The case studies and questions discussed in this podcast are listed below.

Jessica case study:

1. Is delay in a return to cycling after stopping a pill unusual?
2. When would you start to be concerned?
3. What Initial investigations would one advise for a young woman like Jessica, who’s got secondary amenorrhea? What would you ask for?
4. How common is premature ovarian insufficiency in Australia?
5. What are the reasons you might order these tests in more detail?
6. What are her chances of a spontaneous pregnancy with POI?
7. How common is that in the Australian population? How do we test for it and why is it so important to know whether someone’s a carrier?
8. Is a sister conception an option for Jessica if she fails to conceive spontaneously, and what are the options?
9. Does Jessica’s POI have any implications for her baby? And how would you suggest the discussion with the parents?
10. In view of Jessica’s POI, what would be your advice as to when she should stop her menopausal hormone therapy and any tips on weaning off if she wants to stop?

Sarah case study:

1. At what point would you suggest investigating irregular bleeding? what investigations would you recommend?
2. What causes this heavy bleeding in a woman in her 40s and the breasts symptoms Sarah is describing?
3. Why does that make prescribing conventional hormone therapy much more difficult?
4. Are there any tips for optimising the benefits of contraceptive pills in perimenopausal women?
5. Why do we need to stop using the pill at 50 and does that go for the newer pills as well?
6. What are the current recommendations as to when a woman can safely stop contraception and not be concerned about possible unintended pregnancy?
7. Tips in a general practice setting that are useful in discussing breast cancer risks with these patients.

Emma case study:

1. What are the causes of the emotional and psychological symptoms and how much evidence is there that menopausal hormone therapy helps?
2. Can you use menopausal hormone therapy, in addition to the patient taking Slinda?
3. What about this lack of desire that the patient describes? How common is that in the older women? Are there any other areas that should be explored?
4. What are the current indications for the use of exogenous testosterone? Are there any risks at all in using it?

Angela case study:

1. How common are vulva vaginal symptoms, post menopause and when are they most likely to kick in?
2. Are there any tips on using vaginal estrogen in someone like this patient?
3. What would you tell the patient on how long to use? Are there any health risks in its use long term?
4. If a patient has a family history of breast cancer, can vaginal estrogen still be used?

Host: Dr Terri Foran, Sexual Health Physician

Guests: Prof Rod Baber, Obstetrician and Gynaecologist, Dr Jane Elliott, General Practitioner & A/Prof John Eden, Gynaecologist

Total time: 59 mins

Recommended resources:

• Case study handbook – Menopausal hormone therapy panel