Menopause e-Consult for Healthcare Professionals 

The Menopause e-Consult e-Newsletter is a benefit of membership in The Menopause Society. This bimonthly publication presents clinical questions and cases commonly seen in a menopause specialist’s practice. Recognized experts in the field provide their opinions and practical advice in response.

2024 Menopause e-Consult Example

Here’s a sneak peek at the March 2024 issue of Menopause e-Consult. 

Case: A 52-year-old woman presents to her menopause healthcare clinician having had 3 months of vaginal bleeding. She has been on hormone therapy (HT; transdermal estradiol patch and Prometrium) for 5 years, with excellent control of her vasomotor symptoms. She reports no missed doses or changes in other medications. Her last menstrual period was at age 48. Her medical history indicates hypercholesterolemia, class 2 obesity, and well-controlled diabetes. Her social history says that she is Black and not sexually active. She had a similar episode 3 years ago and underwent an ultrasound. The endometrial stripe was 2 mm, thus an endometrial biopsy was not performed. The clinician increased the Prometrium for 3 months, and the bleeding never recurred. Her clinician recently read an article that concluded that ultrasound evaluation in Black women with postmenopausal bleeding is neither sensitive nor specific, contributing to undiagnosed endometrial cancer. The clinician would like to know current best practice guidelines for evaluating postmenopausal bleeding in Black women, specifically regarding ultrasound findings, performing an endometrial biopsy, risk factors, and HT status. 

—Submitted by Sally MacPhedran, MD, FACOG, IF, MSCP, Cleveland, Ohio 
—Commentary by Steven R. Goldstein, MD, FACOG, CCD, MSEC, New York 

Question: A 56-year-old woman was diagnosed with left breast ductal carcinoma in situ at age 45. She underwent lumpectomy and local radiation and completed 5 years of tamoxifen. Her last menstrual period was at age 50. She is experiencing moderate vasomotor symptoms that disturb her sleep and is having dyspareunia and urge incontinence. She has tried various botanical and selective serotonin-reuptake inhibitors (venlafaxine) that were ineffective at controlling her nightly symptoms. At her annual visit, she asked whether she can be prescribed hormone therapy, given that she is more than 10 years from her cancer diagnosis. How would you respond to her request? 

—Submitted by Leigh K. Lewis, ND, LAc, Phoenix, Arizona 
—Commentary by Holly J. Pederson, MD, MSCP, Cleveland, Ohio 

Menopause e-Consult e-Newsletter presenting clinical questions and cases.