A 50-year-old woman with severe vasomotor symptoms requests menopausal hormone therapy. Her medical history includes a deep vein thrombosis 6 years ago while on combined oral contraceptives. According to NICE and major international guidelines, which statement about her management is most accurate?

• A Combined oral HRT is safe because the prior thrombosis was contraceptive-related
• B She should be started on raloxifene for vasomotor symptoms
• C Menopausal hormone therapy is absolutely contraindicated in all women with any prior venous thromboembolism
• D Transdermal estrogen with a progestogen is preferred over oral estrogen because transdermal route avoids first-pass hepatic effect on clotting factors ✓

Explanation

Transdermal estradiol bypasses first-pass hepatic metabolism and does not increase hepatic production of clotting factors to the same degree as oral estrogen, making it safer in women with prior VTE or thrombophilia. Prior VTE is a relative contraindication to oral HRT, not an absolute contraindication to all HRT. Raloxifene does not relieve vasomotor symptoms and may worsen them.

Reference: NICE NG23 (Menopause: Diagnosis and Management), 2015 (updated 2024) ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.