A 58-year-old woman stopped systemic hormone therapy two years ago. She now has persistent dyspareunia, vaginal dryness, urinary frequency and recurrent urinary tract infections. Systemic oestrogen is contraindicated due to prior venous thromboembolism. What is the most effective treatment?

• A Vaginal moisturisers alone
• B Oral conjugated oestrogens
• C Oral tibolone
• D Low-dose vaginal oestrogen cream or ring ✓

Explanation

Genitourinary syndrome of menopause responds best to local low-dose vaginal oestrogen, which reverses urogenital atrophy and reduces recurrent UTIs. Because absorption into the systemic circulation is minimal, it is considered acceptable even in women with a history of venous thromboembolism, where systemic oestrogen is contraindicated. Moisturisers give modest symptomatic relief but do not reverse the atrophic change.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.