MIDWIFERY TERMINOLOGY

1. Definition of midwife:
a. A person who has successfully completed a midwifery education programme that is
based on the ICM Essential Competencies for Basic Midwifery Practice and the
framework of the ICM Global Standards for Midwifery Education and is recognized
in the country where it is located; who has acquired the requisite qualifications to be
registered and/or legally licensed to practise midwifery and use the title ‘midwife’;
and who demonstrates competency in the practice of midwifery. 
b. Midwifery is the profession of midwives, only midwives practise midwifery. It has a
unique body of knowledge, skills and professional attitudes drawn from disciplines
shared by other health professions such as science and sociology, but practised by
midwives within a professional framework of autonomy, partnership, ethics and
accountability. 
2. Terminology in midwive
a. Embryo : Developing organism during first 8 weeks 
b. Gravid : A woman who is or has been pregnant, regardless of pregnancy outcome 
c. Primigravida : A woman pregnant for the first semester 
d. Multigravida : A woman who has been pregnant more than once 
e. LMP : Last Menstrual Period 
f. Para : Refers to past pregnancies that have reached viability 
g. Primipara : Refers to woman who had completed one pregnancy to the period of
viability 
h. Multipara : Refers to a woman who has completed two or more pregnancies to the
stage of viability 
i. Morning sickness : Nausea or vomiting occurs usually in the morning 
j. Quickening : Sensations of fetal 
3. Prefixes : consist of one or more syllables placed at the beginning of a word. A prefix
placed in front of a verb, adjective or noun for modifying its meaning. Many prefixes do
occur frequently in medical language and studying them is very important first step in
learning medical terminology.
4. Suffixes : Suffixes consist of one or more syllables placed at the end of a word and never
stand alone. Suffixes are added to the roots of the words to modify the meanings. There
are two general rules that may be followed:
a. The last vowel of the root may be changed to another vowel and another vowel may
be inserted between the root and a suffix that begins with a consonant that called
combining vowel.
For example: Cardiology study of the heart
comes from : the root -> cardi -> heart 
: hesuffix -> logy -> study of 
b. When the suffix begins with a vowel, the last vowel of the root may be dropped
before adding the suffix. 
For example: carditis inflammation of the heart
 comes from : the root -> cardi -> heart 
: the suffix -> it is -> inflammation
5. Roots and combining e-forms : Root is the foundation or basic meaning of a word. And
the combining forms is the root with a combining vowel added, attaching the root to a
suffix or another root. 
6. Abbreviations : Abbreviations and Symbols Commonly Used by Health Practitioners
7. How to communicate and use of language function 
a. Asking question 
 Yes/no question and short answer 
 Information question : how, whom, who, what, where, why, when,
 Choice question 
 Attached/negative questions/tag questions 
 Introducing yourself
 Offering services 
 Giving direction
 Explaining 
 Describing 
 Convincing 
 Persuading 
 Consoling/soothing
b. Language function 
 Encouraging/motivating 
 Reprimanding 
 Complaining 
 Praising 
 Entertaining 
 Apologizing 
 Requesting/ordering 
 Advising 
 Rejecting 
 Consulting 
 Reporting 

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REPRODUCTIVE CYCLE – BU ENDYKA

1. Female Reproductive Cycle 

a. The fertile period of a female extends from the age of puberty (11-14years) to the
age of menopause (40-45years). 
b. The reproductive system in females consists of the ovaries, uterine tubes, uterus,
vagina and external genitalia. 
 c. Periodic changes occur, nearly every one month, in the ovary and uterus of a fertile
female 
d. A fertile female exhibits two periodic cycles: the ovarian cycle, which occurs in the
cortex of the ovary and the menstrual cycle that happens in the endometrium of the
uterus. 
e. The phases of the menstrual cycle are under the control of the hormones secreted
during the different phases of the ovarian cycle. 
