Coping with Menopausal Symptoms Through Physical Activities

COMS PROBLEM-SOLVING PAPER
Student’s Name
Professor’s name
Institutional affiliation
Course Title
Date
COMS PROBLEM-SOLVING PAPER
Introduction
Menopause is a critical phenomenon in a woman’s life. Menopause is defined as cessation of menstrual periods for at least 12 consecutive months, and such stoppage should not be occasioned by a physiological process such as lactation or pathologic causes (Whiteley et al., 2013). Whiteley et al. (2013) postulate that the cessation of menstrual periods is often associated with various unpleasant symptoms, including raised anxiety, depression, dwindling libido, vaginal dryness, increasing insomnia, difficulties concentrating, and vasomotor symptoms comprising hot flashes and night sweats. Thus, menopause is a quite destabilizing phase of woman’s life where an individual at substantial risk of losing the desired quality of life (Lobo et al., 2014). How the women manage vasomotor symptoms remains inclusive, but the physical exercise program geared towards managing these symptoms is gaining traction and interest over recent times. This paper seeks to demonstrate that Advanced Registered Nurse (s) (APRN/s) have a critical role to play in educating Asian American Women on approaches to coping with menopausal symptoms by engaging in physical exercise programs to relieve vasomotor symptoms.
This paper aims to demonstrate arguments supporting the adoption of physical exercise as an approach to tackling postmenopausal associated symptoms such as hot flashes. There sin sufficient literature citing the substantial effectiveness of physical exercise in battling vasomotor symptoms. Previous studies show that a Web-based physical activity promotion program with educational modules on menopausal symptoms and physical activity targeting Asian American midlife women has been developed to reduce their menopausal symptoms via enhancing increasing their physical activity (Im et al., 2017). The web Web-based 3-month intervention for menopausal symptom management among Asian American midlife women showed increased efficacy levels of the program (Im et al., 2017). The use of hormonal replacement therapies among Asian American women is of mixed results where some women are not comfortable with hormonal replacement therapies due to perceived and proven side effects. According to the Academic Committee of the Korean Society of Menopause (2020), the importance of women's health and the quality of life (QoL) after menopause is increasing, and the most effective treatment for vasomotor symptoms (VMS) and genitourinary syndrome of menopause (GSM) is menopausal hormone therapy (MHT), which is also effective in preventing osteoporosis. MHT offers more advantages than disadvantages for women aged less than 60 years or who have had menopause for less than ten years( Academic Committee of the Korean Society of Menopause,2020). The 2020 core guidelines on menopausal symptoms management support the use of estrogen as the most effective treatment available for relieving hot flashes and for other menopausal symptoms (Martin, & Barbieri, 2017). Despite such evidence, women are still skeptical about MHT. Thus, physical exercise programs could fill such gaps which are found in hormonal replacement therapy. The search for alternative options for hormonal replacement therapy widens the role of Advanced Registered Nurse (s) (APRN/s) in creating educational and practical avenues through which Asian American women (AWW) could cope with vasomotor menopausal symptoms.
There is a far-reaching health implication when people adopt habitual regular physical excise. However, the question of whether physical activity alleviates or relieves the adverse health effects accompanying the menopausal transition, such as the occurrence of vasomotor symptoms (VMS), increased weight and body fat, decreasing bone density, and changes in mood and somatic symptoms, remains inconclusive (Sternfeld & Dugan,2011). This paper is a buildup of knowledge to demonstrate the role of physical exercise in managing postmenopausal symptoms, especially vasomotor symptoms, including hot flashes and night sweats. It demonstrates that non-pharmacological alternatives such as physical exercise programs still offer viable solutions to menopausal symptoms so long as they are contextualized and designed to meet the targeted populations' needs.
