A 52-year-old perimenopausal woman complains of severe vasomotor symptoms (12+ hot flushes per day), vaginal dryness, and mood instability for 8 months. She had a hysterectomy 5 years ago for fibroids; both ovaries were conserved. Her last period was 9 months ago. The most effective and appropriate hormonal therapy is:

• A Combined continuous oestrogen-progestogen oral HRT
• B Tibolone alone
• C Selective serotonin reuptake inhibitor (SSRI) for vasomotor symptoms
• D Oestrogen-only hormone replacement therapy (HRT) via transdermal patch ✓

Explanation

In a woman with a previous hysterectomy (no uterus), there is no endometrium to protect; therefore, progestogen is unnecessary. Oestrogen-only HRT is the preferred regimen — it provides effective relief from vasomotor symptoms and genitourinary syndrome of menopause, with a more favourable risk-benefit profile (lower breast cancer risk) than combined oestrogen-progestogen therapy. Transdermal delivery is preferred as it avoids first-pass hepatic metabolism and has lower VTE risk than oral preparations. Combined HRT is for women with an intact uterus. SSRIs are second-line for women who cannot take oestrogen.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.