A 54-year-old healthy woman with a history of hypothyroidism taking thyroid replacement medication comes in for her annual visit. Her last menstrual period was over 2 years ago and she reports severe hot flashes. They have greatly affected her quality of life and she must take frequent breaks at work. She wakes up frequently at night due to night sweats, which is impacting her sleep and, subsequently, her energy level. She has noted increased vaginal dryness so has been abstaining from sexual intercourse due to the discomfort. She has an intact uterus. Her family history is significant for heart disease, diagnosed in her mother at age 75.

Magnesium treatment reduces the risk of seizure in patients with preeclampsia. However, prolonged postpartum magnesium infusion may cause harm, including a delay in early ambulation, return to full diet, discontinuation of a bladder catheter, and initiation of breastfeeding.

How muscle mass, strength, and performance are playing a recognized role in bone health, plus when to measure BMD in premenopausal women R ecently, the National Osteoporosis Foundation (NOF) changed its name to the Bone Health and Osteoporosis Foundation (BHOF). Several years ago, in 2016 at my urging, this column was renamed from "Update on osteoporosis" to "Update on bone health. " I believe we were on the leading edge of this movement. As expressed in last year's Update, our patients' bone health must be emphasized more than it has been in the past. By contrast, in this country a hip fracture carries a mortality in the first year of 21%! 3 Furthermore, approximately one-third of women who fracture their hip do not have osteoporosis. While the risk of hip fracture is greatest in women with osteoporosis, it is not absent in those without the condition. Finally, the role of muscle mass, strength, and performance in bone health is a rapidly emerging topic and one that constitutes the core of this year's Update.

Reduce the use of perioperative opioids with a multimodal pain management strategy Patients undergoing cesarean surgery who were previously nave to opioid medications have a 0.33% to 2.2% probability of transitioning to the persistent use of prescription opioids. A multimodal pain management strategy for cesarean surgery, including intravenous ketorolac, has been shown to reduce the use of opioids both during hospitalization and following discharge from the hospital.