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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