2. The female reproductive system 
a. Ovary : Where eggs are stored. One egg is released each month (ovulation). The egg
dies if not fertilized by sperm within 12 to 24 hours after release. 
b. Womb lining (endometrium) : Lining of the uterus, which thickens and is then shed
once a month, causing menstrual bleeding. During pregnancy, this lining is not shed
but instead changes and nourishes the foetus (growing baby). 
c. Womb (uterus) Where a fertilized egg grows and develop into a foetus. 
d. Fallopian tube : An egg travels along one of these tubes. once a month, starting from
the ovary. Fertilization of the egg (when egg meets the sperm) occurs in these tubes. 
e. Clitoris : Sensitive ball of tissue creating sexual pleasure. 
f. Pubic Hair : Hair that grows during puberty and surrounds the female organs. 
g. Opening for urine : Opening where urine (liquid waste) leaves the body. 
h. Inner lip : Two folds of skin inside the outer lip that extend from the clitoris. 
i. Cervix : The entrance of the womb, which stretches down into the back of the
vagina. It produces mucus. 
j. Vagina : Joins the outer sexual organs with uterus. Babies are born through this
passage. To clean itself, the vaginal sheds mucus every now and then (vaginal
discharge). 
k. Vaginal opening : Opening of the vagina. The man's penis is inserted here during
sexual intercourse. Blood flows from here during menstrual periods. 
l. Outer lip : Two folds of skin, one on either side of the vaginal opening, that protect
the female organs. 
m. Anus: Opening where solid waste leaves the body. 
3. REPRODUCTIVE CYCLE 
a. Menstrual Cycle : The menstrual cycle is a series of physiological changes that can
occur in fertile females. Overt menstruation (where there is blood flow from the
uterus through the vagina) occurs primarily in humans and some other animals. 
b. The ovarian cycle consists of three phases: follicular (preovulatory) phase,
ovulation, and luteal (postovulatory) phase, whereas the uterine cycle is divided into
menstruation, proliferative (postmenstrual) phase and secretory (premenstrual)
phase. 
c. Hormonal effects (hypothalamus & ant. Pituitary) 
4. ROLE OF HORMONES 
a. GnRH: The ovarian and uterine cycle are controlled by GONADOTROPIN
RELEASING HORMONE secreted by hypothalamus
b. FSH : FOLLICLE-STIMULATING HORMONE -> Initiate follicular growth and
secretion of estrogens by the growing follicles. 
 c. LH : LUTEINIZING HORMONE -> Stimulates the further development of ovarian
follicle and their full secretion of estrogens, brings about ovulation, promotes
formation of the corpus luteum and stimulates the production of estrogens,
progesterone, relaxin and inhibin by corpus luteum 
d. ESTROGEN: secreted by follicular cells. 
 secondary sex characters. 
 Increase protein anabolism. 
 Lower blood cholesterol. 
 Moderate level inhibit release of GnRH, FSH, LH. 
e. PROGESTERONE: secreted by corpus luteum and act synergistically with estrogen.
For implantation. high level inhibit GnRH and LH 
f. hCG : similar to LH and rescue corpus luteum 
g. RELAXIN : secreted by corpus luteum 
 Inhibit contractions of uterine smooth muscle. 
 during labor, relaxes pubic symphasis and dilates uterine cervix. 
 INHIBIN: inhibit release of FSH and to lesser extend LH 
5. Basic terms 
a. Endometrium: Lining of the uterus 
a. Oocyte: Developing reproductive cell 
b. Ovum: Mature egg after meiosis 
c. Menopause: Last menstrual cycle, afterwhich egg production stops 
6. The ovarian cycle 
a. Follicular phase (in the first half of the cycle) -> preovulatory, estrogenic
 Pituitary Gland -> Produces FSH -> Triggers formation of the Follicle Within
the ovary -> Produces Estrogen & Ovum -> Triggers uterine lining thickening 
 Maturation of Graffian follicle containing ovum 
 Early follicular phase: Rising FSH and LH levels and low estrogen and
progesterone levels 
 Late follicular phase: Rising estrogen levels slowly initially, then rapidly 
 Follicular phase (1-14 days) 
 Granulosa cells of some primary follicles proliferate 
 Theca cells proliferate (estrogen secreting cells) 
 Theca cells and Granulosa cells are collectively known as follicular cells 
 Under the effect of FSH 15-20 of the follicles grow rapidly forming secondary
follicle which are capable of secreting estrogen 
 Oocyte inside each follicle enlarges 
 One follicle usually grows more rapidly and mature (graafian follicle) about 14
days after onset of follicular development 
 Graffian follicle bulges on ovarian surface -ruptures to release secondary oocyte
from Early ovary (ovulation)- facilitated by burst in LH secretion 
 Released oocyte enters oviduct where it may or may not be fertilized 
 The other follicles undergo atresia (atreticMature follicles) 
 c. ovulation (at about the middle of the cycle) 
 the process of rupture of the Graa an follicle and release of the mature ovum
from the ovary 
 The time of ovulation is variable but it is usually on the 14th day of the ovarian
cycle. 
