Clinical Cases- the expert’s opinions!

Following an influx of discussion on literature, this afternoon it was time to turn our attention to clinical cases. In this post I’m going to cover two scenarios posed by Dr. Maki which were a popular source of discussion in the “Optimizing a healthy menopause diet and lifestyle session.”

The first case was centred on cognition. “A 50- year old woman is healthy with mild hot flashes. Her main complaint is that she is forgetful at work and in social situations. Her mother has Alzheimer’s disease and she is worried about whether she, too, might be getting dementia”

Dr. Maki then gave attendees four courses of action to choose from:

  • Refer her to a neurologist for an AD evaluation
  • Prescribe MHT for her memory problems
  • Prescribe a cholinesterase inhibitor
  • Help to normalise her experience by describing how women’s memory changes at midlife.

Whilst some people suggested giving the patient MHT, the most popular course of action was to normalise the patient’s experience.

So what does this mean in practice? Dr. Maki suggested explaining to the patient that 60-80% of women notice memory problems during transition, but data collected to date suggests this change in temporary. Although MHT may improve her memory problems (see blog post on a Link between MHT and Cognition?) as the patient is not experiencing VMS symptoms this is unlikely to be the first port of call. As well as normalising the situation other suggestions for the patient should include; a Mediterranean diet which has shown to improve memory, reduction in alcohol consumption, improvement in quality of sleep and practising of mindfulness.

The second case focused more on depression. “Deanne is a 48 year-old woman. During her annual exam, she said her periods are not as regular as they used to be but she has not skipped any periods. She said that she felt sad a lot lately, has trouble sleeping, and has withdrawn from her friends. These symptoms have affected her ability to maintain relationships and function at work as a corporate lawyer.  She got divorced a year ago and has felt depressed for months although she is not sure if her feelings are ones of true depression.”

It was agreed by the experts in the room, that the mention of depression should immediately focus the conversation. When a patient is depressed it is important to recommend that they come back for a longer discussion or referred to a mental health councillor, it is also vital to agree a plan with them if they do not attend that follow up session ( as often patients with depression do not come back to visit their doctor).

Hot flushes can contribute to depression as surges of glucocorticoid can lead to low mood. In this case cognitive behavioural therapy should be prescribed. Hormonal and non-hormonal VMS treatments should be discussed as well as gaging the patient’s interest in trying an antidepressant or seeing a psychologist.  

Do you agree with the advice given? Comment below and let us know what you would do in these scenarios!