Learning Objectives: To understand the options for treating symptoms of menopause. To understand the risks vs benefits of hormone replacement therapy.
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A 48 yr old woman presents with concerns about her periods.
She has been having irregular periods over the previous 6 months, some heavy and some lighter, with the heavier periods occurring after a longer pause between periods.
There has been no postcoital bleeding and she has had no pain with menstruation. The heaviest days she has had to use a tampon and large pad and change them frequently.
She is getting tired and feels she may be approaching menopause. She has occasional severe sweats and flushes easily. Her skin is getting drier.
When asked about her main concern it is the flooding and irregular menses as she is unable to predict it and she has lost time at work.
Past history - mild well controlled hypertension, nil else
Family history - Mother had menorrhagia and had a hysterectomy aged 45
Drinks 2 standard drinks of alcohol per day
Current medications: Ramipril 5mg daily
Issues of concern
Perimenopause oestrogen deficiency symptoms
Menorrhagia and irregular cycle
Possible iron Deficiency
Exclude Thyroid disorder?
Risk evaluation of HRT: