Though our clinic is small and run on minimal funding, it does allow for teaching. The spin off from this is that there are now a number of colleagues based in general practice whose knowledge, skills and confidence allow them to manage most menopause-related presentations. A referral from one of these general practitioners (GPs) immediately signifies that a challenge is on the way.Janet was one such woman. She was 65-years-old but had seen her last period only four years earlier. She was referred with severe vasomotor symptoms and generalized intense pruritis that she had had for the previous eight years. In the course of this time, she had sought the opinion of specialists in immunology, endocrinology and dermatology, none of whom felt that this was a problem of menopause. With a working hypothesis of idiopathic urticaria, she had been prescribed an antihistamine which had helped to ease the itching, but the problem had not gone away. She had also had a stabbing pelvic pain, worse when sitting and described as 'sitting on a hot stone'. Her GP had tried a variety of hormone replacement products but these had provoked the pelvic pain and been discontinued for that reason. I was asked whether this was a problem of menopause and what else might she try.
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