman U Menopause 2004;11:726-40; Shifren JL Obstet Gynecol
• Osteo means “bones”
• Porosis means porous condition (full of
• Osteoporosis is a disease that can cause
bones to become thin, brittle and more
likely to break.
• Considered the silent disease
• few warning signs
Definition of Osteoporosis
A disease characterized by low bone mass and microarchitectural
deterioration of bone tissue leading to enhanced bone fragility and a
consequent increase in fracture risk
Pentice A Public Health Nutr 2004;7:227-43; WHO Study Group In Assessement of Facture Risk and Its Application to Screening for Postmenopausal
Osteoporosis. Geneva: WHO, 1994
Osteoporosis – Social Impact
• Osteoporosis causes 1.5 million fractures
• 300,000 of those will be hip fractures
• 700,000 vertebral fractures annually, most common
manifestation of osteoporosis
• 5 – 20% of those women die within the year of that
• 15-25% become permanently disabled
• Cost of these fractures is $10 Billion annually
• 65% of patients post hip fracture never regain
prefracture level of independence.
A Gender-Related Condition
• Osteoporosis is the most common bone
disorder affecting humans.
• The risk of hip fracture doubles for every
5- to 6-year increase in age from ages 6585.
• Of the 10 million Americans estimated to
have osteoporosis, 8 million are women
National Osteoporosis Foundation http://www.nof.org/node/40. Accessed 8/24/2012; Kim SH Arthritis Care Res 2012;64:751-7
National Osteoporosis Foundation http://www.nof.org/node/40. Accessed 8/28/12
• The Fracture Risk Assessment Tool (FRAX)
• The FRAX tool was developed by the World Health
Organization to help predict the risk of having a
fracture related to osteoporosis in the next 10
• The tool is meant for people who are not already
being treated with medicine for osteoporosis.
• If you are interested in the tool and it’s components
BMD Testing Recommendations
• All women age 65 and older
• Postmenopausal women younger than age 65
if FRAX score for 10-year risk of major fracture is
≥9.3% (average fracture risk for healthy women)
• Postmenopausal women with medical causes of
• Postmenopausal women with history of fragility
Pfister AK Ann Intern Med 2011;155:275-6
• For postmenopausal women age 50 and older
with one or more of following:
• Previous fracture after menopause
• Thinness (body weight <127 lb [57.7 kg] or BMI <21 kg/m2) • History of hip fracture in a parent • Current smoking • Rheumatoid arthritis • Excessive alcohol intake BMD • Bone density tests (bone mineral density tests) examine bone strength and are used to help diagnose osteoporosis. • Dual energy X-ray absorptiometry (DEXA) DEXA is the most accurate method for measuring bone mineral density. • Two X-ray beams are projected onto the bones. • The amounts of each X-ray beam that is blocked by bone and soft tissue are compared to estimate the bone density. BMD • Bone mineral density results are reported as a T-score. • T-score is the bone density compared with what is normally expected in a healthy young adult of a sex (male or female). • Your T-score is the number of units — called standard deviations — that your bone density is above or below the average. Bone Health: Exercise Is a Key Component • The most important exercise for your bones is developing and maintaining good posture. • No amount of exercise will undo 16 hours of bad posture a day. • Think about sitting and standing as tall as possible, pulling your belly button towards your spine, lowering your shoulders, and gently drawing your shoulder blades together. 3 Types of Exercise for Your Bones • 1. Weight-bearing exercise means carrying your body weight in activities. • Brisk walking, jumping, running • Dance, tennis, soccer • Swimming and biking are very good for your heart, but note that they are not considered weight-bearing exercises to strengthen your bones. 