The MRS (Menopause Rating Scale) and the Greene Climacteric Scale measure menopausal symptoms. Genitourinary syndrome of menopause (GSM) was defined in 2014 as a replacement for the term 'vulvovaginal atrophy'. Which of the following treatments for GSM is considered preferred over systemic HRT because it achieves efficacy with minimal systemic oestrogen absorption?
- A Low-dose vaginal oestrogen (vaginal oestradiol tablet 10 mcg or vaginal oestrogen cream) ✓
- B Oral conjugated equine oestrogen 0.625 mg daily
- C Tibolone 2.5 mg daily
- D Transdermal oestradiol patch 50 mcg/day
Explanation
Genitourinary syndrome of menopause (GSM) — comprising vaginal dryness, dyspareunia, recurrent UTIs, urinary urgency, and dysuria — is primarily a local oestrogen deficiency syndrome. Low-dose vaginal oestrogen (vaginal oestradiol tablets 10 mcg, oestradiol vaginal ring, or low-dose vaginal cream) delivers oestrogen locally to atrophic vaginal and urogenital tissue with minimal systemic absorption, making it safe even in women with contraindications to systemic HRT (e.g., breast cancer survivors). Systemic HRT (oral, transdermal) is appropriate for vasomotor symptoms but carries systemic risks. The MENQOL endorses vaginal oestrogen as first-line for isolated GSM symptoms.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.