Operational Definition
Asian American women (AAW): Asian American women trace their ancestral descent to Asia. The study will focus on vasomotor symptoms amongst Asian American women, where a physical exercise program will be introduced as an interventional strategy to menopausal symptoms. Vasomotor symptoms are prevalently reported menopausal symptoms, often characterized by hot flashes. Hot flashes feature an abrupt increase of blood flow, mainly to the face, neck, and chest, leading to the sensation of heat and profuse sweating. Hot flashes are the sudden sensation of heat and sweating, primarily on the upper body (Kronenberg, 2010). When hot flashes occur at night, they are often described as “night sweats” and can disrupt sleep. Episodes of vasomotor symptoms such as hot flashes can last up to about five minutes and often feature perspiration, flushing, chills, anxiety, and even heart palpitations. Vasomotor symptoms constitute the primary reasons why women seek healthcare services. Hot flashes may occur day or night. Each episode lasts between 3 and 10 min and can recur with varying frequency. Other women experience hot flashes hourly or daily, while others may only experience occasionally. For most women, hot flashes begin and peak during the peri- and early postmenopausal periods, especially in the late 40s and early 50s. Most women have hot flashes for a year or two, but ∼15% may have them nonstop for 10, 20, or 30 years (Kronenberg, 2010)
Physical exercises: physical exercises comprise all activities that can relieve menopausal symptoms and enhance the overall quality of care and individual well-being. The physical excessive is tailored to relieving vasomotor symptoms or hot flashes. The reduction in the severity and frequency of sweating, perspiration, chills, anxiety, and heart palpitations represents a desirable outcome of physical exercise. Hot flashes are the most common symptom of a woman’s menopause. Feelings of intense heat characterize hot flashes, followed by skin reddening caused by increased blood flow, sweating and reduced blood flow to the brain for two to three minutes. In a study, the women who performed 16 weeks of supervised exercise training were told to fill a 7-day hot flush questionnaire: most of them less incidence and severity of self-reported hot flushes (Bailey et al., 2016).In a controlled trial involving 21 post-menopausal women, 16 weeks of supervised training entailing moderate-intensity exercise improved cardiorespiratory fitness and reduced cutaneous vasodilatation, sweating, and reductions in cerebral blood flow during hot flashes. Thus, regular physical exercise can help manage vasomotor symptoms.
Pathophysiology
The pathophysiologic process begins the premenopausal and progressive move to peri-menopausal, menopausal and postmenopausal. Premenopausal is the period before the appearance of menopausal symptoms, perimenopausal represents the transition period where symptoms begin to emerge, while menopause is a time at which symptoms are at peak, and post-menopause reflects duration or phase that symptoms are becoming less prominent (Clayton & Ninan, 2010). Perimenopausal often starts in women's 40s, but it can begin as early as 30s or even earlier. Menopause marks the end of menstrual cycles and often starts at 50, but it also occurs in the 40s (Ramadan, Eldesokey & Hassan, 2020).
The pathophysiology of the menopause phenomenon is quite intricate and inconclusive. It involves a cascade of many physiological processes mediated by various factors, including hormonal and age-related variables. The pathophysiologic changes herald a new phase of life marked by specific and non-specific symptoms. The symptoms experienced by most women during menopause, perimenopause, and postmenopausal include vasomotor comprising of hot flushes and night sweats: psychological which involves depression and insomnia, somatic or physical symptoms such as palpitations, backache and, dizziness: and sexuality symptoms including reduced libido and, vaginal dryness (Thomas & Daley, 2020).
Hot flashes are attributed to changing hormone levels before, during, and after menopause. It remains unclear how hormonal changes cause hot flashes. However, strong evidence shows that hot flashes occur when there are decreased estrogen levels which cause the hypothalamus to become more sensitive to slight changes in body temperature. Thus, when the hypothalamus receives a signal about warmth, a cascade of physical events begins resulting in hot flashes as an approach to cooling the body. Menopause does not affect women universally. It has been shown that smoking, obesity, and being of African descent increase predisposition to hot flashes, while being of Asian origin denotes less exposure to hot flashes. In addition, age can be considered a risk factor for hot flashes. Levels of both estrogen and progesterone experience substantial fall at about 40 years, especially during perimenopause, where the emergence of vasomotor symptoms marks progressive transitions. The increasingly high hormonal fluctuations underpin vascular constrictions and dilatations, leading to vasomotor symptoms comprising hot flashes and night sweats, manifested by increased seating, sleep disruptions, increasing anxiety, and heart palpitations. The causes of hot flashes can be examined at the neurovascular level involving the interaction of the hormonal-nervous-vascular axis.
