A 55-year-old postmenopausal woman complains of vaginal dryness, dyspareunia and recurrent urinary tract infections. Examination shows pale, smooth vaginal epithelium with loss of rugae and a pH of 6.5. First-line therapy is:

• A Systemic combined hormone replacement therapy
• B Topical vaginal oestrogen ✓
• C Oral ospemifene
• D Vaginal moisturisers only

Explanation

Genitourinary syndrome of menopause results from oestrogen deficiency causing vaginal pH rise and epithelial thinning. Low-dose topical vaginal oestrogen is first-line because it delivers oestrogen locally with minimal systemic absorption, making it suitable even when systemic therapy is not desired. Moisturisers are adjunctive and less effective; systemic HRT treats vasomotor symptoms and helps GSM but is not required when symptoms are purely genitourinary.

Reference: The North American Menopause Society Position Statement, 2022 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.