HRT Decision Making Quiz

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15 Questions

What is the most likely diagnosis for the 52-year-old university lecturer?

Menopause

What supports the diagnosis of menopause in the given history?

Average age of menopause in the UK

What additional symptoms should be considered to support the diagnosis?

Depression and hair loss

What family history factors are important to consider in this case?

Osteoporosis, breast cancer, and heart disease

What clinical examination is necessary for this patient?

General examination including blood pressure measurement

What additional symptoms of menopause should be considered in the history?

Depression, loss of libido, hair loss, dry skin, and painful intercourse (dyspareunia)

What are the important family history factors to consider in this case?

Family history of osteoporosis, breast cancer, or ischaemic heart disease, or early menopause

What clinical examination is necessary to perform and why?

General examination, including blood pressure measurement, to exclude hypertension

What would warrant further investigations in this case?

Any evidence of vaginal bleeding

What supports the diagnosis of menopause in the given history?

The patient has been suffering from menopausal symptoms for 3 years, indicating that the climacteric and menopause are occurring at the appropriate age

Should I take HRT. A slim 52-year-old university lecturer presents with an 18month history of amenorrhea and a 3-year history of hot flushes and night sweats. She has a family history of heart disease and breast cancer. Should I take HRT. Q1: What is the likely differential diagnosis. A1

Menopause

Q2: What issues in the given history support the diagnosis. A2

The average age of menopause in the UK is 51 years. This patient has been suffering from menopausal symptoms for 3 years, indicating that the climacteric and menopause are occurring at the appropriate age.

Q3: What additional features in the history would you seek to support a particular diagnosis. A3

Other symptoms of the menopause include depression, loss of libido, hair loss, dry skin and painful intercourse as a result of a dry vagina (dyspareunia). It is important to check whether there is any family history of osteoporosis, breast cancer or ischaemic heart disease, or early menopause, as well as checking factors such as smoking, previous Colles’ or hip fracture, sedentary lifestyle and low body mass index. It would be important to exclude any evidence of vaginal bleeding, which would warrant further investigations (see Case 10.3)

Q4: What clinical examination would you perform and why. A4

General examination, including blood pressure measurement, is necessary to exclude hypertension.

Q5: What are the important family history factors to consider in this case. A5

Heart disease and breast cancer

This quiz explores the decision-making process for hormone replacement therapy (HRT) in menopausal women. It presents a case of a 52-year-old woman with symptoms and family history, prompting consideration of HRT.

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