AB, a 50-year-old female, presents with hot flashes, chills, and mood changes. Her menstrual periods have been irregular over the last year and she has a low libido. Laboratory tests show elevated FSH and normal thyroid levels. She is diagnosed with menopause-related hormonal dysfunction and treated with antidepressants and hormone replacement therapy, which improve her symptoms. JH, a 16-year-old female, has had irregular periods since age 13 and symptoms of mood changes and hot flashes. Laboratory tests show elevated FSH and normal thyroid and calcium levels. She has a history of fractures and low bone density. She is diagnosed with premature ovarian failure and treated with hormone replacement therapy and calcium

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.