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Case #827
Council on Menopause Management

A 52-year-old Caucasian woman with fatigue, sleep disturbances, and hot flushes who has been experiencing painful intercourse

Release Date: October 15, 2009
Expiration Date: October 14, 2010

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Chief Complaint

Fatigue, sleep disturbances, hot flushes, pain with sexual intercourse

History of Present Illness

Elizabeth is a 52-year-old Caucasian woman who comes to the office for a routine blood pressure check. She mentions that she is not sleeping well lately and finds herself feeling fatigued. During the past 3 months, she has had difficulty falling asleep and is easily awakened by noises in the night. Upon further discussion, she admits to feelings of warmth and drenching sweats that come and go in an unpredictable manner. She mentions that her sex drive is not what it used to be, and when she has intercourse with her partner, it is somewhat painful. She is not sure whether she has decreased desire or is afraid of painful intercourse.
   
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Disclosures and Important Information


Sponsored by the Duke University School of Medicine


In collaboration with MedCases, LLC

Supported by an educational grant from Wyeth Pharmaceuticals, Inc.

Release Date: October 15, 2009

Expiration Date: October 14, 2010

Estimated time to complete this activity: 1.0 hour

Accreditation Statement

The Duke University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement

The Duke University School of Medicine designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

"The Council on Menopause Management" has been reviewed and is acceptable for up to 4.0 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins September 15, 2009. Term of approval is for one year from this date. (Each case study is approved for 1.0 Prescribed credit; the newsletter is approved for 1.0 prescribed credit; and the video is approved for 1.0 prescribed credit. Credit may be claimed for 1 year from the date of this case study).

Faculty

Charles B. Hammond, MD
E. C. Hamblen Professor
Chair Emeritus, Department of Obstetrics and Gynecology
Reproductive Endocrinology and Fertility
Duke University Medical Center
Durham, NC

Faculty Reviewer

Michelle P. Warren, MD
Medical Director, Center for Menopause, Hormonal Disorders and Women’s Health
Department of Obstetrics and Gynecology
Columbia University Medical Center
New York, NY

Target Audience

This activity is intended for gynecologists, family practitioners, internists, and other practitioners who care for menopausal women.

Prerequisites

There are no prerequisites.

Statement of Need

Menopause-related vasomotor symptoms can diminish menopausal women’s quality of life. With so many different types of interventions available for the treatment of vasomotor symptoms, women should be active participants in the treatment decision-making process. This educational activity has been designed to facilitate application of the latest research and guidelines to help clinicians improve counseling, management, treatment, and care of menopausal women with the ultimate goal of increasing their longevity and quality of life.

Objectives

Upon completion of this case, you should be able to:

  • Describe the impact of menopause on life functions and quality of life
  • Discuss the effects of hormone therapy (HT) on menopause symptoms
  • Identify the effects of SSRIs, SSNRIs, and gabapentin on hot flushes, mood, and depression
  • Discuss the use of alternative agents for the management of menopause therapy

Method of Participation

This Internet-based activity takes approximately 1 hour to complete. You should review the objectives and case, answer the multiple-choice post-test and complete an evaluation form online. Once completed, you will be able to save your certificate to your own computer and print it on your own printer.

Staff and Content Validation Reviewer Disclosure

The staff involved with this activity and any content validation reviewers of this activity have reported no relevant financial relationships with commercial interests.

Policy on Speaker and Provider Disclosure

In accordance with the ACCME Standards for Commercial Support of CME, the Duke University School of Medicine implemented mechanisms, prior to the planning and implementation of this CME activity, to identify and resolve conflicts of interest for all individuals in a position to control content of this CME activity.

Planning Committee/Faculty Disclosure

The following planning committee members have indicated they have no relationship(s) with industry to disclose relative to the content of this CME activity: Brian McDonough, MD; Lillie Chen; Carolyn Darrow, MPH; and Daryl Ehrentreu, RPh, MBA.

The following speakers and/or planning committee members have indicated that they have relationship(s) with industry to disclose:

David Archer, MD Consultant: Bayer, Schering Plough Organon, Agile Therapeutics, Radius Pharmaceuticals Inc, Xanodyne
PI: Wyeth, Bayer, Schering Plough Organon, Zanodyne
Speaker: Wyeth, Schering Plough Organon
Charles B. Hammond, MD Board Member and Scholar Award: Bayer Pharmaceuticals
Michelle P. Warren, MD Consultant: Barr Laboratories (Duramed), Bradley Pharmaceuticals, Ferring, QuatRx, Warner Chilcott, National Cattlemans Beef Association
Speaker: Novartis, Novo Nordisk, Upsher Smith, Warner Chilcott, Wyeth Pharmaceuticals Inc.
PI: Novartis, Solvay, Wyeth Pharmaceuticals, Inc., Ferring
Solicited Manuscript: Up to Date
Advisory Board Member: Yoplait
Wyeth-Ayerst Professor of Woman's Health: Wyeth Pharmaceuticals, Inc.

Off-label Statement/Unapproved Uses

The Duke University School of Medicine requires CME faculty (speakers) to disclose to attendees when products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not FDA approved); and any limitations on the information that is presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. Faculty will discuss information about pharmaceutical agents that is outside of U.S. Food and Drug Administration approved labeling. This information is intended solely for continuing medical education and is not intended to promote off-label use of these medications. If you have questions, contact the medical affairs department of the manufacturer for the most recent prescribing information.

No faculty member has indicated that their presentation will include information on off-label products.

Disclaimer

The information provided in this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own.

The MedCases Web site does not define a standard of care, nor is it intended to dictate an exclusive course of management. Cases are provided for informational and educational purposes only and are not intended as medical advice. This information should not substitute for a visit or consultation with a health care provider.

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Copyright Information

© 2009 MedCases, LLC and Duke University School of Medicine

For Further Information

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For Questions/Information Regarding CME Credits:

Duke University School of Medicine Office of CME
3100 Tower Boulevard, Suite 1300
Durham, NC 27707
Phone (919) 401-1200
Fax (919) 401-1213
cme@mc.duke.edu
http://cme.mc.duke.edu

Hardware/Software Requirements and Technical Assistance

This Web-based CME activity is best experienced using a current generation browser, such as Internet Explorer 5.5 or higher. This Web site requires that JavaScript and session cookies be enabled. In addition, you will require the Adobe Flash Player plugin to view the case simulation.

Detailed Requirements:

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  • Windows 98 or newer
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  • Audio playback with speakers for programs that have video content
  • Internet Explorer 5.5 or higher or Mozilla Firefox 1.0 or higher or Apple Safari
  • 1024 x 768 resolution
  • Broadband connection highly recommended

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