 Ovulation occurs at about 14days (± one day) before the beginning of the next
menstruation 
 Positive feedback of estrogen increase GnRH LH & FSH. 
 Occurs in response to high concentrations of FSH and LH. 
 Follicle become corpus hemorrhage. 
 Clot absorbed and become corpus luteum 
 Hormonal contraceptives inhibit ovulation by interfering with this mid-cycle
surge in estrogen and LH 
d. Luteal phase (in the second half of the cycle) 
 the wall of the ovarian follicle collapses 
 Bleeding occurs inside the follicle with the formation of a blood clot. Corpus
hemorrhagicum lasts for about three days before it changes into corpus luteum. 
 Secretion of progesterone (from corpus luteum)which prepares endometrium
(uterus) for pregnancy if it occurs 
 Last 14 days of ovarian cycle 
e. Pituitary Gland -> Produces LH -> Triggers Ovulation and the formation of the
Corpus Lutium With in the ovary -> Produces Progesterone -> Continues uterine
lining thickening 
f. L.H. changes the corpus hemorrhagicum into corpus luteum. 
g. L.T.H. (the luteotrophic hormone) stimulates the corpus luteum to secrete
progesterone and small amount of estrogen. 
h. Progesterone inhibits the production of L.H. and L.T.H. leading to regression of the
corpus luteum. 
i. Decreased estrogen level stimulates F.S.H. secretion and a new cycle starts. 
7. The uterine (endometrial, menstrual) cycle  : the endometrium of the uterus depending on
the hormonal changes that occur in the ovarian cycle. It has four phases:
menstrual, regenerative, proliferative and secretory phases. The cycle duration extends
from the first day of one menstruation to the rst day of the next menstruation, in most
typical cycles it is about 28days 
a. Stage 1 Day 1-5 menstruation // Menstrual Phase
 Degeneration of the corpus luteum at the end of the ovarian luteal phase leads to
a decreased level of progesterone and estrogen 
 ischemia and necrosis of the endometrium and walls of the capillaries occur 
 blood escapes from the damaged capillaries and it ows with the necrosed
endometrium 
 At the end of this phase, the endometrium is about 0.5mm thick. The average
duration of menstruation is 3-5days 
 Blood about 50-60cc 
 b. Stage 2 Day 5-13 pre-ovulatory stage // Regenerative phase (repair) 
 From the fourth to the sixth day of the mature graafian antrum filled with cycle,
regeneration of the endometrium is developing carried out by the stratum basale 
 At the end of this phase, the epithelium reaches thickness of 2mm and is at. 
c. Stage 3 Day 14 Ovulation // Proliferative (follicular, postmenstrual, estrogenic)
phase 
 It occurs from the seventh to the fifteenth day of the cycle. 
 It corresponds to the follicular phase of the ovarian cycle. 
 It is under the control of estrogen secreted by the ovarian (Graafian) follicle. 
 Endometrium starts to repair itself and proliferate under influence of estrogen
from newly growing follicles 
 The endometrium proliferates, increases in thickness (4mm) 
 Peak estrogen levels trigger LH surge responsible for ovulation 
d. Stage 4 Day 15-28 post-ovulatory stage // Secretory (luteal, premenstrual,
progestational) phase 
 It occurs from the 16th to the 28th day of the cycle. 
 It corresponds to the luteal phase of the ovarian cycle. 
 under the control of progesterone secreted by the corpus luteum. 
 Corpus luteum secretes large amounts of progesterone and estrogen 
 The endometrium is thick (10mm), soft, velvet, and is loaded with water. 