During menopause, estrogen substantially reduces due to deterioration of ovarian function, leading to physical symptoms such as vasomotor symptoms involving facial flushing, sweating, sleep disorders, joint and muscle disorders, weight changes, lipid redistribution, reduced physical strength, depression, lower motivation, and morale, hypothermia and memory loss (Noh et al., 2020). Due to the changes in estrogen production, the ratio of estradiol to estrone changes after menopause—the estrone level more than that of estradiol. Gonadotropin levels greater than 30 mIU/ml are typically diagnostic of menopause, with the ratio of FSH to luteinizing hormone (LH) being greater than 1. In the postmenopausal woman, the secretion of gonadotropins is pulsatile, with FSH pulses commonly happening at 60- to 90-minute intervals (Zhu et al., 2018).
It is critical to understanding the risk factors that accentuate host flashes. However, despite the profound effect of hot flashes on a woman's life, the risk factors for hot flashes or the events that precipitating hot flashes remained unclear. The factors frequently reported factors linked to an increase in the incidence of hot flashes to include obesity, lower socioeconomic status, being of African descent, sedentary lifestyle, smoking, and presence of premenstrual syndrome (Bansal & Aggarwal, 2019). However, genetic factors are recently also being identified as critical factors that increased the risk for hot flashes. Gallicchio et al. (2015) observed that factors that increased the risk of hot flashes during midlife include cigarette smoking, obesity, and lower levels of education, but their relationships with hot flashes remain inconsistent. Other factors such as eating spicy foods, stressful life, high temperature, wearing warm clothing in hot or warm environments, medical treatments, and some health disorders such as tuberculosis, overactive thyroid, and diabetes could worsen vasomotor symptoms. The International Menopause Society (IMS) introduced 2016 recommendations on women’s midlife health and menopause hormone therapy (MHT) to help healthcare professionals optimize their management of women in the menopause transition and beyond in controlling menopausal symptoms (Baber, Panay & Fenton,2016).
Study Background and Significance of the Problem
Menopause is a substantial threat to women’s well-being. It comes with symptoms that destabilize women’s health and physical well-being. Even though not all women complained of menopausal symptoms, there is adequate evidence to demonstrate an association between menopausal symptoms and lower quality of life (Whiteley et al., 2013). In the Menopause Epidemiology Study, a significant portion of women with mild or moderate hot flashes negatively impacted their work productivity caused by menopausal symptoms (Whiteley et al., 2013). The adversity associated with menopausal symptoms culminates in the need for practical and effective solutions to minimize such symptoms and improve the overall quality of life. The fundamental solutions that have been advanced included hormonal replacement therapies and physical exercise. However, the discussions, downsides, and benefits of each of these major approaches remain inconclusive.
There are increasing mixed views regarding the benefits and downsides of using hormonal replacement therapies. The risk-benefits ratio of hormone replacement therapy (HRT) has been a subject of investigation in terms of cardiovascular risk (Gambacciani et al., 2017)
Physician exercise is increasingly becoming an area of interest as an approach to addressing menopausal symptoms. Lifestyle impacts people’s health. Various menopausal symptoms can be improved via lifestyle changes such as adopting physical exercise programs (Im et al., 2020).
The menopausal period is marked by dwindling estrogen levels. Thus, a hormonal replacement could alleviate some of the symptoms that are associated with menopause. Menopausal hormone therapy (MHT) containing estrogen and progesterone may lessen such symptoms by 80% to 90% (Javadivala et al., 2020). However, MHT involves health access and economic, which can be quite troubling and burdensome in developing nations. Even in cases where patients can easily access physicians, doctors are often unwilling to prescribe MHT due to increased risk of heart disease, thromboembolic events such as stroke, and cancers involving breast and endometrium (Javadivala et al., 2020).
