Susan is a 39-year-old (G2P2) married white female with menstrual cycle changes

 

Susan is a 39-year-old (G2P2) married white female with menstrual cycle changes. She tells you, “My bleeding varies in how heavy or light it is—sometimes I am 5 to 7 days late and only have light spotting”. She reports that she has become much more irritable and moody prior to the onset of her menses, and is experiencing hot flashes and night sweats that wake her up two to three times a night. She is fatigued and finds herself dozing off throughout her work day. Her boss has commented on fatigue and has suggested she see her health care provider.

Questions

What is the background or “big picture” of the problem or issue?”
On an average, what is the length of a normal menstrual cycle?
A deficit in which hormone can lead to heavy menstrual bleeding and hot flashes?
What laboratory abnormalities would you anticipate, given her menopausal symptoms?

 

Sample Solution

Big Picture of the Problem

Susan’s symptoms (irregular menstrual cycle, mood swings, hot flashes, night sweats, fatigue) suggest she might be experiencing perimenopause. This is the transitional period leading up to menopause, when a woman’s ovaries start producing less estrogen.

Normal Menstrual Cycle Length

On average, a normal menstrual cycle is 28 days, but it can range anywhere from 21 to 35 days.

Hormone Deficiency

A deficit in estrogen can lead to heavy menstrual bleeding and hot flashes.

Laboratory Abnormalities

While a full workup would be necessary for diagnosis, some anticipated laboratory abnormalities associated with perimenopause might include:

  • Elevated FSH (Follicle Stimulating Hormone): FSH levels rise as the body tries to stimulate the ovaries to produce more estrogen.
  • Estradiol levels: Estradiol is the most potent form of estrogen and might be lower than usual.
  • Thyroid tests: Sometimes, thyroid issues can mimic perimenopause symptoms, so these tests may be included to rule out other causes.

Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult a healthcare provider for diagnosis and treatment.

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