 Corpus luteum degenerates 
 New follicular phase and menstrual phase begin once again 
8. Various factors can disrupt the menstrual 
a. Weight loss/low body weight 
b. Disordered eating 
c. Vigorous physical activity 
d. Stress 

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MIDWIFERY CARE - BU FARIDA

1. ICM Philosophy of Midwifery Care (ICM, 2014)

a. normal physiological processes
b. significant meaning to the woman, her family, and the community. 
c. Midwives are the most appropriate care providers 
d. promotes, protects and supports
e. holistic and continuous in nature
f. partnership
g. emancipatory 
h. Ethical and competent 
i. promote and protect 
 j. respect and have confidence 
k. promote and advocate for non-intervention 
l. appropriate information and advice 
m. respectful, anticipatory and flexible care
n. empower women to assume responsibility 
o. practice in collaboration and consultation 
p. maintain midwifery competence
q. use technology appropriately 
r. individually and collectively responsible for the development of midwifery care
2. The unique role of the midwife (ICM):
a. Partnership with women
b. Respect for human dignity 
c. Advocacy for women 
d. Cultural sensitivity
e. A focus on health promotion and disease prevention 
3. Shared aims, universal goals of midwifery care
a. To support health, wellbeing and a positive experience of care around pregnancy,
birth and the early weeks of life
b. To consider long term as well as short term effects of care
c. To give the best start in life and family integrity
d. To contribute to the growth of secure attachments between parent(s) and baby.
e. The reduction of mortality and morbidity of mother and baby during pregnancy,
birth and postpartum, including the morbidity of unnecessary intervention.
4. Characteristics of midwifery care
a. A fundamental respect for the personal autonomy and dignity of the woman and
her reproductive rights.
b. Centre of wellbeing.
c. Moves away from the restrictions of risk-based medicine.
d. Complex and requires a high level of knowledge in a number of fields, including
not only health care but also psychology, sociology, counselling and the
humanities.
5. The midwifery model of care is based on (but not limited to) the six key principles:
a. continuity of care
 A woman’s relationship with their pregnancy care providers is vitally
important.
 Not only are these encounters the vehicle for essential lifesaving health
services,
 but a family’s experiences with caregivers can empower and comfort, or inflict
lasting damage and emotional trauma.
 The midwifery approach starts in the relationship through which they work
with women; a reciprocal partnership: getting to know and trust each other
over time.
  This partnership is made possible by what has come to be known as
‘continuity of care’, and is arguably the most central aspect of the midwifery
care.
b. woman-centred care
 The woman being ‘wrapped around’ by their midwife who, when necessary,
facilitates referral and consultation with other specialist services, and care that
is personalized to her needs.
 This symbolizes the relationship with women which is at the heart of women-
centred care.
 The development of relational continuity in midwifery has illustrated the
powerful effect of midwives developing a relationship with women over time
c. informed choice
 Working in partnership with means working together to support childbearing
women to make decisions about their own care.
 Midwives recognize the woman as the primary decision-maker for the course
of her care.
 They support the woman’s rights to make informed choices, and support
thoroughly informed decision-making by ‘providing complete, relevant,
objective information in a non-authoritarian, supportive manner.’
 Informed decision making is a process which involves five steps for
conversation and information management:
o Finding out what is important to the woman and their family
o Using information from the clinical examination
o Seeking and assessing evidence to inform decisions
o Talking it through
o Reflecting on outcomes feelings and consequences
d. evidence-informed practice
 Evidence-informed practice uses evidence to identify the potential benefits
and risks of any clinical decision.
 This means that that midwives must commit to continually developing and
sharing midwifery knowledge.
 They must attend continuing education opportunities in the field of midwifery
and obstetrics, and related topics and must keep their knowledge current about
emerging practice guidelines and the research that supports them.
 Factors affecting Evidence-informed practice:
o health care resources
o the individual clinical state and circumstances,
o the clinician’s own expertise and experience
o availability of appropriate resources
o the woman’s own preferences.
 The midwife’s clinical expertise ties them all together to inform practice
decisions, and in support of informed choice decision making.
 e. companions – ‘being with’ each & every woman
 midwife means literally, ‘being with the woman’ – a companion on the
journey to through pregnancy, labour and birth, and through the immediate
postpartum.
 ‘Being with’ implies support, giving and helping the woman understand
information, helping lay out the decisions to be made, giving confidence,
while also being honest about situations.
 Underlying all of this is compassion and understanding of the woman’s
situation and life circumstances.
 Midwives need to be educated and skilled, but also compassionate and
responsive to multiple social contexts.
 It is critical that the midwife get to know the woman and her family by
listening and responding to them with respect and compassion for their
particular life circumstances.
f. Promotors of Health & Wellbeing
 Wellbeing includes physical health as well as emotional wellbeing and a sense
of security, hope and optimism.
