Notes

Hormone replacement therapy - The principal symptom of endometrial cancer is abnormal vaginal bleeding. Although the patient’s worsening symptoms make treatment an important consideration, the specific organic cause(s) of abnormal bleeding must be ruled out prior to initiating therapy with HRT. A tissue diagnosis consistent with normal endometrium or a pelvic ultrasound with an endometrial stripe of <4 mm ought to be documented.
average age of menopause is 51.3.
postmenopausal women require a total of 1200 mg of elemental calcium per day.
Prior to beginning treatment with bisphosphonates, a bone mineral density (BMD) should be documented and repeated at two-year intervals to monitor treatment.
An FSH level is not indicated as by definition she is menopausal given amenorrhea for greater than 12 months. Estrogen and LH levels are not indicated in the diagnosis of menopause
The World Health Organization (WHO) defines osteopenia (low bone mass) as -1 to -2.5 but interpret with other risk factors before deciding on whether to treat.
Estrogen production by the ovaries does not continue beyond menopause. Since menopausal ovaries are known to continue production of androgens, surgical removal of postmenopausal ovaries may result in the resurgence of menopausal symptoms from the abrupt drop in circulating androgens.
Primary infertility is defined as the inability to conceive for one year without contraception.
Metformin and ovulation induction agents are the first-line of treatment for ovulatory dysfunction in PCOS patients.
This patient has hyperprolactinemia due to imipramine.
This patient is having abnormal cycles due to hypothyroidism, which is also the most likely cause of her hyperprolactinemia.
This patient most likely has exercise-induced hypothalamic amenorrhea, which is characterized by normal FSH and low estrogen levels
This patient, most likely, has decreased ovarian reserve due to her age. A clomiphene challenge test, which consists of giving clomiphene citrate days five to nine of the menstrual cycle and checking FSH levels on day three and day 10, will help determine ovarian reserve. This will help counsel the patient on appropriate options to have a child, as most women will not be able to conceive at this age and would not be good candidates for ovarian stimulation or IVF.
During menopause, your FSH levels increase, and estrogen levels decrease.
The basal body temperature charts tell when a patient ovulated retrospectively, so it cannot be used to time intercourse to conceive, as the egg is only viable for about 24 hours
PMDD is a psychiatric diagnosis, describing a severe form of premenstrual syndrome in which the diagnostic criteria include five out of 11 clearly defined symptoms, functional impairment and prospective charting of symptoms present during the last week of the luteal phase that begin to resolve with the beginning of the follicular phase.
Vitamin deficiency of A, E and B6 have been associated with an increase in PMS.
This woman has premenstrual syndrome (PMS) with symptoms that warrant treatment. Patients with PMS and premenstrual dysphoric disorder (PMDD) experience adverse physical, psychological and behavioral symptoms during the luteal phase of the menstrual cycle. Mild symptoms of PMS often improve by suppressing the hypothalamic-pituitary-ovarian axis with oral contraceptive pills.
Selective serotonin reuptake inhibitors increase the amount of active serotonin in the brain and have been found to be effective in alleviating PMS and PMDD symptoms.