04-2013 Case of the Month


What would you do in this this case?

A 50-year-old diabetic woman who has had a total abdominal hysterectomy presents with intractable night sweats that are not relieved by lifestyle measures. Her body mass index is 22 kg/m2 and she is a non-smoker.

Choose your answer:  

A. Non-hormonal therapy with gabapentin
B. Conjugated estrogens 0.625 mg
C. Transdermal estradiol 50 mcg
D. Micronized progesterone 300 mg nightly

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Answer A is incorrect: Non-hormonal therapy with gabapentin Rationale: Gabapentin is not FDA-approved for the treatment of hot flashes and is less effective than estrogen. 

Answer B is incorrect: Conjugated estrogens 0.625 mg Rationale: Conjugated estrogens are not a bad choice but oral estrogen may increase triglycerides and that may increase health risks in relation to transdermal estradiol. 

The correct answer is C: Transdermal estradiol 50 mcg Transdermal estradiol will relieve hot flashes with the greatest efficacy, is FDA-approved for this indication, and has a slight edge over oral conjugated estrogens because of the lack of effect on triglycerides. Canonico, M. and P. Y. Scarabin (2011). "Further evidence for promoting transdermal estrogens in the management of postmenopausal symptoms." Menopause 18(10): 1038-1039.  

Answer D is incorrect: Micronized progesterone 300 mg nightly Rationale: Micronized progesterone is not proven effective although there is one large scale trial that indicates it might work. Its efficacy in comparison to estradiol is not known and it is not FDA-approved for this indication. In a woman who has had a hysterectomy, it's also not a good first choice.

Learn more about this topic while earning CME at ASRM eLearn®.  


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