Hot flashes. Mood swings. Anxiety. For many women, these symptoms are frequent manifestations of menopause. And with more nurses working later in life, thousands will face these issues during their shifts. What's a nurse to do?
Starting in perimenopause, which occurs about 2 to 10 years before the onset of menopause, women can experience irregular menstrual cycles and an increase in mood swings, explained JoAnn V. Pinkerton, MD, NCMP, executive director of the North American Menopause Society.
Top Physical Complaints
As women progress into menopause, additional symptoms manifest themselves. Laura Dankof, MSN, ARNP, a nurse practitioner from Urbandale, Iowa, who runs the website menopausesisters.com, commented, "Hot flashes and night sweats are at the top of the list" of her patients' complaints. She estimated that 3 in 4 women in menopause experience hot flashes.
Yet every female nurse (indeed, every woman) experiences menopause differently. "For the vast majority of women, hot flashes are manageable," said Susan A. Peck, RNC, MSN, APN, a women's health nurse practitioner from Cedar Knolls, N.J. "What is more common is sleep disturbance and related mood changes."
Pinkerton concurred. She named insomnia, frequent awakenings and a worsening of anxiety as common effects of menopause, along with weight gain, especially in the mid-section.
Loss of libido is another side effect. "Not everyone has hot flashes, but everyone's vagina changes," Peck said. "It can be personal discomfort with friction and chafing, or it can be sexual discomfort."
Psychological manifestations include concentration difficulty and decreased attention span. "They just don't feel like themselves," Dankof noted.
It's up to women's health practitioners, then, to help their fellow women get back to feeling healthy. "You have to individualize care to the person, taking into account what they are comfortable with and their health history," said Dankof, who treats a lot of nurses. "Patients want to know what they can do themselves to work on these symptoms."
Diet Makes a Difference
Following a healthy diet and exercising regularly are two self-directed ways to ease menopausal symptoms. "The first thing I advise women to do is look at their diet. The food we eat creates hormone imbalance," Dankof said. Women should build their diet around unprocessed foods and shop the perimeter of the grocery store.
"It turns out that hot flashes may be less severe if women eat a healthy diet," Pinkerton said. The Mediterranean diet, in particular, is recognized for its anti-inflammatory properties.
Certain trigger foods can lead to hot flashes. Among them are alcohol (especially red wine), carbohydrates, spicy foods and caffeine. "Red wine is big vasodilator. Don't have a glass the night before your shift," Peck advised. Nurses should also avoid soda and coffee to help reduce the likelihood they will have a hot flash on the job. Packing fruits and veggies to snack on can help nurses steer clear of unhealthy break room treats.
Physical Activity Eases Transition
Maintain an active lifestyle to help manage menopausal symptoms. "Exercise helps detoxify the body and increase endorphins," Denkof explained. Something as simple as walking every day can reduce the frequency of hot flashes and improve sleep quality.
Exercise helps maintain muscle mass, which in turn maintains metabolism rates. It also decreases insulin resistance. Our bodies are trained to hold onto insulin and cortisol, which in menopausal women cause dreaded and unhealthy weight gain around the midsection. "They need to keep moving," said Dankof.
Fitting in exercise during shifts is beneficial to nurses' well-being, whether they are in menopause or not. "Walking and talking during breaks or before or after work provides extra exercise and stress reduction," Pinkerton noted.
Relief on the Job
Because hot flashes are so common in menopause, nurses should plan ahead for them. "If you struggle with hot flashes, keep yourself well-hydrated at work," Peck recommended. Dressing in layers at the hospital is a simple way to battle body temperature fluctuations.
Since nurses can't leave a code to shed their extra layers of clothes, strategies such as wearing cooling camisoles under scrubs can help regulate body temperatures.
Cooling towels and bands are portable methods to provide similar relief from hot flashes.
There are other ways menopausal nurses can improve their quality of life. Yoga and meditation are two well-tested stress reducers. Coloring is a hot mindfulness trend. Journaling is another outlet. "Being able to turn off their brain after work by doing relaxing activities before sleep will help them be more rested," noted Pinkerton.
During shifts, "simply stopping and taking 10 slow, deep breaths can help a nurse get on top of stress," Dankof remarked.
Talk It Out
The talking Pinkerton advocates is almost as important as the walking. Finding a work buddy who is also going through menopause can be invaluable. "In our mother's generation, a lot of women suffered in silence," Dankof said. Today, that does not need to be the case. One of the most important things a women's health practitioner can do is simply encourage open communication. Peck recommends scheduling a dedicated time to talk only about menopause, so that women and their providers don't feel rushed during a regular check-up. "The first thing is asking the questions. Make sure it's an important part of the visit," said Peck.
One question many women ask is about the efficacy and safety of hormone replacement therapy. The medical community is divided over this issue. Weighing the risks and benefits should be part of open communication. For women with any familial risk of breast cancer, hormone replacement therapy may be prescribed cautiously and in lower doses. Healthy women without contraindications can consider low-dose estrogen therapy, experts state. "Risk of breast cancer is considered possible but rare, and the benefits for hot flashes, night sweats, sleep issues, mood changes, joint pain, and vaginal dryness outweigh the rare risks of blood clots and stroke for most women, especially those younger than 60 and within 10 years of menopause," Pinkerton said.
Quality of Life
Making a plan together is a key part of any patient/provider relationship. While all menopausal women need to take care of themselves, nurses in menopause should pay extra attention to their needs.
"Nurses can't take care of others-whether it be at work or within their family-if they don't take care of themselves first," explained Pinkerton. "Don't suffer in silence. Seek help!"
Dankof agreed. "You need to take time to heal the healer. Learn to say no. Schedule time for relaxation." It is possible to make life changes within work confines.
Finally, Peck offers an important reason for self-care: "Our patients are always watching us." Taking care of themselves through this life change helps nurses be proactive role models for their patients and for each other.
Danielle Bullen Love is a staff writer. Email her at firstname.lastname@example.org.