Nursing Care of the Postmenopausal Woman, 3rd Edition
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Thyroid screening Women are at increased risk for thyroid disease, especially right after menopause (Office of Women’s Health [OWH], 2021). During menopause, decreased estrogen causes decreased thyroid-binding glob- ulin. This reduction causes a decrease in the thyroid hormone. Appropriate inter- pretation of thyroid hormone testing can be complicated, which causes difficulty in treatment titration (Mammen & Cappola, 2021). Palpation of the thyroid should be a part of every physical examination. The USPSTF has found no direct evidence for or against screening for thyroid disease in a patient without symptoms or risk fac- tors, as there is no evidence it improves outcomes. However, if a woman presents with signs or symptoms that could be con- gruent with a problem of the thyroid, the first blood test of choice is to check thy - roid-stimulating hormone (OWH, 2021). Hearing screening If a woman is asymptomatic and young- er than age 65, routine hearing screening is not recommended. For women ex- posed to excessive noise or women older than age 65, a hearing screening should be performed (USPSTF, 2021b). Vision screening A comprehensive vision screen for women ages 41–60 years should be per- formed every two years. For women over age 60, it is important to have an annual comprehensive vision screen. There are a number of vision changes and problems that may present without symptoms un- til the disease causes permanent visu- al changes. These include age-related macular degeneration (AMD), cataracts, diabetic retinopathy, dry eye, glaucoma, and retinal detachment. The earlier these diseases are diagnosed and treated, the more likely it is that the woman can retain good vision (American Optometric Asso- ciation, 2022).
Bone density screening Osteoporosis is a disease of the bones that makes them weak and more likely to break. Osteopenia is when the bones be- come weaker than normal but haven’t yet reached the level of osteoporosis. Wom- en who have osteoporosis are at higher risk of breaking a bone in their hip, spine, or wrist. There are no symptoms of osteo- porosis, so screenings must be performed to find concerns. Routine bone mineral density (BMD) testing, using dual-ener - gy x-ray absorptiometry (DEXA), is rec- ommended for women beginning at age 65 (USPSTF, 2018c). A DEXA scan uses low-dose x-ray to measure the amount of bone mineral density in the bones, usual- ly the hip and spine. DEXA scans should be repeated no sooner than every two years. For women who have a fracture risk that is equal to or greater than that of a 65-year-old woman, and for women at risk for bone loss, testing should begin earlier (IOF, 2022; NLM, 2021a). Women at risk for early bone loss in- clude those who have used a steroid for more than three months and those with poor lifetime calcium intake, hyperthy- roidism, smoking and/or alcohol intake, renal disease, multiple myeloma, leuke- mia, hepatic disease, metastatic cancer, or hyperparathyroidism. Treatments for osteoporosis include proper nutrition, ex- ercise, fall prevention—to help prevent fractures—and possibly medication. Sup- plementing with calcium and vitamin D, as well as eating foods high in calcium, can help prevent or slow the progress of osteopenia/osteoporosis (IOF, 2022; NIH, 2019).
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