# data[].attributes.body
Nancy is experiencing symptoms of dysmenorrhea, hot flashes, sleep disturbances and irritability for the past 3 months and dyspareunia recently despite the use of lubricants confirming the diagnosis of menopause requiring pharmacological and non-pharmacological interventions to control these symptoms.

# data[].attributes.body
Reduce hot flashes within 3 months
Reduce symptoms associated with osteoporosis and increase bone density.
Reduce risk of falls.
Improve the quality of life.
Minimize adverse effects associated with therapy.

# data[].attributes.body
Non- pharmacological:

Wears layering clothes that can be removed

Avoid spicy food, coffee and hot beverages

stay in cool environment

Cranberry for UTIs

Psychological support

Pharmacological:

SSRIs

SNRIs

Dyspareunia: prasterone

# data[].attributes.body
Paroxetine 7.5 mg per day
Prasterone
Non pharm: Cranberry supplements for UTI

# data[].attributes.body
The clinical response is more rapid (days) in menopause than the typical response to SSRIs for depression (weeks).

SSRIs/ SNRIs appear to be equally effective in women with breast cancer and in women with surgical or natural menopause

Although no head-to-head trials have been performed, indirect comparisons suggest that Venlafaxine, Desvenlafaxine, Paroxetine, Citalopram, and Escitalopram have a similar modest benefit for hot flashes.

Several studies suggest against the use of Sertraline and Fluoxetine, because neither has a clinically important effect on hot flashes. In three trials, sertraline was no more effective than placebo.

Although Venlafaxine is well studied, it has more acute toxicity (nausea and vomiting) and can have significant withdrawal symptoms in occasional patients.

Prasterone - vaginal atrophy
Better than estradiol - can't give estradiol/estrogen bc of prev breast cancer.

# data[].attributes.body
Reduced vasomtor symptoms like hot flashes.
Reduced symptoms of dyspareunia.
Increased bone density.

# data[].attributes.body
DRP
Patient is experiencing symptoms of menopause like dysmenorrhea, hot flashes at night  and dyspareunia recently despite the use of lubricants requiring pharmacological and non-pharmacological management .

# data[].attributes.body
1- Nancy is experiencing symptoms of menopause (vasomotor symptoms) requiring initiation of therapy

# data[].attributes.body
Treat menopause sx (hot flashes usually at night, dysmenorrhea, irritability, dyspariunia not relieved by lubricants)

# data[].attributes.body
1- treat vasomotor symptoms
2- prevent complications
3- treat dyspareunia
4- minimize side effects of drug
5- improve quality of life
6- educate patient about pharmacological and non pharmacological treatment strategy

# data[].attributes.body
1. Ms Nancy is experiencing vasomotor symptoms (Hot flashes, sleep disturbance) Dyspareunia, dysmenorrhea.

# data[].attributes.body
Gabapentin Oral: Initial: 300 to 400 mg once daily at bedtime; some experts use an initial dose of 100 mg once daily to avoid adverse effects (Ref); increase gradually (eg, over 3 to 12 days) based on response and tolerability up to 600 mg to 2.4 g/day in 2 to 3 divided doses (Ref). Some experts suggest gabapentin for women whose symptoms occur primarily at night and favor a maximum dose of 900 mg to 1.2 g, given as one dose at bedtime (Ref).

# data[].attributes.body
Nancy is experiencing symptoms of menopause (vasomotor symptoms such as hot flashes, sleep disturbances, vulvovaginal symptoms such as dysparenia requiring initiation    of therapy

# data[].attributes.body
For hot flushes and night sweats:

·       Wear layered clothes that be removed or added as necessary

·       Turn the AC to lower room temperature

·       Spend time in open air

·       reduce amount of spicy food intake, caffeine, hot beverages

Vaginal Lubricant

# data[].attributes.body
AC
Light clothes
Avoid spicy food

# data[].attributes.body
non-hormonal therapy:
SNRI: venlafaxine
SSRI: paroxetine
clonidine
gabapentin

AND

vaginal moisturizer or lubricants

# data[].attributes.body
Paroxetine
Clonidine
Gabapentin
Tibolone
SNRI
MPA
Megestrol acetate

# data[].attributes.body
SSRIs/ SNRIs
Clonidine
Paroxetine
Venlafaxine
Citalopram
Ecitaloprem

# data[].attributes.body
1. Releive symptoms (vasomotor symptoms)
2. Minimize side effect of drug
3. Resolve pain and irritable dyspareunia
4. Improve quality of life
5. Educate about non pharmacological options

# data[].attributes.body
side effects:
nausea, somnolence, insomnia, headache

# data[].attributes.body
Paroxetine 7.5 mg/day

# data[].attributes.body
Pharmacological
1-Paroxetine 7.5 mg orally per day
2- Vaginal Lubricant Gel -KY- apply liberal so that your vulva and vagina are sufficiently wet as needed

Non-Pharmacological
1- For Vasomotor symptoms
Wear layered clothes that be removed or added as necessary

Turn the AC to lower room temperature
Spend time in the open air

Reduce the amount of spicy food intake, caffeine, and hot beverages

# data[].attributes.body
Pharm
1. SSRI (paroxetine, sertraline) SNRI (venlafaxine, duloxtine, desvenlafaxine)
2. clonidine
3. Gapapentin
4. Vaginal mositurizing

Non-pharm
1.Wearing layered clothing that can be removed or added as necessary
2. Lowering room temperature
3. Decreasing intake of hot spicy foods, caffeine, and
hot beverages
4.Exercise

# data[].attributes.body
Comparisons of gabapentin and placebo revealed reductions of 20% to 30% in the frequency and severity of hot flashes with gabapentin
A randomized, double-blind, placebo-controlled trial concluded that Gabapentin at 900 mg/day is an effective and well-tolerated treatment for hot flashes in women treated for breast cancer.

# data[].attributes.body
Pharm:
1. Paroxetine 7.5mg per day
2. Non estrogen mostorizing cream

Non-pharm
1.Wearing layered clothing that can be removed or added as necessary
2.Lowering room temperature
3. Decreasing intake of hot spicy foods, caffeine, and
hot beverages