A 52-year-old woman, 18 months post-menopause, presents with significant vasomotor symptoms and genitourinary syndrome of menopause (GSM). She has no contraindications to HRT. She has an intact uterus. According to current guidelines (NICE 2024/NAMS 2022), the MOST appropriate HRT regimen is:

• A Systemic oestrogen alone (unopposed)
• B Systemic oestrogen combined with continuous progestogen (combined continuous HRT) ✓
• C Vaginal oestrogen alone for both vasomotor symptoms and GSM
• D Tibolone 2.5 mg daily as alternative to HRT

Explanation

Women with an intact uterus who use systemic oestrogen-based HRT MUST receive progestogen opposition to prevent oestrogen-induced endometrial hyperplasia and carcinoma. Since she is > 12 months post-menopause, continuous combined HRT (daily oestrogen + daily progestogen = no withdrawal bleeds) is preferred over sequential HRT (cyclical bleeds expected). Systemic oestrogen alone (unopposed) is contraindicated with intact uterus. Vaginal oestrogen addresses GSM but not systemic vasomotor symptoms. Tibolone is an alternative but not first-line per NICE 2024.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.