 A more complex concept in maternity care is the balance between the
woman’s health and that of the baby. Holding both of these in mind, not
placing the health of one over the other, is critical in considering the
appropriateness of interventions to maintain optional health in maternity care.
 Midwives do this by supporting physiological processes, whenever possible,
while keeping in mind the overall context and preferences of each individual
woman and case.
 Central to midwifery practice is that we recognize the need to support normal
human physiology by helping women to have a normal birth, and supporting
them so that they can, if possible, avoid the use of unnecessary interventions.
 Meanwhile, if these interventions are needed (or desired), then the midwife’s
role becomes to support the woman to have the best birth experience possible
for them: physiologically, but also emotionally.
 An understanding of the woman’s current health status, their values and
preferences and life circumstances are critical for optimal health. This
demands a unique mix of empathy, compassion, listening, understanding, and
availability.
6. Conclusion
a. Philosophy of care, characteristics and key concept of midwifery care take us
beyond a medicalized approach to pregnancy, birth and postpartum, towards
individualized, humanized care.
 b. Midwives are concerned not only with concrete clinical outcomes relating to
mortality and morbidity, but also health and wellbeing, maternal capability, secure
attachment between mother and baby, and family integrity.
c. Midwives who are educated, skilled and compassionate, who work in effective
health services with adequate resources, are critical in the movement towards
humanized, woman-centred care for childbearing families in this country.

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MIDWIFE AND NORMAL CHILDBIRTH - FARIDA FITRIANA

1. WHAT IS NORMAL CHILDBIRTH?

a. without induction, without the use of instruments, not by caesarean section and
without general, spinal or epidural anaesthetic before or during delivery”
b. Furthermore, it includes “women whose labour starts spontaneously, progresses
spontaneously without drugs, and who give birth spontaneously”
2. NORMAL CHILDBIRTH AND UNNECESSARY MEDICALISATION
a. Medicalisation refers to “the process by which human experiences are redefined as a
medical problem” (Becker and Naghtigall, 1992 p.456).
b. Medical intervention may be useful while used appropriately but will be harmful and
disrespectful if it is unnecessarily used (Miller, Abalos and Chamillard et al., 2016).
c. Moreover, the unnecessary medicalisation will impact on the decreasing the respect
of maternal choice and satisfaction (Cahill, 2001; Mattebo, Lindkvist and Pedersen
et al., 2016; Clesse et al., 2018).
d. Non-medically indicated Caesarean Section is one kind of unnecessary
medicalisation for normal childbirth.
3. THE BIRTHPLACE COHORT STUDY: KEY FINDINGS
Giving birth is generally very safe: For ‘low risk’ women the incidence of adverse
perinatal outcomes (intrapartum stillbirth, early neonatal death, neonatal encephalopathy,
meconium aspiration syndrome, and specified birth related injuries including brachial
plexus injury) was low (4.3 events per 1000 births).
4. COMPARISON HAVING CHILDBIRTH BETWEEN IN HOSPITAL ANDIN
MIDWIFE-LED CARES FOR ‘LOW RISK’ MOTHER
Women having childbirth in midwife-led care unit, such as midwifery private practice,
will experience less maternal morbidity, less intervention, thereby enhancing positive
birth experience (Birthplace in England Collaborative Group, 2011).
5. MIDWIFE AND NORMAL CHILDBIRTH
a. Midwives have expertise to promote, facilitate and optimise the normal childbirth
(International Confederation of Midwives, 2018).
b. If medical involvement is necessary, then midwives collaborate with obstetricians to
optimise the perinatal outcomes (Royal College of Midwives, 2016).
 c. Midwives use the midwifery model of care (Walsh, 2012), which is related to the
social and the holistic model of care (Davis-Floyd, 2011) in giving midwifery care
for childbirth.
d. It looks at a human as a subject and holistic creature, having ability to adapt and
adjust everything that happens in the body (Davis-Floyd, 2011; Walsh, 2012).
e. Midwives do not use the biomedical model (Walsh, 2012), which is related to the
medical model of care and the technocratic model of care (Davis-Floyd, 2011) looks
at human as an object having the mind which is separated from the body and it is
dominated by control and power (Davis-Floyd, 2011; Walsh, 2012).
