All Sample Questions

Menopausal Symptoms 1

Question

Vignette: A 45-year-old woman presents to the clinic complaining of severe hot flashes and night sweats. She reports that she underwent a total hysterectomy 2 years ago due to severe endometriosis. She says her symptoms have been causing her significant discomfort, and she is having difficulty sleeping through the night. Her medical history is significant for deep vein thrombosis. She is currently on warfarin for anticoagulation. She asks you if there are any medications that can alleviate her symptoms. Which of the following would be the most appropriate treatment for this patient?

Choices

A. Estrogen replacement therapy

B. Alendronate

C. Progesterone

D. Selective estrogen receptor modulator (SERM)

E. Medroxyprogesterone

Answer

D. Selective estrogen receptor modulator (SERM)

Explanation

This patient is presenting with symptoms of menopause, which include hot flashes, night sweats, and sleep disturbances. Estrogen replacement therapy is typically the first line treatment for these symptoms. However, in this patient, estrogen replacement is contraindicated due to her history of deep vein thrombosis. The use of estrogen can increase the risk of thromboembolic events. Instead, selective estrogen receptor modulators (SERMs), such as raloxifene, can be used. SERMs have estrogen agonist effects on bone (preventing osteoporosis) and the cardiovascular system (reducing LDL and total cholesterol), but they act as estrogen antagonists on the breast and endometrial tissue. They are associated with a decreased risk of breast cancer and do not increase the risk of endometrial cancer. However, like estrogen, they can increase the risk of venous thromboembolism, but in this case, the patient's anticoagulation with warfarin mitigates this risk. Thus, SERMs would be the most appropriate treatment for this patient.