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Blog posts tagged in Menopause

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There's a lot going on in the world of pelvic rehab, and continuing education is no exception! This March, Herman & Wallace is hosting NINE courses around the country. It's a lot to keep up with, so we thought you might appreciate a brief overview of what's coming up next!

Where's this pain coming from?

Pelvic pain can have many sources, and Elizabeth Hampton wants to help you quickly get to the source. Finding the Driver in Pelvic Pain empowers you to play detective in order to help even the most complex patients. Don't miss out on Finding the Driver in Pelvic Pain in San Diego, CA on March 4-6, 2016

What goes in eventually comes out

How important is a good diet? For most of us eating healthy is important, and for many pelvic rehab patients it is a necessity. That's why Megan Pribyl wrote her "Nutrition Perspectives for the Pelvic Rehab Therapist" course. This beginner level course is intended to expand the your knowledge of the metabolic underpinnings for local to systemically complex disorders. Don't miss out on Nutrition Perspectives for the Pelvic Rehab Therapist - Kansas City, MO - March 5-6, 2016!

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After menopause, more than half of women may have vulvovaginal symptoms that can impact their lifestyle, emotional well being and sexual health. What's more, the symptoms tend to co-exist with issues such as prolapse, urinary and/or bowel problems. But unfortunately many women aren't getting the help they need, despite a growing body of evidence that skilled pelvic rehab interventions are effective in the management of bladder/bowel dysfunctions, POP, sexual health issues and pelvic pain.

Vaginal dryness, hot flashes, night sweats, disrupted sleep, and weight gain have been listed as the top five symptoms experienced by postmenopausal women in North America and Europe, according to a study by Minkin et al 2015, and they also concluded ‘The impact of postmenopausal symptoms on relationships is greater in women from countries where symptoms are more prevalent.’ Between 17% and 45% of postmenopausal women say they find sex painful, a condition referred to medically as dyspareunia. Vaginal thinning and dryness are the most common cause of dyspareunia in women over age 50. However pain during sex can also result from vulvodynia (chronic pain in the vulva, or external genitals) and a number of other causes not specifically associated with menopause or aging, particularly orthopaedic dysfunction, which the pelvic physical therapist is in an ideal position to screen for.

According to the North America Menopause Society, ‘…beyond the immediate effects of the pain itself, pain during sex (or simply fear or anticipation of pain during sex) can trigger performance anxiety or future arousal problems in some women. Worry over whether pain will come back can diminish lubrication or cause involuntary—and painful—tightening of the vaginal muscles, called vaginismus. The result can be a vicious circle, again highlighting how intertwined sexual problems can become.’

Commonly in physical therapy we treat patients with osteopenia or osteoporosis, however, they are usually in our office for another diagnosis such as back, hip, or pelvic pain as the primary complaint and we learn about the osteoporosis from health history review. Physical therapy is an opportunity to provide them with not just relief from their primary complaint, but a chance to learn from a professional how to move in a more healthy way and learn the right ways to exercises to make a regular routine that can help them to protect their body and even slow or stop bone mineral density loss. This is important as the primary concern for a patient with the diagnosis of osteoporosis is risk of fracture (especially of the hip or spine) due to minimal trauma because of low bone mineral density. So let’s make sure we are giving patients comprehensive exercise programs that address their primary complaint, however be comprehensive and include exercise modes that may reduce fractures and may improve bone mineral density.

