[Hot flashes resistant to hormone replacement in menopausal women: panic disorder?]

Of two women aged 52 and 49, the first one was treated with increasingly high doses of oestrogens to reduce menopausal complaints and the second suffered from menopausal complaints while receiving antiepileptic treatment following surgical removal of a meningioma. The women had hot flushes refractive to hormone supplementation. The first one even developed addictive symptoms, demanding more and more hormone supplementation from her gynaecologist as her symptoms would not subside. Ultimately a panic disorder was diagnosed in both women. Symptoms of panic disorder can be disguised as or comorbid with menopausal complaints such as hot flushes. As patients with these complaints present themselves generally to their general practitioner or gynaecologist, the panic disorder may easily be overlooked. Both women reacted well to reattribution of their complaints, explanation that they had developed a panic disorder, behaviour therapy and treatment with clomipramine. Clues for diagnosis are lack of reaction to hormonal supplementation, worsening of symptoms after hormonal supplementation, as well as a positive history for anxiety symptoms and somatizing behaviour.