A 50-year-old woman with severe vasomotor symptoms requests hormone therapy. She had a hysterectomy 5 years ago. She has no contraindications. The most appropriate HRT formulation is:

• A Combined continuous oestrogen plus progestogen to protect endometrium
• B Tibolone as the safest preparation post-hysterectomy
• C Oestrogen alone (without progestogen) as she has no uterus ✓
• D Low-dose combined OCP as an alternative to HRT

Explanation

Women who have had a hysterectomy (no uterus) do not require progestogen, as its sole purpose in HRT is endometrial protection. Oestrogen-alone therapy is used and is associated with a more favourable side-effect and risk profile than combined therapy (less VTE risk, no increase in breast cancer with shorter duration use). Adding unnecessary progestogen increases thrombotic risk and breast cancer risk. Tibolone has specific indications but is not the preferred first-line option for post-hysterectomy vasomotor symptoms.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.