A 48-year-old perimenopausal woman with an intact uterus requests HRT for hot flushes and sleep disturbance. Which HRT regimen is mandatory to protect the endometrium?

• A Oestrogen-only therapy (oral or transdermal)
• B Progestogen-only therapy (norethisterone)
• C Combined oestrogen-progestogen therapy ✓
• D Vaginal oestrogen cream alone

Explanation

Women with an intact uterus receiving systemic oestrogen therapy must also receive progestogen to protect the endometrium from oestrogen-induced hyperplasia and carcinoma. For a perimenopausal woman with irregular periods, sequential combined HRT is used initially; continuous combined HRT is appropriate once amenorrhoea is established for 12 months. Oestrogen-only therapy is restricted to hysterectomised women. Vaginal oestrogen addresses genitourinary symptoms only.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.