An interesting article by Palombaro et al1 in 2013 from Physical Therapy discusses a Cochrane review by Howe et al2 and applies the findings from this review to an example patient similar to the participants reviewed in the study. The goal of the article is to link evidence in the literature with how we practice as PT’s. The topic explored in the systematic review by Howe et al was exercise for the management of osteoporosis in women postmenopause and which exercise approaches reduce the loss of bone mineral density or reduce chance of fractures in women who are healthy postmenopause. The systematic review2 included 43 randomized controlled studies of postmenopausal women age 45-70 where the intervention groups included exercises that improved aerobic capacity or improved aerobic capacity and muscle strength and had a comparison group completing “usual activity: or placebo intervention. The duration of exercise lasted from 6 months to 2 years in the various studies. The results of the review demonstrated decreased bone loss (of the spine or hips) in groups who performed any type of exercise compared to the control groups. The review also performed additional sub group analysis to take into account the various types of exercise programs in the studies and found favorable effect for all types of exercises completed (dynamic, low force, high force, weight bearing, or non-weight bearing) all had favorable effect on bone density. The take home message from this systematic review is that exercise programs combining various forms of exercises lasting 6 months to 2 years resulted in reduced risk for fracture, and a slightly beneficial effect on bone mineral density of the spine, trochanter, and neck of the femur in postmenopausal women with osteoporosis.

At the end of this article1 the authors give a case of an active, postmenopausal female patient with history of osteopenia without a fracture seeking PT for an unrelated complaint. The authors took the findings from this review and showed the relevance of the findings, applying it to the patient and the outcome of care for this patient when giving her an exercise program. We can implement findings from this review simply to the common question posed by our patients… “what exercises should I be doing to help with my osteoporosis?”

By Mikael Häggström (Own work) [CC0], via Wikimedia Commons Sleep difficulties are a common problem among women in the menopausal period, with hot flashes and night sweats commonly interfering with a restful night’s sleep. According to Baker and colleaguesBaker, 2015 , disturbed sleep is present in 40-60% of women in the menopausal transition. The authors also point out that insomnia is not well characterized, with poor identification of a physiologic basis for the sleep disturbances. In the research linked above, perimenopausal women diagnosed with clinical insomnia (n=38) were compared to women who did not have insomnia (n=34). Outcome measures included the Beck Depression Inventory, the Greene Climacteric Scale, sleep diaries, sleep studies, and nocturnal hot flashes via dermal conductance meters.

Results of the study concluded that women with insomnia, compared with controls, had higher levels of psychologic, somatic, vasomotor symptoms, and had higher scores on the depression inventory, shorter sleep duration, and lower sleep efficiency. Women with insomnia were also more likely to have hot flashes, with number of hot flashes predicting awakenings during the sleep study. Episodes of wakefulness after sleep onset, and decreased time of sleep were noted in the women who were diagnosed with new-onset insomnia.

Because untreated insomnia is associated with negative consequences including hypertension, stroke, diabetes, and depression, the authors suggest that women who are diagnosed with insomnia should be treated for their insomnia. If you are interested in learning about natural methods to manage and reduce hot flashes, among many other interesting topics, you will likely enjoy Herman & Wallace faculty Michelle Lyons and her newer course: Special Topics in Women’s Health. The next chance to hear Michelle discuss these topics is in Denver in January. Bring your skis!

Cognition in later years may be affected by premature menopause, according to an article published online in the British Journal of Obstetrics and Gynaecology. In the study 4,868 women at least 65 years old were assessed on a cognitive test battery and were evaluated for clinical dementia. Associations between the subject’s age at menopause, surgical versus natural menopause, use of menopausal hormone therapy, and cognitive function later in life were studied. According to introductory concepts described in the article, estrogen level changes postmenopause are associated with brain atrophy and memory complaints.

Variables such as verbal fluency, visual memory, psychomotor speed and global cognitive function can be negatively impacted by premature menopause

Tests were administered at baseline, and again at 2, 4 and 7 years from baseline. Tools included the Mini-Mental State Examination (MMSE) for global cognitive function, Benton’s Visual Retention Test (BVRT) for visual memory assessment, Isaacs Set Test for verbal fluency or semantic access, and the Trail Making Tests A and B for timed visual motor tasks of psychomotor speed and attention and executive function. Unrelated to cognitive function, The Rosow and Breslau mobility and Instrumental Activities of Daily Living scales, the Centre for Epidemiology Studies Depression Scale (CES-D), and other instruments were used to assess socioeconomic, demographic, lifestyle and health information. Dementia was also evaluated by a trained psychologist (or neurologist if subject was suspected to have dementia) and cases were assessed by a panel of dementia experts as a third step in the process.Symptoms of menopause (raster)

Natural menopause was noted in 79% of the subjects, surgical menopause in 10%, and 11% due to other causes including radiation, chemotherapy, or unknown. Less than 1 in 7 women was currently using hormone therapy, and over 1/5 used hormone therapy at menopause (most commonly reported treatment was transdermal estradiol- median time of use was 10 years).

