Hot Flashes

HISTORY:

Hot flashes for ‍ ‍hoursdays

Severity: ‍mildmoderatesevere

Duration: ‍ ‍secminhours

Episodes: ‍ times per ‍hoursdaysweeksmonths

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective

‍sleep disturbances

‍night sweats

‍fever

‍chills

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍dizziness

‍cold sweats

‍irritability

‍mood swings

‍decreased concentration

‍vaginal dryness

‍decreased sex drive

Last menstrual period: ‍ ‍daysweeksmonthsyears ago



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Breasts: -R: ‍normal, -L: ‍normal

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Menopause ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍FSH, ‍LH, ‍estradiol, ‍TSH, ‍glucose, ‍LFTs, ‍creatinine, ‍β-hCG

- Urine: ‍urine catecholamines, ‍urine 5-HIAA

- Benefits of hormone replacement therapy discussed: control of symptoms, decrease in osteoporosis, endometrial cancer, colon cancer, myocardial infarction, and overall mortality

- Risk of hormone replacement therapy discussed: breast cancer, stroke, venous thromboembolism, gallbladder disease

- ‍Estrogens

- ‍Progesterone unnecessary if no uterus

- ‍Non-hormonal treatments

- ‍Over-the-counter remedies

- Reassess medications that may contribute to hot flashes (SSRIs, SNRIs, TCAs, opioids, tamoxifen, raloxifene, aromatase inhibitors, GnRH agonists, GnRH antagonists, antiandrogens, corticosteroids, isoniazid, hydralazine, niacin, metronidazole)

- Avoid hot environments

- Avoid caffeine

- Avoid alcohol

- Avoid spicy foods

- Regular exercise

- Referral to endocrinologist

- Referral to gynecologist

- Follow-up in ‍ ‍weeksmonths

- Return if hot flashes worsen, if new symptoms develop such as fever, chills, or weight loss