6. POSITIVE CHILDBIRTH EXPERIENCE AS THE END GOAL (WHO, 2018)
a. A “positive childbirth experience” as a significant end point for all women
undergoing labour.
b. It defines a positive childbirth experience as one that fulfils or exceeds a woman’s
prior personal and sociocultural beliefs and expectations, including giving birth to a
healthy baby in a clinically and psychologically safe environment with continuity of
practical and emotional support from a birth companion(s) and kind, technically
competent clinical staff.
c. According to WHO (2018), entitled “Intrapartum Care for a Positive Childbirth
Experience”, there are four aspects of recommendation for care throughout labour
and birth, i.e.:
 Respectful maternity care
 Effective communication
 Campionship during labor and birth
 Continuity of care
7. RESPECTFUL MATERNITY CARE
a. Respectful maternity care – which refers to care organized for and provided to all
women in a manner that maintains their dignity, privacy and confidentiality, ensures
freedom from harm and mistreatment, and enables informed choice and continuous
support during labour and childbirth is recommended. (Recommended)
b. Effective communication – between maternity care providers and women in labour,
using simple and culturally acceptable methods, is recommended. (Recommended)
c. COMPANIONSHIP DURING LABOUR AND CHILDBIRTH -- A companion of
choice is recommended for all women throughout labour and childbirth.
(Recommended)
d. CONTINUITY OF CARE – Midwife-led continuity-of-care models, in which a
known midwife or small group of known midwives supports a woman throughout
the antenatal, intrapartum and postnatal continuum, are recommended for pregnant
women in settings with well functioning midwifery programmes. (Context-specific
recommendation)

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MIDWIFERY MANAGEMENT IN MENOPAUSAL WOMAN

1. Definition
a. Menopause is a process that involves the whole woman (body, mind, spirit). Is a
normal life event, not a disease.
b. Climacteric : Process of age-related change from reproductive to nonreproductive
state. Sometimes used interchangeably with perimenopause. This imprecise term has
fallen out of favor.
c. Early menopause : Natural or induced menopause that occurs long before the
average of spontaneous menopause. This somewhat vague umbrella term
encompasses premature menopause. Frequently used cutoff is 40 years.
d. Final Menstrual Period (FMP) : Last menstrual period of a woman’s life; recognized
as her FMP after 12 months of amenorrhea have passed after the FMP.
e. Induced Menopause : Cessation of menstruation due to surgical removal of a
woman’s ovaries or ablation of ovarian function from chemotherapy or pelvic
radiation therapy.
f. Menopause : One-time event that marks permanent cessation of ovulation and
menstruation. Diganosed when a woman has had 12 months of amenorrhea with no
other indentified cause.
g. Menopause Transition : Time of menstrual endocrine changes, beginning with
variation in cycle length and ending with the FMP. Average age at onset is 46 years;
range 39-51 years. Average duration is 5 years; range: 2-8 years.
h. Perimenopause : Symptomatic years of menopausal transition, encompassing the
time from early menopausal transition to 12 months after the FMP.
i. Postmenopause : Time after a woman’s FMP, have serum estradiol levels lower
than 37 pg/mL, Estron level between 6 and 63 pg/m, Estradiol levels in the range of
10-100 pg/mL in the early follicular phase, 200-800 pg/mL at midcycle, and 200-
340 pg/mL during the luteal phase
j. Premature Menopause : Any menopause that occurs in women younger than 2
standard deviations (SD) below : the man estimated age for the reference population.
Frequently used cutoff is 40 years.
k. Premenopause : Time approaching the FMP.
2. Presentation of Perimenopause and Menopause (Most commonly physical changes)
a. Bleeding Pattern Changes
 Changes in menstrual cycle length and menstrual flow amount and duration are
so common.
 Approximately 90% of women experience 4 to 8 years of menstrual changes
before their final menstrual period.
 The most common pattern: gradual decrease in both amount and duration of the
menstrual flow, leading to spotting and then to cessation..
 Some women experience more frequent or heavier periods in perimenopause.
b. Vasomotor symptoms
  Including: hot flashes, hot flushes, and night sweats: recurrents, transient
periods of flushing, sweating, and a sensation of heat, often accompanied by
palpitation and a feeling of anxiety, and sometimes followed by chills.
