A 48-year-old woman presents with hot flushes, night sweats, mood changes, and irregular periods for 8 months. Her FSH is 62 IU/L and estradiol is 22 pmol/L. She has no contraindications to HRT. She has an intact uterus. What is the APPROPRIATE hormone replacement therapy regimen?

• A Combined estrogen + progestogen HRT (sequential regimen if perimenopausal) ✓
• B Estrogen-only HRT (oral or transdermal estradiol)
• C Progesterone-only HRT for the first year
• D Tibolone as the preferred first-line HRT for all menopausal symptoms

Explanation

For a woman with an intact uterus, combined estrogen + progestogen HRT is mandatory — estrogen alone causes endometrial hyperplasia and increases endometrial carcinoma risk. In perimenopausal women (irregular periods still present for <12 months), a sequential (cyclical) combined regimen is used, providing a monthly withdrawal bleed. After 12 months of amenorrhea (postmenopausal), a continuous combined regimen can be used, which eliminates bleeds. Estrogen-only HRT is reserved for women who have had a hysterectomy.

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

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Written and medically reviewed by the StethoPrep medical team.