3 Types of Exercise for Your Bones • 2. Strength-training exercises can include the use of resistance machines or inexpensive equipment: • Resistance bands, free weights, or barbells. • 3. Balance work: • Advanced activities include tai chi and yoga, which improve muscle strength, flexibility, and balance. • Note that yoga can be both beneficial and risky in women with osteoporosis. • There is controversy regarding the safety of some of the spinetwisting positions in yoga. Exercise • Goal • 30-40 minutes weight bearing exercise • 3-4 times per week Lifestyle Modifications • Maintain a healthy weight • Eat a balanced diet • Obtain adequate calcium and vitamin D • For calcium: 1,200 mg/d from food (preferably) and/or supplement • For vitamin D: RDA is 600 IU/d until age 70 and 800 IU/d after age 70 • Participate in appropriate exercise • Avoid excessive alcohol consumption • Do not smoke • Institute measures to prevent falls NAMS Menopause 2010;17:25-54 Calcium Needs by Age Group 1-3 years Elemental Calcium Needed per day 50mg 4-8 years 800 mg 9-18 years 1300 mg 19-50 years 1000 mg 50+ years 1200 mg Treatment • Bisphosphonates are the most common medications prescribed for osteoporosis treatment. • These include: • • • • Alendronate (Fosamax) Risedronate (Actonel) Ibandronate (Boniva) Zoledronic acid (Reclast) • Biophosphonates work by retarding bone resorption Treatment • Hormones, such as estrogen, and some hormone-like medications approved for preventing and treating osteoporosis, such as raloxifene (Evista), also play a role in osteoporosis treatment. Treatment • Prolia® (denosumab) is a prescription medicine used to treat osteoporosis in women after menopause who: • are at high risk for fracture, meaning women who have had a fracture related to osteoporosis, or who have multiple risk factors for fracture. • cannot use another osteoporosis medicine or other osteoporosis medicines did not work well. Objectives/Study Guide • Name several symptoms of perimenopause/menopause. • Understand when vasomotor symptoms have the highest occurrence. • Name several factors that can contribute to hot flashes. • Describe some other problems associated with midlife. • Discuss the social impact of osteoporosis. • Know the typical sites associated with osteoporosis. • Understand what risk factors are associated for osteoporosis. • Know what age peak bone mass is reached. • Know the 2 main nutrients needed to prevent osteoporosis. • Understand how vitamin D works to prevent bone loss. Objectives/Study Guide • Understand what the FRAX tool is. • Know how to evaluate BMD. • Know the recommended amounts of calcium and vitamin D intake. • Name some treatments for osteoporosis. Menopause, Hormone Therapy And Osteoporosis Part One Wendy Bonnar WHNP-BC, MSN Introduction • In this lecture we will review: • The process of menopause (physiology) • The negative and positive effects menopause can have on a woman’s life. • Hormone use and studies related to it’s use. • Osteoporosis • Nutrition for the older woman. Introduction • Menopause is the point in a woman's life at which she is no longer fertile, and menstrual periods have ceased. • Menopause is a specific event that occurs during midlife years that brings both physical and emotional changes. • Menopause is an important women’s health issue. Introduction • It was not until the 20th century that women that the life expectancy of the U.S. woman reached a point where most women lived much beyond menopause. • Today most women will live one third or more of their lives postmenopausally. Life expectancy at birth SOURCE: CDC/NCHS, Health, United States, 2013, Figure 1. Data from the National Vital Statistics System. Introduction ❑ Age – Population over 65 years old ◼ 1900 4% ◼ 2010 at 13% (CDC) ◼ 2030 20% approx. 58 million ◼ Average life expectancy of women 80.5 years (CDC) ❑ Increase of 32 years since 1900 Introduction • The medical definition of menopause is the cessation of menstrual cycles for one year. • Menopause is a natural biological process and is not a disease. • The transition stage before menopause is called perimenopause: • Changes in menstruation can occur such as heavy and frequent menstrual cycles. • Mood swings • Hot flashes and night sweats. Introduction • Most women enter and complete menopause between the ages of 45 and 55. • The average age being 51. • Early menopause occurs before the age of 40. • Early menopause is a risk factor for cardiovascular disease. • Induced menopause is cessation of menstruation that follows bilateral oophorectomy (with or without hysterectomy), chemotherapy, or pelvic radiation therapy. • Late menopause occurs after age 55. Introduction • Risk factors for early menopause include: • • • • • Smoking Not graduated from college