A 58-year-old postmenopausal woman has vaginal dryness, dyspareunia and recurrent urinary symptoms. Examination shows pale, thin vaginal mucosa with loss of rugae. She had hormone receptor positive breast cancer treated with tamoxifen and prefers to avoid systemic hormones. What is the most appropriate first-line treatment?

• A Systemic combined oestrogen-progestogen therapy
• B Oral ospemifene
• C Topical vaginal oestrogen ✓
• D Vaginal moisturisers alone as definitive therapy

Explanation

Genitourinary syndrome of menopause is a progressive oestrogen-deficiency condition that does not improve spontaneously, so active treatment is needed. Low-dose topical vaginal oestrogen is first line and provides symptom relief with minimal systemic absorption, making it acceptable even in many women with a history of hormone-sensitive breast cancer after oncology discussion. Systemic therapy adds progestogen exposure and higher systemic levels, ospemifene is an oral option not widely available in India, and moisturisers give only temporary relief.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.