Practice observed.

Abstract

‘‘I would be grateful if you could see this 50 year old woman in your clinic. She has a longstanding mood disorder. She describes herself as always being feisty and prone to extremes of mood and has often drunk to excess to blot out days when she feels bad. More recently her mood seems to have been more unstable resulting in antisocial behaviour, where she has been arrested, suicidal ideation and at other times is very over stimulated. Worsening of her mood has coincided with perimenopause and for a short while was on HRT which possibly seemed to improve matters. However there is a marked family history of breast cancer, her mother developed it in her 30’s and her sister had ovarian cancer at the age of 28. She has now been discharged from the family history clinic and screening there and is being screened by the NHS breast programme 3 yearly. She had a vaginal repair earlier this year. She is awaiting assessment by the mental health services. I would however be grateful for your input on the level of risk involved with HRT and what you feel the potential benefits are in her. Many thanks’’.