A 50 year old patient came to the clinic in september 2014., with following complaints

feeling so tired that she cannot even open her eyes!!

Heat in head..

Not able to eat as much as she wants

Constipation

Black spots in knees and hands

Cramps in muscles.

The reasoning for her complaints I could make out was:

She probably had oestrogen deficiency causing hot flashes.

fluctuations in oestrogen levels causing decreased serotonin causing depression

some amount of vitamin d3 deficiency

she was prescribed.

estradiol valerate 2mg daily for 28 days. no progesterone. so no worry of breast cancer ( no uterus so no worry of endometrial hyperplasia.)

vitamin d3 once weekly tablets

fluoxetin 20 mg daily

bisacodyl for constipation

tab vitamin e 400 mg for leg cramps

her symptoms decreased in 2 weeks time

and she has been put on fluoxetin, and calcium for long term and vitamin d3 for 8 weeks

question is back pain decreased for this patient.

is it because of d3? fluoxetin?calcium?

should we insist on dexa? and vitamin d3 levels?

is empirical treatment always right?

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