49F
Data gathering
- D: What brings you to the clinic today?
- P: Husband asked me to come see you.
- D: Why he asked you to come and see us?
- P: Because he thinks I have not been myself.
- D: Can you tell us some of things that worries your husband?
- Mood swings
- Irritability
- Snapping at my husband and children
- LMP is <12 months and periods are irregular, therefore, this is perimenopause
DDs
- Hyperthyroidism: Diarrhoea? Tremors in hand? Sweating? Weight loss?
Diagnosis
- Peri - menopause
- She is approaching menopause
- Menopause occurs between 45 - 55 years of age
Management
- HRT (Does not want medication)
- Counseling
- Couple counseling
- Leaflet
Who you are:
You are an FY2 in GP.Who the patient is:
Mrs Hannah Jakes, aged 50, has come to you with some concerns.What you must do:
Please talk to the patient, take history, assess, and discuss the initial plan of management
with the patient.
Common symptoms include:
- hot flushes – short, sudden feelings of heat, usually in the face, neck and chest, which can make your skin red and sweaty
- night sweats – hot flushes that occur at night
- difficulty sleeping – this may make you feel tired and irritable during the day
- a reduced sex drive (libido)
- problems with memory and concentration
- vaginal dryness and pain, itching or discomfort during sex
- headaches
- mood changes, such as low mood or anxiety
- palpitations – heartbeats that suddenly become more noticeable
- joint stiffness, aches and pains
- reduced muscle mass
- recurrent urinary tract infections (UTIs)
- osteoporosis
- It happens when your ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month.
Premature or early menopause:
- It can occur at any age, and in many cases there’s no clear cause.
- Sometimes it’s caused by a treatment such as surgery to remove the ovaries (oophorectomy), some breast cancer treatments, chemotherapy or radiotherapy, or it can be brought on by an underlying condition, such as Down’s syndrome or Addison’s disease.
Investigations:
- FBC, Urine (Pregnancy), FSH (40-45 years), TFT, Blood glucose, Cholesterol, Pelvic scan, Cervical screening and mammograms.
Treatment:
- HRT
- Tibolone – suitable for women who had last period more than 1 year ago.
- Clonidine – non hormonal medication effective for hot flushes.
- Lifestyle Modification
- Mood changes – CBT, Anti-depressants
- Loss of libido – Testosterone gel on legs or tummy
- Vaginal dryness – Oestrogen pessary, cream, or ring
If you experience hot flushes and night sweats as a result of the menopause, simple
measures may sometimes help, such as:
- wearing light clothing
- keeping your bedroom cool at night
- taking a cool shower, using a fan or having a cold drink
- trying to reduce your stress levels
- avoiding potential triggers, such as spicy food, caffeine, smoking and alcohol
- taking regular exercise and losing weight if you’re overweight
Side effects of HRT: As with any medicine, HRT can cause side effects. But these will usually pass within 3 months of starting treatment.
Common side effects include:
- breast tenderness
- headaches
- feeling sick
- indigestion
- abdominal (tummy) pain
- vaginal bleeding
HRT may not be suitable if you:
- have a history of breast cancer, ovarian cancer or womb cancer
- have a history of blood clots
- have untreated high blood pressure – your blood pressure will need to be controlled before you can start HRT
- have liver disease
- are pregnant – it’s still possible to get pregnant while taking HRT, so you should use contraception until 2 years after your last period if you’re under 50, or for 1 year after the age of 50
- In these circumstances, alternatives to HRT may be recommended instead.
Alternatives to HRT include:
- lifestyle measures. such as exercising regularly, eating a healthy diet, cutting down on coffee, alcohol and spicy foods, and stopping smoking
- tibolone – a medicine that’s similar to combined HRT (oestrogen and progestogen), but may not be as effective and is only suitable for women who had their last period more than 1 year ago
- antidepressants – some antidepressants can help with hot flushes and night sweats, although they can also cause unpleasant side effects such as agitation and dizziness
- clonidine – a non-hormonal medicine that may help reduce hot flushes and night sweats in some women, although any benefits are likely to be small
- Several remedies (such as bioidentical hormones) are claimed to help with menopausal symptoms, but these are not recommended because it’s not clear how safe and effective they are.
- Bioidentical hormones are not the same as body identical hormones. Body identical hormones, or micronised progesterone, can be prescribed to treat menopausal symptoms.