Unemployment Formally married History of heart disease. • Risk factors for late menopause: • History of taking oral contraceptives • Japanese ancestry • Have had a child The Biology of Menopause • Perimenopause: • Definition • Time period when hormone secretion begins to decline as a prelude to menopause • Age of Onset • 39 to 51 (typically mid 40’s) • Duration • 2 to 10 years The Biology of Menopause • Perimenopause Continued: • Decrease in fertility: • # of capable ovarian follicles decline • Menstrual cycles become irregular • Hormone levels begin to shift: • Follicle Stimulating Hormone (FSH) • Luteinizing Hormone (LH) • Estrogen • Pregnancy remains a possibility during this time because ovulation may occur in sporadic intervals. • Eventually Progesterone & Androgen The Biology of Menopause • Natural menopause occurs when the ovaries fail to respond to LH and FSH. Weight Gain • Many women gain an average of 5 lb (2.27 kg) at midlife related mostly to aging and lifestyle, not menopause or hormone therapy (HT). • However, menopause may be related to changes in body composition and fat distribution. • • Brown WJ Obes Res 2005;13:1431-41; Milewicz A Climacteric 2004;4:273-83; Crawford SI Menopause 2000;7:96-104 Body mass index for women Underweight Normal weight Overweight Obese Morbidly obese <18.5 kg/m2 18.5-24.9 kg/m2 25.0-29.9 kg/m2 30.0-39.9 kg/m2 ≥40.0 kg/m2 National Library of Medicine http://www.nlm.nih.gov/medlineplus/ency/article/007196.htm. Accessed 8/22/12 Percent of population Overweight in US • 70% of women ages 55-75 and 65% of women ages 45-55 are overweight • Approximately 40% are obese The Biology of Menopause • Skin: • Estrogen inhibits skin ageing by preventing skin ageing and promoting skin thickness, collagen content and skin moisture. • 30% decline in skin collagen in the first 5 years after menopause, ~2% per year decline over next 20 years. • Estrogen receptors are present in significant numbers in skin. • Brincat M Br Med J 1983;287:1337-8; Verdier-Sevrain S Exp Dermatol 2006;15:83-94 The Biology of Menopause • Muscle: • Several studies have indicated that lower circulating estrogen levels are associated in loss of muscle strength and muscle mass. • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356020/ The Biology of Menopause • Hair: • Increase in the ratio of androgen to estrogen during the menopause transition may influence hair changes in some women. • Female pattern hair loss (thinning on crown) most common diagnosis. • Large “rogue hairs” can appear on the chin around menopause. The Biology of Menopause • Cardiovascular: • Coronary artery disease is the narrowing or blockage of arteries that surround the heart muscle. • It results when fatty plaque builds up in the artery walls (known as atherosclerosis). This buildup is associated with high levels of cholesterol in the blood. • After menopause, a woman's risk for coronary artery disease increases. The Biology of Menopause • Genitourinary Tract: • Vagina and surrounding tissues require estrogen stimulation to maintain normal structure and function. • Decline in estrogen levels—regardless of the cause— can result in vaginal atrophy and its associated symptoms, such as vaginal dryness, itching, burning, and inadequate lubrication during sexual activity. • Urinary symptoms associated with vaginal atrophy include increased frequency, urgency, and recurrent urinary tract infections, as well as urinary incontinence resulting from pelvic floor relaxation. The Biology of Menopause • Effects of Estrogen Loss: • Bone: Women lose an average of 25 percent of their bone mass from the time of menopause to age 60 due in large part to the loss of estrogen. • Over time, this loss of bone can lead to bone fractures. There are many options, including estrogen therapy, to treat brittle bones. Objectives/Study Guide • Define menopause • Understand the difference between natural menopause and surgical menopause. • Name risk factors for early menopause. • Name risk factors for late menopause. • What age does perimenopause typically start. • Understand the physical changes associated with the perimenopausal period. • Understand the difference between normal body mass index and obesity. • Name several effects estrogen depletion has on a woman’s body. ... Purchase answer to see full attachment