2. Complain
AB, a 50-year-old female, presents with chief complaints of
“sweats and hot chills” (6-7 episodes/day), accompanied by
increased emotional liability.
She reports irregular periods over the last year
She is currently sexually active but has progressively lost her
sexual drive, with some dryness and low libido
History
Occasional headaches. G3P3, non-smoker. Mild drinking, OTC
medication
Case 1
3. The most differential diagnosis
Menopause-related “hormonal dysfunction”
Hyperthyroidism
Generalized Anxiety Disorder
Laboratory Examination
FSH = 28 IU/ml
Estrogen = 200 mIU/ml
T3, T4 and TSH= normal
4. Diagnosis
menopausal related hormonal dysfunction
Treatment
Anti-depression drug e.g. “SSRI“ &placebo
Hormonal replacement therapy
Follow up
Improvement in her sleeping pattern her sexual drive
gradually going back to her normal routine.
5. Complain
JH, 16 years old, had one period when she was 13, "and that was it," she said,
She had the mood swings and hot flushes
History
She had two great aunts and neither of them were able to have children
No marked medication just taking OTC ones
She had two fracture when she was 15 year and recently had additional one
"hip bone" although all trauma were not dangerous.
Case 2
6. The differential diagnosis of this case.
Hyperthyroidism
Hyperparathyroidism , calcium deficiency
Premature ovarian failure
Laboratory investigation
FSH: 28 IU/ml
Calcium: 10 mg/dl
T3, T4, TSH are normal
PTH: normal
Physical examination
X-rays: low density of the Hip bone
7. Diagnosis
Premature ovarian failure
Treatment
Hormonal replacement therapy
Calcium tablets, bisphosphonate
Anti-depression drug can be useful.
CI: Raloxifene
Follow up
JH relive from those previous symptoms
except she still suffer from mild osteoporosis but she became more careful.
8. complain
CD, a 48-year-old female, presents with a complaint of severe insomnia, haven’t
sleep well for years particularly in the week prior to her menses
some nights she wakes up sweating, she denies feeling sad or anxious
History
Hypertension.
G2P2
Smoking 10 cigarettes/day for 30 years
Last menstrual period - 9 months ago
Medication: beta blocker once/day for hypertension
Case 3
9. The differential diagnosis of this case
Premenstrual Dysphoric Disorder
Hyperthyroidism.
Menopause-related insomnia "menopause transition" +Exacerbation of
Premenstrual Syndrome.
Obstructive sleep apnea syndrome "OSA".
Laboratory examination
FSH = 36 IU/ml
Estrogen = 180 mIU/ml
LDL, HDL, Cholesterol Levels are normal
T3, T4, TSH levels are normal
10. Diagnosis
Menopause insomnia +Exacerbation of Premenstrual
Treatment
Hormonal replacement therapy
Follow up
Severe headaches
11. Treatment
Lowering the dose of HRT
Follow up 2
CD reports that her headaches progressively disappeared
moderate hot flushes and night sweats
unable to remain asleep throughout the night
12. Treatment
Non-benzodiazepine sleeping agent
Hot flushes and sweating is a normal sign after lowering the dose of HRT
Follow up 3
CD achieve what she considers a “restorative” sleeping pattern.