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Old 10-26-2012
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Question Management of Menopause

A 54-year -old women complains of hot flashes and night sweats. Her last menstrual period was 2 years ago. She also has migraine headaches and a family history of breast cancer via maternal aunt. What is the appropriate treatment for her?
A) Hysterectomy
B) Endometrial biopsy
C) Metroxyprogesterone acetate
D) Estrogen cream
E) Estrogen and progestin therapy
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Old 10-26-2012
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i guess its C.
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Old 10-26-2012
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C) Metroxyprogesterone acetate (not estrogen due to her risk of breast cancer)

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Old 10-26-2012
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I am guessing it is C?
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Old 10-26-2012
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I would choose C) Metroxyprogesterone acetate. This woman has menopause symptoms with a history of breast cancer (so E is not an option). Estrogen cream is the treatment for atrophic vaginitis, which again I don't think it would be a good option because of her family history (estrogen is absorbed and can lead to increase in estrogen blood level).
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Old 10-26-2012
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I'd choose E.
I don't think progesterone derived drugs alone would relieve menopausal symptoms. It's the lack of estrogen that causes these symptoms.
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Old 10-26-2012
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thanks for the question

also would choose C) medroxyprogesterone acetate(coz have risk of breast cancer in family and also migraine history too..)
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Old 10-26-2012
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Answer C
This women has vasomotor instability and needs hormonal replacement.Because she has two contraindication to estrogen therapy
Metroxyprogesterone acetate is the best treatment of choice even though it is less affective that estrogen,it still can offer symptomatic relief.
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