A 65 year old lady came with history of having hot flashes since 10 years. She has under gone hysterectomy 12 years back. She gets hot flashes particularly on the left side. She is diabetic on oral drugs. She had a transient ischaemic attack 4 years back and is now on low dose aspirin.

Estrogen therapy may cause stroke in women after 60 years, since there may be plaques in her vessels which may increase the incidence of stroke. Since she has already had a stroke, definitely estrogen is contraindicated. there is no definite data on the use of tibolone in patients with stroke.

So I put her on Venlafaxine 75mg per day, estro G, a tablet containing korean root extracts and an isoflavone powder. Any other suggestions?

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