The authors concluded that variables such as verbal fluency, visual memory, psychomotor speed and global cognitive function can be negatively impacted by premature menopause. Specifically, premature menopause including premature ovarian failure or surgical menopause at 40 years of age or less was independently associated with increased risk of poor verbal fluency and visual memory later in life. Premature menopause was also associated with increased risk of psychomotor speed and global cognitive decline. The primary conclusion of the article is that when an ovariectomy is being considering in younger women, the potential negative impact on cognitive function should make up part of the risk/benefit discussion. Hormonal influence during various stages of a woman’s life can have a dramatic impact on many variables impacting quality of life and rehabilitation efforts. To learn more about menopause, the Institute offers several courses that contain information about rehabilitation for women throughout the lifespan.

Upcoming Continuing Education Courses

Feb 26, 2016 - Feb 28, 2016
Location: Evergreen Hospital Medical Center

Mar 4, 2016 - Mar 6, 2016
Location: Comprehensive Therapy Services

Mar 5, 2016 - Mar 6, 2016
Location: St. Luke’s Hospital Rehab Services

Mar 6, 2016 - Mar 8, 2016
Location: Touro College: Bayshore

Mar 11, 2016 - Mar 13, 2016
Location: Cottage Rehabilitation Hospital

Mar 12, 2016 - Mar 13, 2016
Location: Pacific Medical Center

Mar 12, 2016 - Mar 13, 2016
Location: Texas Children’s Hospital

Mar 18, 2016 - Mar 20, 2016
Location: The George Washington University

Mar 19, 2016 - Mar 20, 2016
Location: One on One Physical Therapy

Mar 19, 2016 - Mar 20, 2016
Location: Mercy Hospital

Apr 1, 2016 - Apr 3, 2016
Location: Marathon Physical Therapy

Apr 1, 2016 - Apr 3, 2016
Location: Mercy Hospital

Apr 2, 2016 - Apr 3, 2016
Location: Anne Arundel Medical Center

Apr 2, 2016 - Apr 3, 2016
Location: Florida Hospital - Wesley Chapel

Apr 8, 2016 - Apr 10, 2016
Location: CentraState Medical Center

Apr 8, 2016 - Apr 10, 2016
Location: Meriter Hospital

Apr 15, 2016 - Apr 17, 2016
Location: Loyola University Stritch School of Medicine

Apr 16, 2016 - Apr 17, 2016
Location: Doctors Hospital Pelvic Health Institute

Apr 16, 2016 - Apr 17, 2016
Location: Kima - Center for Physiotherapy & Wellness

Apr 22, 2016 - Apr 24, 2016
Location: Providence St. Josephs Medical Center

Apr 23, 2016 - Apr 24, 2016
Location: The George Washington University

Apr 23, 2016 - Apr 24, 2016
Location: Mizzou Physical Therapy-Rangeline

Apr 29, 2016 - May 1, 2016
Location: Duke University Medical Center

Apr 30, 2016 - May 1, 2016
Location: Sports Medicine Institute

May 1, 2016 - May 3, 2016
Location: Southview Hospital

May 1, 2016 - May 2, 2016
Location: Southview Hospital

May 13, 2016 - May 15, 2016
Location: Isanti Physical Therapy

May 14, 2016 - May 15, 2016
Location: Inova Alexandria Hospital

May 21, 2016 - May 22, 2016
Location: Seton Healthcare Center

May 21, 2016 - May 22, 2016
Location: Unity at Ridgeway Physical Therapy