A 50-year-old woman with an intact uterus is started on unopposed oral oestrogen for menopausal symptoms. What is the principal risk of this regimen that mandates adding a progestogen?

• A Venous thromboembolism
• B Breast carcinoma
• C Endometrial hyperplasia and carcinoma ✓
• D Ischaemic stroke

Explanation

Unopposed oestrogen in a woman with an intact uterus drives endometrial proliferation and substantially increases the risk of endometrial hyperplasia and adenocarcinoma in a dose- and duration-dependent manner. Adding adequate progestogen for at least 12 days per cycle (or continuous combined therapy) abolishes this excess risk. Venous thromboembolism and stroke risks relate to oestrogen itself and are not prevented by progestogen addition.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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