 A single hot flash usually lasts 1 to 5 minutes: a sudden wave of heat that soon
spreads over woman’s body, and particularly over her face and upper torso.
 Other symptoms: Elevation in skin temperature, heart rate, skin blood flow, and
metabolic rate follow quickly.
 Hot flushes is so common 🡪 hallmarks of perimenopause.
 Ethnicity, diet, climate, lifestyle factors, and women attitudes about aging 🡪
influence women’s perceptions of vasomotor changes.
 Approximately 50% of women have hot flushes for 4 to 5 years after their final
menstruation.
c. Sleep Disturbances
 Defined as an inadequate number of hours of sleep, sleep of poor quality, or an
inability to function in an alert state during desired waking hours.
 Women might experience insomnia as a prolonged time needed to fall asleep, as
inability to stay asleep all night, or as early awakening without being able to get
back to sleep.
 These sleep difficulties can be either short term or persistent.
d. Genitourinary Changes
 Almost 90% of postmenopausal women experience some atrophic changes of
the genitourinanry tract that affect their quality of life and sexual function.
 The term of atrophy refers to vaginal and cervical epithelium that is thin, dry,
and pale in a diminished-estrogen environment.
 Women feel dryness or itching of the vulva and vagina and pain with vaginal
penetration.
 The cervix usually decrease in size and produces less mucus, this can contribute
to painful intercourse.
e. Sexuality
 Many women are sexually active at midlife and beyond.
 Midlife and older women enjoy sex for a veriety of reasons, including feeling
more feminime, reducing tension, improving sleep, enhancing feelings of
intimacy with partner.
 However, some midlife women report difficulties with sexual functioning:
decreased sexual desire, decreased vaginal lubrication, and inability to have an
orgasm.
 The most problematic aspect of the menopausal transition is a lack of
knowledge 🡪 clinicians should routinely ask about sexual health.
 Begins by using open-ended questions to ask changes in a woman’s sexual
health, vaginal changes, including moisture or dryness, itching, or pain, and
discuss about sexuality
f. Emotional and Psychological Changes
 Several risk factors for mood problems are: women with a history of depression
aroud menopause, and women who undergo bilateral oopheroctomy, especially
when youngerthan 48 years, are at increased of experiencing anxiety symptoms.
g. Weight Changes
 The average weight gain during the menopause transition being approximately 5
pounds.
 Aging and lifestyle are more likely to cause an increase in weight.
 Lean muscle mass decreases with age, lowering a woman’s metabolic rate,
combined with a more sedentary lifestyle, causes women to burn fewer calories
and gain weight if they do not lower their caloric intake.
 Thus, diagnosis and management of obesity and overweight, including
counseling about lifestyle management strategies, are vitally important roles for
midwives.
h. Hair and Skin Changes
 Sun damage redistributed or decreased subcutaneous fat, skin laxity from
weight changes, and decreased underlying muscle tissue cause most of the skin
changes at menopause.
 Other potential midlife skin changes: dryness, acne, hair loss, brittle, and slow-
growing nails, and decreased wound healing 🡪 contribute to psychological
distress or altered body image.
3. Diagnosing Menopause
a. No single laboratory can predict or confirm menopause 🡪 the diagnosis of
menopause
b. The diagnosis is based on a woman’s menstrual and medical histories and on her
report of symptoms 🡪 diagnosis of menopause is generally assured if a woman has
been amenorrhe for 12 months, and typical menopausal symptoms.
c. Women sometimes request “hormone testing” to confirm menopause, to predict its
course, or to help manage symptoms.
4. Lifestyle Strategies for Management of Women with Perimenopausal or Menopausal
Symptoms
a. Vasomotor Symptoms
 Regular physical exercise and maintenance of healthy weight : Evidence is
mixed regarding whether poor exercise habits and obesity have a causal
relationship with hot flushes.
 Avoidance or cessation of smoking
o Women to smoke tend to have more hot flashes than women who do not.
o The more a woman smokes, the greater her risk for more severe vasomotor
symptoms.
 Use of Relaxation Techniques :
o Women can consider modalities such as yoga, meditation, deep breathing,
muscle relaxation, guided imagery, mindful stretching, massage,
aromatherapy, and prayer.
o It can diminish the anxiety that can lead to hot flashes, are promising.
