A) History will include details of menstrual history as age at menarche as early mearche is on of risk factor for premature menopause, regularity of her cycles. Asking about her current contraception and if she is on hormonal contraception as COC or depot progesterone injection duration of her use which can affect her cycles as well as history of other medications like steroids, antipsychotic History of recent change in her weight , hair growth, nipple discharge. Lastely if she had recent chemo or radiotherapy treatment and family history of similar condition.
At examination I will check her BMI as obesity will point out to PCOS followed by systemic general examination of neck for any thyroid swelling ,breast for galactorrhoea, any central obesity,skin pigmentation. Pelvic examination to check uterine size and if any adenxal swelling.
B) I will check her hormonal profile as FSH >30 will diagnose Premature ovarian failure , I will check LH /FSH if raised ratio in cases of PCOS. Serum prolactin if galactorrhoea is present and serum androgens if abnormal hair growth or symptoms suggestive of virilism.
TVS is the next investigation tool to assess ovaries for cystic changes or any ovarian swelling and or other pelvic pathologgy. Other investigations like brain CT/MRI will only be needed if history and examination suggestive of intracranial leison or if there is galactorrhoea.
C) I will senstively explain the diagnosis of Premature ovarian failure and the implictions on her health
at short term regarding relief of symptoms like hot flushes ,sweating ,mood swings an long term regarding osteoporosis . So; if her main concern are menopausal symptoms I will offer sequential combined HRT if no contrindications after exlaining the benfits and risks.Althought pregnancy is rare in cases of POF but carries major risks so I will advice her to have contraception for 2 years fron the diagnosis . In case if she wish another pregnancy I will explain that that could only be possible by oocyte donation.Patient will need p[sychological support as well as information leaflet and support group.
Posted by Farrukh G.
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