Red flag to remember
Any vaginal bleeding after menopause is reported and evaluated to rule out endometrial cancer.
What is menopause?
Declining estrogen causes hot flashes, vaginal dryness, mood changes, and accelerated bone loss. Lower estrogen raises long-term risk for osteoporosis and cardiovascular disease.
Key points to remember
- Menopause is diagnosed after 12 months of amenorrhea; the years of transition before it are perimenopause.
- Decreased estrogen causes vasomotor symptoms (hot flashes, night sweats), vaginal dryness, and mood swings.
- FSH rises and estrogen falls; an elevated FSH supports the diagnosis.
- Estrogen loss accelerates bone loss, increasing osteoporosis and fracture risk.
- Cardiovascular risk increases after menopause as the protective effect of estrogen declines.
- Hormone therapy can relieve symptoms but raises risk of thromboembolism, stroke, and certain cancers.
Signs & symptoms
- Hot flashes, night sweats
- Vaginal dryness, ↓libido
- Mood swings, sleep issues
Nursing priorities
- Assess the pattern and impact of symptoms such as hot flashes, sleep disruption, and mood changes.
- Counsel on weight-bearing exercise, adequate calcium and vitamin D, and bone density screening.
- Provide nonhormonal comfort measures: layered clothing, cool environment, and trigger avoidance.
- Educate on cardiovascular risk reduction through diet, exercise, and smoking cessation.
- Screen patients on hormone therapy for signs of clot, stroke, and abnormal bleeding.
Labs & values
FSH: rises in menopause, often >30 mIU/mL
Estradiol: low in menopause, often <30 pg/mL
Vitamin D: sufficient >=30 ng/mL for bone health
Patient teaching
- Use vaginal lubricants for dryness and dress in layers to manage hot flashes.
- Ensure adequate calcium and vitamin D and do weight-bearing exercise to protect bone; report any postmenopausal bleeding.
Red flags: report now
- Any vaginal bleeding after menopause is reported and evaluated to rule out endometrial cancer.
- Signs of clot or stroke in a patient on hormone therapy (leg swelling, chest pain, sudden weakness, severe headache) require immediate action.
- Sudden severe headache, vision changes, or one-sided leg pain on estrogen therapy is reported now.
References
Clinical references for this topic
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