Menopause

Question 1

Case
A 53-year-old woman presents with occasional vaginal spotting, thin discharge, and dyspareunia. She has been menopausal for 2 years. 2 months ago, she had an endometrial biopsy that revealed no abnormalities. Medical history is otherwise unremarkable. On exam, the vaginal epithelium appears thin and inflamed.

Question
What is the treatment of choice?

Answer 1

Topical estrogen cream

Question 2

Case
A 53-year-old woman is seen by her gynecologist. She has had three children and had her tubes tied through tubal ligation. She reached menopause at 48. Over the last few weeks, she has noted some vaginal bleeding that occurs unpredictably. She has had regular pap smears that have always been normal. The last one was 11 months ago. Speculum examination and bimanual palpation of the genitalia reveal no abnormalities.

Question
What is the next step in the management of this patient?

Answer 2

Endometrial biopsy

Question 3

Case
A 54-year-old woman presents for her annual pelvic examination. Her last menstrual period was 1 year ago, and her last few cycles were extremely irregular. She describes multiple daily episodes of severe, intense heat in the face and trunk accompanied by sweating. She states that these “heat episodes” have been occurring 4-6 times daily for 4 months, and they interfere with her everyday activities and sleep. She reports no other symptoms. She has received yearly annual pelvic examinations and clinical breast exams and mammograms without any significant findings. Her past medical history is negative for cardiovascular disease, blood clots, and breast cancer. Her pelvic examination has findings of excessive dryness and apparent vaginal wall atrophy.

Question Highlights
What pharmacologic intervention can assist in minimizing these symptoms?

Answer 3

Menopausal hormone therapy