A 50-year-old woman presents with hot flushes, night sweats, and moderate vasomotor symptoms. She had a hysterectomy for fibroids 5 years ago. She has no personal or family history of breast cancer, DVT, or cardiovascular disease. Her BMI is 23. What is the MOST appropriate hormone replacement therapy (HRT)?
- A Combined oestrogen-progestogen oral HRT to protect the uterus
- B Tibolone as it avoids the need for progestogen
- C Oestrogen-only HRT (oral or transdermal) as she has no uterus ✓
- D Progestogen-only HRT to avoid the cardiovascular risks of oestrogen
Correct answer: C. Oestrogen-only HRT (oral or transdermal) as she has no uterus
Explanation
In women who have undergone hysterectomy, oestrogen-only HRT is the appropriate choice since there is no uterus to protect from oestrogen-induced endometrial hyperplasia. Progestogen is only added to HRT in women with an intact uterus to oppose oestrogen. Oestrogen-only HRT (oral or preferably transdermal to minimise VTE risk) adequately treats vasomotor symptoms. The WHI substudy of conjugated equine oestrogen alone showed a lower (or neutral) breast cancer risk compared to combined HRT. Tibolone is an alternative but is not the first-line recommendation.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.