Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

970 Menopause Menstrual Cycle Disorders for the Generalist

For short-term for hot flashes only, if uterus absent:

➣Oral conjugated estrogens

➣Oral microcronized estradiol

➣Transdermal estradiol

■HRT if uterus present, add progestin to estrogen to prevent endome-

trial carcinoma: medroxyprogesterone or other progestins daily or

for part of cycle

■Clonidine

Side Effects & Contraindications

■Side Effects

➣Irregular vaginal bleeding/spotting

➣Breast tenderness

➣Leg cramps

➣Endometrial cancer/hyperplasia with unopposed estrogens

➣Gallbladder disease

➣Abnormal clotting

➣Hypertriglyceridemia and pancreatitis

■Contraindications

➣Personal/family history of breast or endometrial cancer

➣Abnormal vaginal bleeding

➣Pain in calf or chest, shortness of breath, or coughing of blood

➣Severe headache, dizziness, faintness, or changes in vision

➣Unevaluated breast lumps

➣Jaundice

➣Depression

follow-up

n/a

complications and prognosis

Osteoporosis

MENSTRUAL CYCLE DISORDERS FOR THE GENERALIST

MAXINE H. DORIN, MD

REVISED BY FREDRIC B. KRAEMER, MD; ANDREW R. HOFFMAN, MD; and

THOMAS F. McELRATH, MD, PhD

history & physical

History

■Premenstrual syndrome (PMS): cyclic appearance of symptoms just

prior to menses that adversely affects lifestyle or work, followed by

period entirely free of symptoms