ABSTRACT
It is not surprising to find women who have experienced ovulatory difficulties presenting with slightly earlier than average perimenopausal symptoms. This may be consistent with the old observation that the later the menarche, the earlier the menopause (due to less ‘robust’ ovaries). A.R. is an ideal candidate for oral contraceptives. She is not fully menopausal, but she is quite symptomatic. The oral contraceptives also have the advantage of offering her some reduction in ovarian cancer risk. She is currently at somewhat increased risk given that she had only one child, as a result of significant FSH therapy. With regard to which pill to choose, really any 20-35 µg pill would be reasonable. In these circumstances, we gave her Mircette, a 20 µg pill which is packaged with five estradiol tablets in lieu of the last five placebo pills, which reduces menopausal symptoms during the withdrawal week.
