Case history
Case history
A 35-year-old woman has not resumed menses since stopping oral contraceptives 1 year ago. She reports normal puberty and regular menses both before and during her use of oral contraceptives. She had one normal pregnancy with a spontaneous vaginal delivery 3 years ago. She has no significant medical history except for mild hypothyroidism. She has noted occasional episodes of vaginal dryness and irritation and feels occasionally as if someone has turned the temperature up in the room. Sexual intercourse has become increasingly uncomfortable. A physical examination demonstrates atrophic changes in the vagina. A pregnancy test is negative.
Other presentations
Some women present with amenorrhoea before the age of 40 years as the only symptom of premature menopause. Others have signs of decreasing ovarian function for months or years before stopping menstruation, including infertility, irregular anovulatory bleeding, hot flushes, sleep disturbances, and irritability. Vaginal dryness and atrophy is a late sign of hypo-oestrogenaemia.
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