Alternative Therapies in Postmenopausal Women

Introduction

Menopause, or the condition that occurs as a result of ovarian function declining and serum levels of estradiol and progesterone decreasing in women between the ages of 45-65, is one of the nine leading causes of depression in America (Schub T., et al. 2018). The symptoms of depression are debilitating for all people that experience them but for women who are experiencing them as yet another effect of living with menopause, they can truly wear on the person even more. With over 27 million American women between the ages of 45-65 experiencing depression and its symptoms as a part of their daily life with menopause, nurses need to be able to offer better ways to alleviate the indications of symptomatic depression for these patients (Schub T., et al. 2018). That is why I endeavored to research in postmenopausal women, what is the effect of alternative therapies such as meditation and yoga and aromatherapy on the symptomatic depression they experience compared with hormonal therapies?

Significance

The significance of this study is to find which kind of treatment, alternative or hormonal, works better for women experiencing depression as a symptom of menopause. The symptoms of menopause differ for every woman, but all effect the patient’s daily life. The most common symptoms are pain during sexual intercourse, insomnia, excessive tiredness, loss of hair, mood swings, and depression (Schub T., et al. 2018). The most common symptoms of depression are intense feelings of sadness, helplessness, hopelessness, anxiety, feelings of apathy and disinterest in activities, and thoughts of suicide (Uribe L., et al. 2018). All of these symptoms have an intense and immediate effect on the patient’s quality of life, which the nurse can have an effect on and improve.

Review of Literature

Article One

The first article I researched was A Study to evaluate the effect of Yoga on Insomnia among Postmenopausal Women in Selected Rural Areas at Vadodara. The reason I chose this article was because insomnia is an over-lapping symptom of both depression and menopause that causes a decrease in quality of life due to tiredness. The study was quantitative and used a pre-experimental design with one group pre-test and post-test. The independent variable was yoga and the dependent variable was the experience of insomnia in post-menopausal women. The conclusion was that the intervention of teaching and then having women implement yoga into their lives changed the incidence of insomnia in post-menopausal from 55% to 35%.

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This article supports the possibility that alternative therapies, such as yoga, can have a positive effect on the symptoms of depression in menopause by itself without the need for hormonal therapy. Simple teaching of alternative therapies that can make a big difference in a patient’s quality of life is an important thing for nurses to add to their normal practice. The ways that this could be implemented into nursing care is to offer learning resources and group classes for patient’s to practice yoga in a way that would best benefit them. (Patel R., et al. 2015)

Article Two

 The second article I researched was Conventional or Natural Pharmacotherapy and the Prevalence of Anxiety and Depression during Menopause. The reason I chose this article was because it measures whether the addition of hormones to pharmacotherapy used to treat depression associated with menopause made a difference in the patient’s experience. The study was multi-centered and conducted in gynecological clinics. The patients were separated into study groups depending on whether they were in pre-menopause, peri-menopause, or post-menopause. The results of the study showed that from all three groups the women that had hormonal therapy along with their antidepressants experienced the most relief from their depressive symptoms.

 This article supports the statement that hormonal therapies, such as supplemental estrogen and progesterone, are most effective in treating peri-menopausal depressive symptoms. The only issue with this therapy is availability. Because estrogen and progesterone are hormonal therapies, they must be prescribed and are able to be taken over the counter and they can be expensive as insurance will not always pay for them. (Kopciuch D., et al. 2017)

Article Three

 The third article I researched was Mindfulness training for coping with hot flashes: results of a randomized trial. The reason I chose this article is because it measures the effect of mindfulness, or meditation, on hot flashes, a common symptom of menopause that can contribute to the symptomatic depression that menopausal women experience. This study was a randomized trial that used a pre-test and post-test to measure how much the women felt that the routine of meditation before bed and every morning affected their experiences with night sweats and hot flashes. The results showed in the post-test which occurred three months after the intervention there was a 21% decrease in intensity.

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 This article supports the possibility that alternative therapies, such as meditation, can have a positive effect on the symptoms of depression in menopause by itself without the need for hormonal therapy. This, like yoga, can be implemented into nursing care through offering educational reading tools or finding public groups that the patient can join to learn how to implement the intervention into their daily life. (Carmody J., et al. 2013)

Article Four

 The fourth article I chose is Effects of Aromatherapy on Menopausal Symptoms, Stress, and Depression in Middle-Aged Women: A Systematic Review. The reason I chose this article was because it measure the effect aromatherapy has on the depressive symptoms of menopausal women. The study involved the review of two randomized controlled trials involving aromatherapy massages as the intervention for alleviation of menopause symptoms. Both trials results showed that aromatherapy was effective in treating depressive symptoms of menopause as well as other feelings of stress and anxiety that patients were expressing.

