Menopause cases

Question 1

•Jane is 48 and has hot flushes and night sweats. She has periods 5/30 cycle but has missed 2 periods in the last year.

Which HRT is required?

Answer 1

• If HRT needs oestrogen to Rx symptoms
• Has a uterus so needs progestogen
• Has some ovarian function so needs
• Cyclical combined
• OR Mirena + Oestrogen oral/transdermal

Question 2

• Sheila has had a hysterectomy for menorrhagia when she was 36 18/40 size fibroids.
• Her ovaries were conserved
• She is now 39 and has hot flushes.
• She wonders if she is menopausal?
• Tests FSH – under 40 and no ‘clue ‘ aboi=ut menopausal status from bleeding pattern after hysterectomy
• FSH level = 73 -menopausal

Which HRT is required?

Answer 2

• Prem menopause frequent after hysterectomy even if ovaries conserved
• If symptomatic needs oestrogen
• Does not have uterus so not need progestogen
• Age < 50 HRT is only replacing ‘what should be there’ benefit > risk
• If not want oestrogen suggest DEXA and bisphosphonates if necessary

Question 3

• Lucy is 55
• Her periods stopped when she was 51. She has vaginal\dryness and soreness.
• She is worried about side effects from HRT
• Management
• Examination- vaginal atrophy only- no other pathology

Which HRT is required?

Answer 3

• May prefer to try regular vaginal moisturisers eg ReplensTM and /or lubricants for sex
• If no help needs vaginal oestrogens: pessary/cream used x 2/week and vaginal ring lasts 3 months
• Minimal systemic absorption
• No need additional progestogen
• Try for 3 months- continue indefinitely if helpful