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Acute pulmonary oedema — UKMLA MCQ

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HardCardiologyAcute pulmonary oedemaUKMLAMRCP Part 1

A 52-year-old with an intact uterus has disabling vasomotor menopausal symptoms and requests systemic HRT. BMI is 34 kg/m², with no personal or strong family history of venous thromboembolism and no other contraindication. Which route strategy best addresses the increased thrombotic risk?

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Correct answer: B — Use transdermal oestrogen with progestogenic endometrial protection

The best answer is “Use transdermal oestrogen with progestogenic endometrial protection”. A BMI above 30 kg/m² increases VTE risk but is not by itself a blanket contraindication to HRT. NICE recommends considering transdermal rather than oral HRT in this group because VTE risk is not increased with transdermal HRT and is greater with oral treatment. Because the uterus is intact, endometrial protection is still required. Aspirin is not routine prophylaxis for oral HRT, and local vaginal oestrogen does not adequately treat systemic vasomotor symptoms.

Reference: NICE NG23, Menopause: identification and management: https://www.nice.org.uk/guidance/ng23/chapter/Recommendations