 This article supports the possibility that that alternative therapies, such as aromatherapy, can have a positive effect on the symptoms of depression in menopause by itself without the need for hormonal therapy. Aromatherapy is an inexpensive and accessible intervention that the nurse can recommend when the patient is unable to leave the house or be mobile enough to attend support groups. (Kim S., et al. 2016)

Article Five

The fifth article I researched was Concurrent use of self-prescribed complementary and alternative medicine, and hormone replacement therapy in menopause: possible side effects. The reason I chose this article was because it tries to find whether women believe that using complementary alternative medicine, such as exercise, yoga, and meditation, along with their prescribed hormones to treat their menopausal symptoms helped more or less than just the hormones themselves. The study was informal and has many limitations because there was no set list of questions asked, but the results showed that the majority of women felt that when alternative therapy was implemented along with their hormonal prescription, they felt better and experienced fewer menopausal symptoms and that the intensity of the symptoms had lessened.

This article combines the two interventions that I had meant to compare into one intervention, and shows how it increases the effectiveness of both. I feel that this shows the importance of alternate therapies, because the women found the hormonal therapy they were already receiving was made more effective by adding alternate therapies such as yoga, meditation, and aromatherapy. These therapies are not difficult for nurses to implement along with the care already given by offering reading materials and places to find group classes in the community that can help women include these interventions into their normal routine. (Peng W., et al. 2016)

Conclusion

After the research that I did, I feel that the answer to the question ‘what is the effect of alternative therapies such as meditation and yoga and aromatherapy on the symptomatic depression they experience compared with hormonal therapies?’ is simply that the wrong question was asked in the first place. I think that either therapy, hormonal or alternative, can be effective alone depending on the individual that the therapy is prescribed or taught to, but that the most effective way to help any patient, but especially post-menopausal women experiencing symptoms of depression, is to include both kinds of interventions into the plan of care to help make the patient’s quality of life increase as much as possible. The interventions posed would mostly involve nurses taking an extra moment or two to do some teaching, which most nurses can easily implement when discussing discharge instructions or when planning the next visit to the healthcare provider. I think that doing this teaching can make a real difference in the lives of these patients, which as nurses should always be our first and foremost priority.

References

1. Carmody, J., PhD, RN, Crawfor, S., PhD, RN, Salmoirago-Blotcher, E., PhD, RN, & Leung, K., BSN, RN. (2013). Mindfulness training for coping with hot flashes: Results of a randomized trial. The Journal of the North American Menopause Society. doi:10.1097/gme.0b013e318204a05c
2. Kim, S., Song, J., Kim, M., & Hur, M. (2016). Effects of Aromatherapy on Menopausal Symptoms, Perceived Stress and Depression in Middle-aged Women: A Systematic Review. Journal of Korean Academy of Nursing, 46(5), 619. doi:10.4040/jkan.2016.46.5.619
3. Kopciuch, D., PhD, Paczkowska, A., PhD, Zaprutko, T., PhD, Michalak, M., PhD, & Nowakowska, E. (2017). Conventional or Natural Pharmacotherapy and the Prevalence of Anxiety and Depression during Menopause. Alternative Therapies, 23(2). doi:1078-6791
4. Patel, R., Suresh, V., & Ravindra, H. N. (2015). A Study to evaluate the effect of Yoga on Insomnia among Postmenopausal Women in Selected Rural Areas at Vadodara. International Journal of Nursing Education, 7(3), 163. doi:10.5958/0974-9357.2015.00157.9
5. Peng, W., Adams, J., Hickman, L., & Sibbritt, D. W. (2016). Longitudinal analysis of associations between women’s consultations with complementary and alternative medicine practitioners/use of self-prescribed complementary and alternative medicine and menopause-related symptoms, 2007-2010. Menopause, 23(1), 74-80. doi:10.1097/gme.0000000000000479
6. Schub, T., BSN, Holle, M. N., RN, BSN, & Pravikoff, D., RN, BSN. (2018). Menopause and Depression. CINAHL Nursing Guide
7. Uribe, L., PharmD, Kornusky, J., MSN, RN, & Pravikoff, D., BSN, RN. (2018). Depression: Non-hormonal Treatment of Symptoms. CINAHL Nursing Guide. doi:T701057