{"text":"v\u2019 \nJAD\/AMMCS \n_CLI 21.4.92. \nTYPED 22ND APRIL, 1992. L \nDr..M. Stephens, \nTHE HEALTH CENTRE \nBurngreen \nKILSYTH \nG65 OHY \nDear Dr. Stephens, \nAgnes Clelland, dob 8.9.55. Unit No. 338654 \n39 Rennie Road, Kileyth, G65. \nThank you for asking me to see this lady who has had qulte heavy perlods' \nfor some time with a lot of cramps. She also gets pre-menstrual \ndiscomfort which makes her feel as if she is pregnant: She also told me \nabout a pre-menstrual rash which she gets from time to time on different \nparts of her anatomy. Currently it is affecting her abdominal wall. \nShe .is otherwise okay. : \u2019 \nExamination shows that she is an obese lady with quite marked \nintertrigo in the abdominal skin .fold. Pelvic examination was \nessentially normal although it was difficult to be certain that there \nwas no uterine enlargment in view of her obeseity. \nShe tells me that the worst symptom is the bloating. She certainly \nseemed quite an unhappy lady and burst into tears .when I suggested that \ngetting her welght down may well help with her problems. Obviously. she \nis well aware of her weight difficulties and I think she would find it \nimpossible to lose the, amount of weight which would make any real \ndifference to her quality of lLfe. \nI really do not know where to start with her. She has quite bad \npre-menstrual symptoms and hormones may help with some of them. I think \nthe best thing would be to try her with a very small dose of Danol say \n100 mg. a day and hope that this does not make her weight problem any \nworse. It this is unacceptable then we may have to try her with some \ncombined oestrogen and progestogen preparatlon. I will see her again in. \nthree months' time.- . \u2019 \nYours sincerely - \nJ.A. Davis . \nConsultant Gynaecologist, \nKilsyth Health 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