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
"It has been very painful to have intercourse recently; nothing I've tried from the drugstore seems to help."
History of Present Illness
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.
Oophorectomy (left ovary) 32 years ago
Tonsillectomy 44 years ago
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.
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.
Three to five alcoholic drinks/wk; states she drinks wine to help her cholesterol; (−) tobacco or illicit drug use
Allergies/Intolerances/Adverse Drug Events
Amlodipine/benazepril 5 mg/10 mg PO q 24 h
Fenofibrate 145 mg PO q 24 h
Calcium with vitamin D 600 mg/400 IU PO bid
Multivitamin one tablet PO q 24 h
Ibuprofen 200 mg PO PRN joint pain after gardening
Several incidences of painful intercourse; (+) dyspareunia; also episodes of increased body temperature and irritability; (+) vasomotor symptoms; (−) night sweats; (−) chest pain; (−) palpitations; (−) tachycardia
Fifty-two-year-old Caucasian woman ...