A 50-year-old woman with an intact uterus and moderate vasomotor symptoms wishes to start menopausal hormone therapy. She has a history of deep vein thrombosis 5 years ago. Which is the most appropriate hormone therapy regimen?

• A Oral conjugated estrogen plus medroxyprogesterone acetate
• B Transdermal estradiol plus oral micronized progesterone
• C Systemic MHT is absolutely contraindicated ✓
• D Oral tibolone

Explanation

History of venous thromboembolism is a contraindication to systemic menopausal hormone therapy due to increased thrombotic risk with oral and transdermal estrogen. Transdermal estrogen has lower thrombotic risk than oral but is still contraindicated in prior VTE. Tibolone also increases VTE risk. Non-hormonal options (SSRIs/SNRIs, gabapentin, cognitive behavioral therapy) should be offered.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.