A 55-year-old G3 P3 white female presents complaining of hot flashes, amenorrhea for 4 months then this month she had spotting for 3 days. She has breast tenderness, vaginal itching, and dyspareunia. Her husband had a vasectomy 20 years ago. She wants to know what she can do for relief. Her last pap was 2 years ago, negative. Her last MMGM was 5 years ago and was negative. FSH is 39. Height 5’ 8”, weight 110 lbs.

1. What additional history do you need from this patient?

2. What is your differential diagnosis?

3. What lab tests will you order and why?

4. What referrals will you provide and why?

5. What is your plan of treatment: medication, education?

6. What information will you provide regarding dyspareunia?

7. What complementary therapies might be helpful for this patient? Support with evidence based literature.

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