EP is a fifty-year-old woman who reports experiencing two to three hot flashes per day, occasionally associated with insomnia. She also states she is awakened from sleep about two to three times per week, needing to change her bedclothes and linens due to sweating. Her symptoms began about three months ago, and over that time, her symptoms have worsened to the point where they have become very bothersome. She is concerned about starting any hormonal treatment because she has read news stories that the medication is not safe. She has been successfully treated for depression and is currently doing well on paroxetine. Her current medications include omeprazole 20 mg daily, paroxetine 20 mg, Synthroid 0.075 mg daily, and hydrochlorothiazide 25 mg daily. Her physical exam is normal; her blood pressure is 128/86, her pulse is 78, and her body mass index (BMI) is 30.5. Answer the following questions:

Is there any additional information you would want to collect?

What are the variables you would take into account before deciding how to help her?

What treatment will you recommend?

What nonpharmacological treatment would you suggest?

For medications, include dosages and schedules. Include highlights of patient teaching and/or lifestyle alterations. Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication.

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