The MENQOL questionnaire and Greene Climacteric Scale are validated tools for assessing menopause-related quality of life. According to MHT (menopausal hormone therapy) prescribing in India (Indian Menopause Society 2022 position statement), which is the recommended first-line MHT for a 52-year-old woman with an intact uterus experiencing severe vasomotor symptoms?
- A Estrogen-only therapy with conjugated equine estrogens 0.625 mg daily
- B Tibolone 2.5 mg daily as it avoids the need for separate progestogen
- C Combined estrogen-progestogen therapy (17β-estradiol + micronized progesterone 200 mg sequentially for 12-14 days/cycle) ✓
- D SERM (raloxifene) plus estrogen without progestogen for women with uterus
Explanation
For women with an intact uterus, unopposed estrogen is contraindicated due to risk of endometrial hyperplasia/carcinoma. Combined estrogen-progestogen therapy is required. The IMS/NAMS/BMS (2022-2023 guidelines) recommend 17β-estradiol (transdermal preferred: patches 50-100 mcg, gel 0.75-1.5 g) combined with natural micronized progesterone 200 mg for 12-14 days per cycle (sequential) or 100 mg daily (continuous). Micronized progesterone (Utrogestan/Prometrium) is preferred over synthetic progestins due to better tolerability and cardiovascular/breast profile. Tibolone has combined estrogenic, progestogenic, and androgenic activity but is not preferred as first-line in India due to stroke risk in older women (LIFT trial). Raloxifene is a SERM for osteoporosis and does not adequately treat vasomotor symptoms.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.