A 31-year-old woman with PCOS has 4 to 5 periods per year and does not desire pregnancy. She is counselled about long-term complications. Which intervention most directly reduces her risk of endometrial hyperplasia?
- A Cyclical progestogen therapy or a combined oral contraceptive ✓
- B Spironolactone 100 mg daily
- C Metformin 1500 mg daily alone
- D Vitamin D and calcium supplementation
Correct answer: A. Cyclical progestogen therapy or a combined oral contraceptive
Explanation
Chronic anovulation in PCOS produces unopposed oestrogen, driving endometrial hyperplasia and carcinoma. Regular progestogen exposure, either cyclically for 10 to 14 days per month or via a combined pill, induces withdrawal bleeding and protects the endometrium. Metformin improves metabolic parameters and may restore ovulation but is not prescribed as endometrial protection. Spironolactone treats hirsutism and has no effect on the endometrium.
Reference: Williams Gynecology, 4th ed.
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