A 61-year-old postmenopausal woman reports vaginal dryness, recurrent urinary tract infections, and dyspareunia. She stopped systemic hormone therapy 5 years ago due to concerns about breast cancer risk. What is the most appropriate first-line treatment for her genitourinary symptoms?
- A Systemic combined oestrogen-progestogen therapy
- B Low-dose vaginal oestrogen applied locally ✓
- C Oral ospemifene
- D Long-course systemic corticosteroids
Correct answer: B. Low-dose vaginal oestrogen applied locally
Explanation
Genitourinary syndrome of menopause results from oestrogen deficiency of vulvovaginal tissue and responds to local low-dose vaginal oestrogen, which relieves dryness, dyspareunia and recurrent urinary infection. Systemic absorption at these doses is minimal, so a progestogen for endometrial protection is not required, making it suitable even when systemic therapy is declined. Ospemifene is a second-line oral option for dyspareunia, not first line.
Reference: Williams Gynecology, 3rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.