tailieunhanh - Tình huống sản khoa - Tình huống 5

Tham khảo tài liệu 'tình huống sản khoa - tình huống 5', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 4 A 49-year-old woman complains of irregular menses over the past 6 months feelings of inadequacy vaginal dryness difficulty sleeping and episodes of warmth and sweating at night. On examination her BP is 120 68 heart rate is 90 min and temperature is 99 F. Her thyroid gland is normal to palpation. The cardiac and lung examinations arc unremarkable. The breasts arc symmetric without masses or discharge. Examination of the external genitalia does not reveal any masses. What is the most likely diagnosis What is your next diagnostic step 52 CASE EILES OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 4 Perimenopause Sunimarv A 49-year-oki woman complains of irregular menses feelings of inadequacy sleeplessness and episodes of warmth and sweating. Most likely diagnosis Climacteric perimenopausal state . Next diagnostic step Serum follicle stimulating hormone FSH and luteinizing hormone LH . Analysis Objectives 1. Understand the normal clinical presentation of women in the perimenopausal state. 2. Understand that elevated serum FSH and LH levels help to confirm the diagnosis. 3. Know that estrogen replacement therapy is usually effective in treating the hot Hushes. 4. Know the risks of continuous estrogen-progestin therapy. Considerations This 49-ycar-old woman complains of irregular menses feelings of inadequacy and intermittent sensations of warmth and sweating. This constellation of symptoms is consistent with the perimenopausc or climacteric. Between the age of 40 and 51 years the majority of women begin to experience symptoms of hypocstrogenemia primarily hot flushes. Hot Hushes which are the typical vasomotor change due to decreased estrogen levels arc associated with skin temperature elevation and sweating lasting for 2 to 4 min. The low estrogen concentration also has an effect on the vagina by decreasing the epithelial thickness leading to atrophy and dryness. Elevated serum FSH and LH levels are helpful in confirming the diagnosis of the perimenopausc. Treatment