  Maintaining a cool environment : Using fan, keep the thermostat down, and
dress in layers of breathable clothing such as cotton to aid in staying cool.
b. Sleep Difficulties
 Avoidance of substances and activities prior to bedtime that can interfere with
sleep.

o A light snack with protein and complex carbohydrates, or a source of

tryptophan such as milk or chamomile tea can be helpful.
o Vigorous exercise or stressful activities close to bedtime can cause
difficulties in relaxing and falling asleep.
o Regular and moderate exercise earlier in the day can promote healthy sleep
habits.
 Maintenance of nightly rituals and a regular sleep schedule.
o Women should maintain a regular bedtime every night of the week.
o Erratic sleep hours as well as naps can negatively affect sleep quality.
o A regular schedule also capitalizes on the light/ dark cycle.
c. Vulvovaginal and sexuality concerns
 Enhancement and Protection of Moisture
o Women can humidify their homes and drink adequate amounts of fluids
each day.
o Vaginal moisturizers and lubricants can reduce vaginal and vulvar irritation.
o Women can use water-based lubricants during sexual activity. It works at
the surface of the skin to reduce friction, and their effects are immediate
and short term.
o Moisturizers are not used at the time of sexual activity, but rather are
longer-lasting products that can maintain moisture and beneficially lower
vaginal pH.
 Promotion of Adequate time for arousal and sexual activity as possible : Sexual
activity itself improves blood supply to the pelvis and the vaginal tissues 🡪
sexually active older women often have less atrophy than older women who are
not sexually active.
 Recognition that information is power : Caring for women with sexual concern
should include explaining the physiology of aging as it relates to sexuality.
5. Hormonal Prescription Options for treatment of menopausal symptoms : Some midlife
women have significant menopausal symptoms and desire Hormone Therapy (HT), in
the form of either Estrogen Therapy (ET) or estrogen-progestin Therapy (EPT).
6. Does she need pregnancy prevention instead of perimenopausal therapy?
a. Until a woman is menopausal (has reached 12 months since her final menstrual
period), pregnancy is possible.
b. Any perimenopausal woman who wants to avoid pregnancy shoulduse contraception
and not rely on hormone therapy to prevent pregnancy.
c. Altough both HT and combined hormonal contraceptives contain estrogen and
progestin, the doe and formulation of HT will not prevent pregnancy.
 d. Women generally do not begin taking HT until they have reached menopause.
7. Contraindication to HT
a. Undiagnosed abnormal vaginal bleeding.
b. Known, suspected, or history of breast cancer
c. Current or history of deep vein thrombosis or pulmonary embolism
d. Current or recent (within the last year) stroke or myocardial infarction.
e. Liver disease
f. Known or suspected pregnancy
g. Known hypersensitivity to ET/EPT
8. Timing of Initiation of HT : The ideal time to initiate HT for symptom relief is as early
as possible. Initiation generally is thought to be best within the first 10 years after
menopause or between ages 50 and 59 years.
9. Complementary and alternative therapies during menopause
a. Acupuncture
b. Homeopathy
c. Phytoestrogens
 Isoflavones are plant-derived compounds with estrogen-like activity and a similar
chemical structure to estradiol.
 Soy and red clover are the two most commonly used isoflavones for the relief of
menopausal symptoms.
d. Herbal therapies
10. Bone health, Ostopenia, and Osteoporosis
Bone mass and strength are lost and bone quality deteriorates. Risk factors:
a. Age > 65 years
b. Personal history of fracture without substantial trauma as an adult
c. Family history
d. White and Asian women are at greatest risk
e. Female gender
f. Late menarche (>15 years) or early menopause (< 45 years)
g. Smoking
h. BMI < 20
i. Eating disorder or excessive exercise-induced amenorrhea
j. Chronic glucocorticoid use
k. Chronic illness: rheumatoid arthritis
l. Heavy alcohol
11. To avoid osteoporosis
a. Engage in regular exercise
b. Maintain a healthy weight
c. Avoid smoking and excessive alcohol intake
12. Conclusion
a. Menopause, similar to pregnancy, is a time when women often present to the
healthcare system for help with changes, to gain knowledge of the processes
occurring, and for regular healthcare.
b. Midwives who care for women at midlife have the opportunity to develop an
individualized preventive health program, health screening, disease identification,
and treatment, and maintenance of continuity of care.