A 47-year-old perimenopausal woman with an intact uterus and no contraindications to hormone therapy asks about the most appropriate regimen to provide both symptom control and endometrial protection. According to standard menopausal hormone therapy principles, which regimen is correct for a woman with an intact uterus?
- A Unopposed transdermal estradiol 100 mcg twice weekly
- B Transdermal estradiol 50 mcg twice weekly plus oral micronized progesterone 200 mg for 12-14 days per month ✓
- C Conjugated equine estrogen 0.625 mg alone daily
- D Tibolone 2.5 mg daily without additional progestogen
Correct answer: B. Transdermal estradiol 50 mcg twice weekly plus oral micronized progesterone 200 mg for 12-14 days per month
Explanation
In women with an intact uterus, estrogen therapy must be combined with a progestogen to prevent endometrial hyperplasia and carcinoma. Unopposed estrogen (options A and C) significantly increases endometrial cancer risk. Option B describes a sequential combined regimen providing adequate endometrial protection. Tibolone does have progestogenic activity on the endometrium, but it is not conventional combined HRT and is not first-line for vasomotor symptoms.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.