1) What are the common presenting symptoms of the menopause.

2) Which patients are most at risk for future osteoporosis.

3) How do you manage a fifty four year old woman troubled by  hot flushes and night sweats

(a) who has not had a period since she was fifty,  or
(b) who's last period was three months ago
(c) same as (b) but does not want HRT induced bleeds
(d) who has angina
(e) who has had a DVT
(f) who had a Wertheim's hysterectomy and radiotherapy
                                    for invasive carcinoma of the cervix aged fifty
(g) who has had a mastectomy
(h) who has a strong F.H. of stroke
(i) who loves horses

4) How do you advise a woman who wants HRT to prevent possible future osteoporosis?

5) How do you advise a woman who is has menopausal symptoms and is interested in HRT but is
   worried about the risk of breast cancer?

6) What can you do to help a patient with an intact uterus who is:

(a) on oral cyclical HRT
(b) on hormone patches
(c) having oestradiol implants

   but feels irritable and pre-menstrual when taking cyclical progesterone.

7) How do you help an 80 year old woman who has severe atrophic (senile) vaginitis. She had
   radical treatment 15 years ago for carcinoma of the body of the uterus.

8) How might you treat a 38 year old patient with severe premenstrual syndrome

9) How do you cope with tachyphylaxis?

10) What are the advantages and disadvantages and of:

(a) Short term HRT
(b) Long term HRT



                                          Tutorial provided by Andrew Crawshaw - Mevagissey - 1999