Case 056: Menopause

PATIENT PRESENTATION

Chief Complaint

“I am so dry down there that sex with my husband has become painful.”

History of Present Illness

JB is a 51-year-old female complaining of dyspareunia symptoms including vaginal burning, itching and painful intercourse over the past 6 months. She has not had a menstrual period since her partial hysterectomy for severe uterine prolapse 6 years ago.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What signs and symptoms of menopause does JB have?

   Hint: See Menopause in PPP

2. What factors in JB’s medical history must we consider when deciding on a treatment plan?

   Hint: See Figure 50-5 and Menopause in PPP

3. What non-pharmacologic therapy would be recommended in JB’s case?

   Hint: See Menopause in PPP

4. What are the pharmacotherapy options for JB’s menopausal signs/symptoms?

   Hint: See Menopause and Figure 50-5 in PPP

5. What risks and adverse effects of therapy would you discuss with JB?

   Hint: See Menopause in PPP

FOLLOW-UP

Three months later, JB reports that she has noticed a little improvement in her vaginal burning and dryness, but intercourse is still uncomfortable. What change in pharmacotherapy do you recommend?

Hint: See Menopause in PPP

CASE SUMMARY

Global Perspective

Menopause happens to every woman once she reaches the end of her reproductive ability and is a physiological change. However, when comparing how menopause manifests itself through signs and symptoms across cultures, the results vary greatly. Signs and symptoms of menopause differ in quality and quantity. Use of medication and alternate therapies can vary considerably as well.

Key References