Menopausal counseling

Menopausal counseling/ Technique

1. MENOPAUSAL COUNSELING Ms. Kanchan Mehra M.Sc. (N) I yr PCNMS

2. INTRODUCTION Menopause is the end of menstruation .The word menopause came from the Greek word ` mens ’ meaning ``monthly’’ and ` pausis ’ meaning ``cessation ‘’. Menopause is a part of a women’s natural ageing process when her ovaries produce lower level of the estrogen and progesterone and when she no longer able to become pregnant.

3. DEFINITION Menopause is the permanent cessation of menstruation at the end of reproductive life due to loss of ovarian follicular activity

4. MENOPAUSAL COUNSELING Face-to-face contact between a patient and clinician may be what most commonly comes to mind when one thinks of "patient counseling." However, there are many methods of providing information to patients, such as classes or support groups, print materials, audio and videotape, telephone resource lines, and Internet tools.

5. OBJECTIVE OF MENOPAUSAL COUNSELING The objectives of counseling include- Addressing women's questions and concerns, providing patient education, facilitating informed decision making, and enhancing the patient's confidence in the decision made and in her ability to carry it out or modify it over time. A partnership between clinician and patient characterized by mutual respect and trust enhances counseling.

6. If a therapy is chosen, the patient and clinician should agree on the goals, whether they are short term (menopause symptom relief), long-term (primary or secondary prevention of diseases associated with aging), or both. The clinician should re-visit decisions about menopause management with the patient at subsequent visits, as new research is published and the woman's health status and preferences may change over time. For instance, a woman who begins taking ERT/HRT to help with the symptoms of menopause will later need to evaluate the risks and benefits of long-term continuation.

7. PSYCHOLOGICAL IMPACT OF MENOPAUSE As a woman approaches the age of menopause, experiencing her first hot flush can be a watershed. It is a sign of the beginning of the menopause, and with it, there can be a sense of huge loss – of youth, attractiveness, femininity, and some woman may consciously or unconsciously assess where she is in her life and the future.   This may be with a sense of renewal of the beginning of a new chapter or a sense of failure For a woman who has not had children, it is the final step in the realization that motherhood is no longer possible. 

8. Even for others who have had children, there may be grief and loss around the end of that part of their lives – the ability to bear and bring life into the world. A  loss of libido may signal a loss of a sense of, femininity  and put a certain amount of pressure on the relationship with her partner.  Having a growing daughter who is becoming a beautiful woman can be difficult if we feel that our own attractiveness is declining.

9. STAGES OF MENOPAUSAL COUNSELING 1) INITIAL DISCLOSURE:- – Relationship Building - Relationship building is the first important step in the counseling process The counselor establish rapport with the counselee based on trust, respect and mutual purpose. One central task of the counselor in the first stage is to allay the client’s fears and encourage self disclosure. To let the counselor know what has been occurring in the client’s life and how the client thinks and feels about those events. To encourage the client to gain some feeling of relief through the process of talking about her or his problems

10. - Interaction A Counselee - “Tell me more about...” “Help me understand more fully…” “Tell me what happened when…” “Help me understand what you are thinking about…” The Counselor’s Verbal Encouragement to Disclose Follow- up invitations that encourage

11. 2) IN-DEPTH EXPLORATION – - Problem Assessment:- • It is the time for in-depth exploration of themes and issues related to the clients concerns The counselor’s task becomes that of helping the client develop new awareness and perspective that can lead to growth, more effective coping and clarification of goals. As the client continues to disclose his or her intimate thoughts and feelings, the counselee and the counselor become more aware of following- Interpersonal relationships with significant other’s in the client’s life. Feelings about self and others

12. Significant events that have shaped the counselee’s present personality and circumstance. Deficiencies in the counselee’s ability to cope with life circumstances Strengths that the counselee has available but may not be applying to resolve his or her problems .

13. 3) COMMITMENT TO ACTION – Selective Response- When a counselor uses selective reflection, he or she chooses to respond more fully to the part of a client’s statement that shows yearning for change The counselor reflected back affective content to the client, but the counselor’s statement were centered on that portion of the feeling associated with readiness to change. Selective reflection is used effectively when the client has progressed to the point of insight into him- or herself

14. - Readiness for Termination- When the counselee has achieved what she wants Positive and identifiable changes in the counselee’s behavior, positive and pervasive changes in the clients mood. Consistent reports of improved ability to cope with stress of menopausal symptoms Clear expressions of commitment to verbalized plans for the future

15. HEALTH EDUCATION Reassurance the client and teach her coping measure. Explain her about the estrogen therapy along with this tell her that the excessive use of ORT increase the risk of endometrial cancer. Hence it should be taken along a with course of synthetic progesterone with the prescription of the doctor. In case of hot flushes the client is advised to avoid alcohol, smoking, spicy food, caffeine, hot coffee to have cold liquid.

16. To try sleep in a room which is ventilated and cool, a fan can also be used, the client can wear light clothes instead of excessive clothes. Insomnia is deal with exercises, yoga, and medication. Dryness of vagina are treated with the help of vaginal moisturizer or lubricant, vaginal estrogen products are used in dyspareunia . For osteoporosis supplementary vitamin D and calcium is given.

17. Advice the client to keep a damp cloth in order to cool oneself in case of night sweat. Avoid heavy bleeding. Get a regular check up including blood pressure, blood sugar level, cholesterol, weight and mammograms etc. Follow aerobic exercise for heart and follow weight bearing exercises for bones. Accept it as a new phase of life and be positive. To have frequent and light and light meals. Antidepressants are given to unlift mood.

18. ABSTRACT Ettinger B, Woods NF, Barrett-Connor E, Pressman A. The North American Menopause Society 1998 conducted a menopause survey: Part II. That is Counseling about hormone replacement therapy: association with socioeconomic status and access to medical care. During May-July 1998 , by means of random-digit telephone dialing, 749 postmenopausal women who were living in the United States and aged 50-65 years were interviewed. Of these 749 women, 75.4% reported that they had received counseling about post-menopausal HRT from health care providers. No differences were observed in prevalence of counseling between women in managed care settings and those with other types of health insurance. The findings suggest that special efforts are necessary to provide menopause education and counseling to underserved women.