A 55-year-old postmenopausal woman presents with vaginal dryness, dyspareunia, and recurrent urinary urgency. She has no vasomotor symptoms. Pelvic examination reveals pale vaginal mucosa and decreased rugae. Which is the most effective treatment for her symptoms?

• A Vaginal low-dose estrogen preparation ✓
• B Systemic hormone replacement therapy
• C Oral ospemifene
• D Vaginal lubricant only

Explanation

This is genitourinary syndrome of menopause (vulvovaginal atrophy). Low-dose vaginal estrogen (estradiol tablets, cream, or ring) is first-line for isolated urogenital symptoms, as it directly treats the atrophic epithelium with minimal systemic absorption. Systemic HRT is not needed if only local symptoms are present. Ospemifene is an alternative for dyspareunia when estrogen is contraindicated.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.