The increasing avoidance of MHT has not had a substantial negative impact on menopausal women's wellbeing. For instance, Javadivala et al.,2020) demonstrated that menopausal women in Iran scored higher on menopausal symptoms than European women, and approximately 72% of the women in Iran didn’t engage with a physician, but they accepted menopausal symptoms as inevitable and as troubles to live with.
With adverse outcomes and the burden caused by menopausal symptoms, there is a need to devise practical, evidence-based strategies to deal with menopausal symptoms. More than 70% of people in developing nations on complementary and alternative systems of medicine, which are often mediated by cultural beliefs and practices (Javadivala et al., 2020). Thus, complementary and alternative medicine such as physical exercise cannot be ignored. Menopausal challenges comprise a spectrum of symptoms. There are commonly recommended interventions such as low-dose paroxetine salt, Gabapentin, pregabalin, selective serotonin reuptake inhibitors (SSRIs), serotonin, and norepinephrine reuptake inhibitors (SNRIs) to relieve overall menopausal symptoms. Despite the deficient understanding of hot flash etiology, the research is ongoing to establish the optimal options. Solutions ranging from conservative to radical interventions such as nutraceutical therapies involving herbals, vitamins, and phytoestrogens and surgical therapies such as the stellate ganglion block exist (Fisher et al.., 2013). In addition, there are complementary and behavioral therapies, including acupuncture, yoga, clinical hypnosis, reflexology, exercise, relaxation training, mindfulness-based stress reduction (MBSR), and cognitive-behavioral interventions (Fisher et al.., 2013).
Review of Literature
Asian women grapple with the problem of hot flashes similar to other women across the globe. Asian women often reported lower rates of various physical and psychological symptoms related to menopause than their western counterparts. Most researchers and others may interpret this to imply that Asian women are less likely to experience menopausal symptoms, which might be incorrect (Im et l., 2010). The lower reported menopausal symptoms such as hot flashes amongst Asian women may be attributed to Asian cultures, where social status often increases with age, and positive attitudes about menopause and aging are frequently observed. Other studies show that the patterns of menopausal symptoms experienced by Asian women are different from their Western counterparts, where post-menopausal Asian women reported backaches, muscle pain, shoulder pain, or joint pain but reported fewer vasomotor disturbances than Western women (Im et l.,2010). Another study showed that more than half of middle-aged women who still experience regular cycles have hot flashes and Asian and Hispanic women are less likely to have them than white women (The North American Menopause Society (NAMS) (2013).
It is increasingly common to find women seeking help regarding health and psychosocial challenges caused by menopausal symptoms. Habitual participation in physical exercises comes with many benefits, including increased longevity, reduced risk of cardiorespiratory and metabolic diseases. However, the question of physical activity in alleviating vasomotor symptoms (VMS) and genitourinary syndrome of menopause (GSM) remains inconclusive. In a specific study, physical activity as an approach to managing menopausal symptoms was appealing to participants since they knew no other way to manage their symptoms, but the participants had no strong beliefs that physical activity could minimize symptoms (Thomas & Daley, 2020). However, the participants were willing to try anything that would help and preferred to embrace a natural approach to deal with their menopausal symptoms, indicating physical activity as a treatment would therefore be appealing (Thomas & Daley,2020). Women appear ill-prepared to deal with menopause but report interest in a structured lifestyle program such as a physical exercise program encapsulating weight-loss and weight-maintenance strategies to combat menopause symptoms (Marlatt, Beyl, & Redman, 2018). A physically active lifestyle can minimize the intensity of menopausal symptoms and enhance psychological fitness. The fact that the healthcare providers dealing with women in the menopausal period gets women to adopt different habits and lifestyles is vital in helping women overcome menopausal symptoms (Ağıl et al.,2010).
