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Clinical case scenarios
122
EMAS2017 / Maturitas 100 (2017) 93–202
She says that life suddenly seems less joyful and she feels less energetic. She is working in a bank and she claims the hot flushes cause embarrassment in front of clients and colleagues. She wants to get rid of this misery. Her physician rightfully suggested to try HT. She said she heard about hormones, but is afraid of taking it because friends told her that this might be risky. She already tried some herbal products, which were not effective enough. She asked whether there are alternative medications with proven effects. Case 2 A 62-year healthy woman. Cessation of periods ten years ago. Feels well, but suffers from vaginal itching, unpleasant irritation and some discharge. She has a lovely partner, but had to reduce the frequency of sex because of painful intercourse. Her physician suggested to try HRT, local or systemic. She refused because her mother and aunt had breast cancer. She tested negative for BRCA. She thought the best for her would be a non-hormonal therapy, but was not sure whether she would feel comfortable with the local administration of a cream. She returned a year later. She tried lubricants but hated the texture.
ATE16
http://dx.doi.org/10.1016/j.maturitas.2017.03.093
Clinical case scenarios
ATE14
Sonia Cerdas
Clinical case scenarios
Clínica San Agustin, San José, Costa Rica
Henk Franke Franke Consultancy Holding BV, Enschede, The Netherlands 1. A 42 year old woman who has an irregular cycle complains of a loss of libido. She had undergone a sterilization and she doesn’t want hormone therapy. What would you recommend? 2. A 58 year old woman had a fracture of her left wrist. DXA investigation demonstrated osteoporosis. She has minor hot flushes but doesn’t want hormone therapy nor bisphosphonates. What would you recommend? 3. A 51 year old women has severe hot flushes and night sweats. She had her last menstrual period 1 year ago. She doesn’t want hormone therapy. What would you recommend? http://dx.doi.org/10.1016/j.maturitas.2017.03.094 ATE15 Clinical case scenarios Margaret Rees University of Oxford, Oxford, United Kingdom A 45 year old woman asks advice about how her hot flushes can be dealt with. She is taking tamoxifen following lumpectomy and radiotherapy for breast cancer. What would be your initial recommendation? A 62 year old woman asks advice about how her vaginal dryness can be dealt with. She has no hot flushes. What would you recommend? http://dx.doi.org/10.1016/j.maturitas.2017.03.095
Clinical case scenarios Petra Stute Inselspital Bern, Bern, Switzerland 1) 55-year old breast cancer survivor treated with aromatase inhibitors suffering from severe hot flushes. 2) 60-year old postmenopausal woman with severe vaginal dryness and dyspareunia but not wanting hormone therapy. 3) 50-year old perimenopausal woman presenting with depressive symptoms, hot flushes and sleep disturbances, not wanting hormone therapy. 4) 55-year old breast cancer survivor treated with aromatase inhibitors suffering from arthralgia. http://dx.doi.org/10.1016/j.maturitas.2017.03.096 ATE17
Case N◦ 1 - V.C. 52 years old presents with complaints of hot flushes and night sweats, 14–20/day, over the past 10 months. Her last period was one year ago. - She reports progressive fatigue and poor sleep quality. She suspended her exercise routine and she gained seven kilograms of weight. - Her gynecologist contraindicated the HRT use because her medical history of thrombophilia. - She reports a history of recurrent miscarriages and at age of 35 she suffered a deep venous thrombosis with no obvious precipitating cause. - A thrombophilia screening panel was performed documenting protein C deficiency and heterozygous mutation for factor V of Leiden and MTFHR. - She has since been treated with folic acid and low doses of aspirin and does not want to take any other medication. Case N◦ 2 L. P. 45 years old presents with complaints of intense and frequent hot flushes and night sweats. She reports feelings of hopelessness since her last period 2 years ago, when she started chemotherapy, followed by radiotherapy after left lumpectomy for Estrogen Receptor Positive Breast Cancer. Medication: She is under treatment with tamoxifen. Physical examination: excellent general health condition. Laboratory: Normal laboratory results. Case N◦ 3 P. O. 65 years old presents with complaints of vaginal dryness and frequent urinary infections. The symptoms have worsened during the last year. She tried using vaginal lubricants with poor results. She was sexual active, but has progressively lost her sexual drive, with vaginal dryness and low libido. Physical examination: severe vaginal and vulvar atrophy Laboratory: normal laboratory general results. Case N◦ 4 A.M. 62 years old was concerned about the diagnosis of osteopenia that was reported in a densitometry exam.
