Reference no: EM133484853

Assignment:

Johara is a 50-year-old cashier who presents to you complaining of hot flushes with sweating 2-3 times a day over the last year. Her symptoms make it difficult for her to concentrate at work. She feels tired most of the day due to lack of sleep. She states that her menstrual cycle has been irregular for the last 12 months, with menses occurring every 6-7 weeks. Her symptoms remain unchanged, despite lifestyle measures such as reducing her caffeine intake and regular yoga. Her friends suggested that either complementary medicines or hormone therapy could be useful. She needs effective treatment but is confused about the right therapy for her symptoms. She is also concerned about the safety of these medicines. Her age at menarche was 13 years. Her past menstrual history includes light and regular 30-day cycles. Her last menses was two months ago.

She is a single mother with two sons aged 9 and 12 years. Her pregnancies were without any complications. She has an intact uterus, and has regular mammograms and Pap smears (which have been normal). She does not smoke or drink alcohol. There is no family history of breast cancer. On examination she looks tired. Her blood pressure is 130/82 mmHg, pulse is 80/min and bodymass index is 30.5 kg/m2 . The rest of the physical examination was unremarkable. Hyperthyroidism has been excluded. Her blood pressure is 120/70 and her total cholesterol is 185 mg/dL with LDL at 125 mg/dL, HDL 60 mg/dL and triglycerides 90mg/dl.

1) Which of the following symptoms are related to Menopause?

2) A selective estrogen modulator drug called Tamoxifen is better than HRT for Johara. SERMs..

If a blood test is performed on Johara, which of these hormones will be lowered.