A 42-year-old mother of 2 children has undergone a total abdominal hysterectomy and bilateral salpingo oophorectomy 4 weeks ago, for extensive recurrent symptomatic pelvic endometriosis.
She attends your gynaecological clinic with her husband. The histopathology report confirms endometriosis. She complains of hot flushes. She is otherwise healthy.
- Outline the issues that you will discuss the with the couple. (30 marks)
She is iatrogenically menopaused.
She is having menopausal symptoms which affects her day to day life
She will experience other menopausal symptoms of reduced sexual functions, mood changes in addition to current problem which can cause family issues.
She is at risk of osteoporosis provided she has other risk factors.
She can be offered pharmacological and non pharmacological methods for hot flushes.
Starting HRT has a risk of reactivation of endometriosis needs to be balanced with her vasomotor symptoms.
Complications of HRT
- Critically evaluate the treatment options for this patient. (50 marks)
Non medical therapies-
Avoid excessive caffeine
Use cold pillows
Teaching relaxation techniques
Increase water intake
Meditation
Medical treatments
Hormonal- HRT
Non hormonal- SSRI, Clonidine, Isoflavones
- Describe the follow up plan. (20 marks)
Patient advice on warning signs
Evaluate for contraindications for HRT
Review the patient in 3 months time for symptom assessment
Continue HRT till natural age of menopause
Evaluate for osteoporotic fractures
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