EMAS2017 / Maturitas 100 (2017) 93–202
She says that life suddenly seems less joyful and she feels less energetic. She is working in a bank and she claims the hot flushes cause embarrassment in front of clients and colleagues. She wants to get rid of this misery. Her physician rightfully suggested to try HT. She said she heard about hormones, but is afraid of taking it because friends told her that this might be risky. She already tried some herbal products, which were not effective enough. She asked whether there are alternative medications with proven effects. Case 2 A 62-year healthy woman. Cessation of periods ten years ago. Feels well, but suffers from vaginal itching, unpleasant irritation and some discharge. She has a lovely partner, but had to reduce the frequency of sex because of painful intercourse. Her physician suggested to try HRT, local or systemic. She refused because her mother and aunt had breast cancer. She tested negative for BRCA. She thought the best for her would be a non-hormonal therapy, but was not sure whether she would feel comfortable with the local administration of a cream. She returned a year later. She tried lubricants but hated the texture.
ATE16
http://dx.doi.org/10.1016/j.maturitas.2017.03.093
Clinical case scenarios
ATE14
Sonia Cerdas
Clinical case scenarios
Clínica San Agustin, San José, Costa Rica
Henk Franke Franke Consultancy Holding BV, Enschede, The Netherlands 1. A 42 year old woman who has an irregular cycle complains of a loss of libido. She had undergone a sterilization and she doesn’t want hormone therapy. What would you recommend? 2. A 58 year old woman had a fracture of her left wrist. DXA investigation demonstrated osteoporosis. She has minor hot flushes but doesn’t want hormone therapy nor bisphosphonates. What would you recommend? 3. A 51 year old women has severe hot flushes and night sweats. She had her last menstrual period 1 year ago. She doesn’t want hormone therapy. What would you recommend? http://dx.doi.org/10.1016/j.maturitas.2017.03.094 ATE15 Clinical case scenarios Margaret Rees University of Oxford, Oxford, United Kingdom A 45 year old woman asks advice about how her hot flushes can be dealt with. She is taking tamoxifen following lumpectomy and radiotherapy for breast cancer. What would be your initial recommendation? A 62 year old woman asks advice about how her vaginal dryness can be dealt with. She has no hot flushes. What would you recommend? http://dx.doi.org/10.1016/j.maturitas.2017.03.095
Clinical case scenarios Petra Stute Inselspital Bern, Bern, Switzerland 1) 55-year old breast cancer survivor treated with aromatase inhibitors suffering from severe hot flushes. 2) 60-year old postmenopausal woman with severe vaginal dryness and dyspareunia but not wanting hormone therapy. 3) 50-year old perimenopausal woman presenting with depressive symptoms, hot flushes and sleep disturbances, not wanting hormone therapy. 4) 55-year old breast cancer survivor treated with aromatase inhibitors suffering from arthralgia. http://dx.doi.org/10.1016/j.maturitas.2017.03.096 ATE17
Case N◦ 1 - V.C. 52 years old presents with complaints of hot flushes and night sweats, 14–20/day, over the past 10 months. Her last period was one year ago. - She reports progressive fatigue and poor sleep quality. She suspended her exercise routine and she gained seven kilograms of weight. - Her gynecologist contraindicated the HRT use because her medical history of thrombophilia. - She reports a history of recurrent miscarriages and at age of 35 she suffered a deep venous thrombosis with no obvious precipitating cause. - A thrombophilia screening panel was performed documenting protein C deficiency and heterozygous mutation for factor V of Leiden and MTFHR. - She has since been treated with folic acid and low doses of aspirin and does not want to take any other medication. Case N◦ 2 L. P. 45 years old presents with complaints of intense and frequent hot flushes and night sweats. She reports feelings of hopelessness since her last period 2 years ago, when she started chemotherapy, followed by radiotherapy after left lumpectomy for Estrogen Receptor Positive Breast Cancer. Medication: She is under treatment with tamoxifen. Physical examination: excellent general health condition. Laboratory: Normal laboratory results. Case N◦ 3 P. O. 65 years old presents with complaints of vaginal dryness and frequent urinary infections. The symptoms have worsened during the last year. She tried using vaginal lubricants with poor results. She was sexual active, but has progressively lost her sexual drive, with vaginal dryness and low libido. Physical examination: severe vaginal and vulvar atrophy Laboratory: normal laboratory general results. Case N◦ 4 A.M. 62 years old was concerned about the diagnosis of osteopenia that was reported in a densitometry exam.