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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Identify the signs and symptoms associated with menopause

  • Explain how to evaluate a patient for the appropriate use of HT

  • Recommend nonpharmacologic therapy for menopausal symptoms

  • Differentiate between topical and systemic forms of HT

  • Educate a patient regarding the proper use and potential adverse effects of HT

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PATIENT PRESENTATION

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Chief Complaint

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"It has been very painful to have intercourse recently; nothing I've tried from the drugstore seems to help."

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History of Present Illness

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Shirley Davis is a 52-year-old Caucasian woman who presents to her primary care physician complaining of dyspareunia for the last 2 months. Due to her embarrassment over the issue, she has tried several OTC lubricants in order to relieve her problem rather than seek medical attention. Within the last year, she has informed her physician that her menstrual cycle has stopped. She denied having hot flashes or mood changes approximately a year ago. Currently, she admits to interruptions in her day several times per week due to profuse sweating and mood swings. She states it usually happens after having hot tea or soup for lunch.

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Past Medical History

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Amenorrhea × 1 year

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HTN × 3 years

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Hyperlipidemia × 4 years

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Past Surgical History

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Hysterectomy 1 year ago

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Oophorectomy (left ovary) 32 years ago

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Tonsillectomy 44 years ago

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Family History

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Father is 78 and has CHD and DM. Mother is 76 and is in overall good health, is a survivor of breast cancer, and had a double mastectomy 20 years ago. SD has no siblings.

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Social History

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SD is a married mother of 3 children, ages 27, 25, and 23. She has been married for 27 years. She works as a librarian.

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Tobacco/Alcohol/Substance Use

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Three to five alcoholic drinks/wk; states she drinks wine to help her cholesterol; (−) tobacco or illicit drug use

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Allergies/Intolerances/Adverse Drug Events

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HCTZ (hypokalemia)

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Medications (Current)

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Amlodipine/benazepril 5 mg/10 mg PO q 24 h

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Fenofibrate 145 mg PO q 24 h

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Calcium with vitamin D 600 mg/400 IU PO bid

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Multivitamin one tablet PO q 24 h

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Ibuprofen 200 mg PO PRN joint pain after gardening

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Review of Systems

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Several incidences of painful intercourse; (+) dyspareunia; also episodes of increased body temperature and irritability; (+) vasomotor symptoms; (−) night sweats; (−) chest pain; (−) palpitations; (−) tachycardia

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Physical Examination

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General
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Fifty-two-year-old Caucasian woman ...

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