Vasomotor symptoms, such including hot flashes, are not contemporary concepts. Hot flashes are a global phenomenon. In the 1970s, adequate studies began to document menopause symptoms as an occurrence (Kronenberg, 2010). Across the globe, Asia is distinct where religion where prevalence and severity of hot flashes are less compared to other countries such as the U.S and Canada. Japan is another country that provides excellent insights into menopausal symptoms. It is postulated that Japanese women have a high dietary intake of soy relative to Western countries, which may explain why they have fewer hot flashes than their western counterparts (Kronenberg, 2010). However, studies show mixed results regarding the cultural practices of specific regions to hot flashes.
The theme of menopause is marked by cultural and regional differentiation.
There are substantial variations on how westerns and Asian women experience the phenomenon of menopause. In a study, Lock observed the Japanese women reported fewer hot flashes than their Western counterparts, and researchers concluded that fewer Japanese women were experiencing hot flashes and night sweats (Kronenberg, 2010). However, some may dispute such a conclusion while arguing that Japanese women might have had few vocabularies to discover hot flashes symptoms. Since the Lock study, there has been increased reporting of hot flashes due to the Western approach to and discussion of menopause (Kronenberg, 2010).
The articles deployed in this paper were sources from various scholarly databases, including PubMed databases and Google Scholar. The search included the following keywords: menopause, postmenopausal symptoms, postmenopausal syndrome, hormonal therapy, genitourinary syndrome of menopause (GSM), vasomotor symptoms (VS), Hot flashes, physical exercise program. The inclusion criteria were English academic journals dealing with menopause, and the database search was limited to sources published from 2010 up to 2021. 25 were chosen for the review of literature as attached in Appendix A: PRISMA, and a Table of Evidence are shown in Appendix D.
Thematic Discussion
History and Management of Menopausal Symptom
Women over the decades have coped with menopausal symptoms. However, in the 20th century, there is an increasing perception that menopause is a deficiency disease. Menopause is a normal biological process, an insignificant event that goes unnoticed in the chaos of life but is distress in silence exacerbated by the intersection of poverty, gender, and patriarchy (Singh, V., & Sivakami, 2020). Menopause is socio-culturally sensitive. This observation explains why it is a highly contested issue over decades regarding perceptions and management of menopausal symptoms.
The extraction of synthetic estrogen established in 1930 heralded a new era of medical practitioners and researchers who developed more interest in menopause. Menopause was now more understood as a hormone deficiency disease leading to loss of femininity, leading to increased advocacy for hormone replacement therapy (HRT) in the 1960s to help women remain ‘feminine forever’ (Singh & Sivakami, 2020). The movement supporting HRT received controversial responses and backlash, including being branded as sexists and against the agenda.
The identification of estrogen led to increased medicalization of menopausal as a deficiency disease, which needs hormonal therapy to rectify the emerging symptoms. The understanding and medicalization of menopause led to three primary models, including biological, psychological, and environmental, for managing menopause. First, the biological model defines menopause as “a physiological process caused by the cessation of ovarian function; thereby, it emphasizes hormone deficiency and treating estrogen or HRT. Second, the psychological model is anchored on women’s personalities affects their symptom experience, where psychotherapy is considered a suitable treatment. Finally, in the environmental model, women’s symptoms result from stresses and strains posed by changing social roles and responsibilities during midlife. The environmental model supports change of lifestyle and habits to manage menopausal symptoms. The three models provide a broader understanding of approaches for managing menopausal symptoms.
HRT has been a controversial intervention. The North American Menopause Society revised its 2005 statement regarding the use of both estrogen therapy (ET) and estrogen and progestin therapy in treating menopausal symptoms reaffirmed that hormone therapy is the most effective treatment for vasomotor symptoms and other symptoms of menopause (Halloran,2014). . However, research findings from the Women's Health Initiative show critical distinctions between estrogen plus progestin and estrogen alone in terms of benefits and risks. In addition, the benefit and risk profile of HRT change based on various factors such as age, time since menopause, and her risk-factor profile. Earlier guidelines recommended avoiding treatment with hormones for more than five years, citing that estrogen plus progestin effects increasing the risk for breast cancer after 3 to 5 years (Halloran, 2014). However, recent guidelines support flexibility in terms of the duration of treatment for women taking estrogen alone.
