A 54-year-old woman presents with new-onset vaginal dryness, dyspareunia, and urinary urgency 4 years after menopause. She declines systemic hormone therapy. Which is the most appropriate first-line treatment?

• A Vaginal moisturizers and lubricants ✓
• B Ospemifene 60 mg daily
• C Vaginal estrogen cream (estriol)
• D Vaginal dehydroepiandrosterone (DHEA)

Explanation

Genitourinary syndrome of menopause (GSM) first-line treatment is non-hormonal vaginal moisturizers and lubricants. Low-dose vaginal estrogen is second-line if non-hormonal measures fail. Ospemifene is an oral SERM approved for dyspareunia but is not first-line. Vaginal DHEA is an option but less commonly used. Non-hormonal therapy is appropriate when patient declines hormonal options.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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