The Women's Health Initiative (WHI) trial results changed prescribing patterns for hormone therapy (HT) in menopause. A 52-year-old woman with an intact uterus experiencing severe menopausal symptoms seeks HT. The optimal regimen to balance symptomatic benefit with endometrial protection is:
- A Oestrogen alone (unopposed) continuous therapy
- B Progestogen alone therapy
- C Oestrogen plus progestogen cyclic sequential regimen (oestrogen daily + progestogen 12–14 days/month) ✓
- D Tibolone — a synthetic steroid with oestrogenic, progestogenic, and androgenic properties
Explanation
In women with an intact uterus, unopposed oestrogen significantly increases endometrial hyperplasia and carcinoma risk (10–14-fold after 10 years). Progestogen must be added for endometrial protection. Sequential regimens (oestrogen daily + progestogen 12–14 days per cycle) are preferred for women within 12 months of menopause or who prefer scheduled withdrawal bleeds; this produces monthly bleeds. Continuous combined regimens (both daily) are preferred for those >1 year postmenopausal to avoid bleeding. The WHI trial demonstrated combined oestrogen-progestogen therapy increased breast cancer risk but reduced colorectal cancer and fracture risk.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.