The Women’s Health Initiative (WHI) study associated HRT use with increased risk of breast cancer, endometrial cancer, and cardiac morbidity (Hyde et al., 2010). As a result of the WHI study, physicians become more cautious regarding HRT use for their patients. Endometrial cancer is a hormonally-responsive tumor, where estrogens unopposed by progestin have been associated with substantial risk increases due to the use of unopposed estrogens, especially among thin women (Brinton & Felix, 2014). These historical and contemporary arguments against HRT support the need for better alternatives to manage menopausal symptoms. APRN/s should both current and historical models regarding perceptions on the management of menopause. APRN/s need to understand the three
The burden of Menopausal Hot Flashes
Although menopause is part of life among women because it is a biological process, it is burdensome to most women. Menopause is a physiological phenomenon featuring a series of bothersome symptoms (Yoshany et al., 2020). Menopause is considered an adaptation process during which women go through a new biological state. Many biological and psychosocial changes accompany this process, which is detrimental to a woman’s health and psychosocial well-being. During menopause, there is a substantial loss of skin flexibility, dwindling libido and sexual arousal, elevated risk of cardiovascular disorders and urinary tract infections, urinary incontinence, bone loss, and somatic and vasomotor symptoms, depressed mood, sleep disorders (Ağıl et al.,2010). Hot flashes are frequent and bothersome symptoms reported by women during the menopausal transition. Recent available data show that up to 80% of women experience hot flashes during midlife; such symptoms last about ten years (Gallicchio et al., 2015). Hot flashes consistently are associated with consistent disruption of comfort and sleep, leading to overall fatigue and decreased quality of life. Recent evidence shows that women having hot flashes depict lower work productivity and greater healthcare resource use than women without hot flashes, and they have been associated with risk for adverse health outcomes such as depression and cardiovascular diseases (Gallicchio et al., 2015). Hot flashes are typical symptoms of menopause, but emerging data link hot flashes to cardiovascular disease (CVD) risks, and whether hot flashes are associated with brain health is remains inconclusive ( Thurston et al., 2016). Thurston et al. (2016) observed that the physiologically monitored hot flashes during sleep are linked to increased white matter hyperintensities (WMH) burden among midlife women without clinical CVD: their findings showed that the relationship between hot flashes and CVD risk observed in the periphery might extend to the brain. Women also bear financial burdens associated with healthcare costs geared towards managing menopause-related health concerns such as vasomotor symptoms.
Socio-cultural Menopausal Symptoms such as Hot Flashes
The determinants of hot flashes and night sweats differ. Pérez-Alcalá et al., (2013) suggested that hot flashes and night sweats should be examined separately, where for example, Latin-American women less likely to report hot flashes, but not night sweats or both symptoms combined, but the authors recommended more studies to clarify the differences in reported hot flashes as the lesser report among immigrants could be attributed to cultural rather than a biological phenomenon. In U.S women, the media often associate menopause with symptoms such as hot flashes and night sweats. However, these complaints are not universal, where variations are observed across different cultures. For instance, women in India most complained of no symptoms during menopause other than menstrual changes (Shea, 2020). In Japan, Margaret Lock observed that most Japanese women during menopause report shoulder stiffness, and those hot flashes were actually very rare Shea (, 2020). Thus, it is apparent that culture may play a role in the symptomatic manifestation of menopause and associated perceptions.
The concept of menopause is culturally defined. Shea (2020) postulated that Chinese language use divides what Americans and Canadians called “menopause” into two, even though overlapping aspects of the narrow juejing or end of menstruation and the broader non-gender-specific gengnianqi , which means a transition from middle age into old age (Shea, 2020). Japan and China may use the same overlapping terms, but the views between the two regions are equally different and...