A 58-year-old woman has bothersome vaginal dryness, dyspareunia, and recurrent urinary urgency for 2 years. Examination shows pale, smooth vaginal walls with loss of rugae and petechiae. She completed adjuvant endocrine therapy for oestrogen-receptor-positive breast cancer 3 years ago and is currently disease-free. Which treatment is most appropriate?

• A Systemic combined continuous estrogen-progestogen therapy
• B Topical testosterone cream
• C Tibolone 2.5 mg daily
• D Low-dose vaginal estrogen applied locally ✓

Explanation

Genitourinary syndrome of menopause reflects estrogen-deficient vaginal epithelium with rising pH, and low-dose vaginal estrogen is the standard first-line treatment. Systemic absorption is minimal, so it is considered acceptable even in breast cancer survivors who have failed nonhormonal lubricants and moisturisers. Systemic estrogen or tibolone would expose breast tissue to circulating steroid and is avoided in this setting, while testosterone has no role in treating vulvovaginal atrophy.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.