A 52-year-old woman has been menopausal for 2 years. She has moderate vasomotor symptoms, no uterus (previous hysterectomy for fibroids), and no personal or family history of breast cancer or thromboembolic events. The MOST appropriate hormone therapy is:

• A Combined oestrogen-progestogen oral HRT
• B Tibolone 2.5 mg daily
• C Oestrogen-only HRT (oral or transdermal) ✓
• D Venlafaxine 75 mg daily as non-hormonal alternative

Explanation

In a hysterectomised menopausal woman, oestrogen-only HRT is the therapy of choice; progestogen is not needed as there is no uterus to protect from oestrogen-induced endometrial hyperplasia. Adding progestogen to oestrogen in hysterectomised women increases breast cancer risk without benefit (Women's Health Initiative). Transdermal oestrogen is preferred over oral due to lower venous thromboembolism risk. Tibolone and non-hormonal agents are alternatives when oestrogen is contraindicated.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.