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HRT route and VTE risk — DRCOG MCQ

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HardGynaecologyHRT route and VTE riskDRCOG

A 55-year-old with a uterus has severe vasomotor symptoms. She had a provoked deep-vein thrombosis after surgery 12 years ago, has BMI 35 kg/m² and is not taking anticoagulation. What is the most appropriate HRT approach if treatment is chosen?

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Correct answer: C — Assess VTE risk; prefer transdermal oestrogen with endometrial protection

The best answer is “Assess VTE risk; prefer transdermal oestrogen with endometrial protection”. A previous provoked VTE and obesity require individual risk assessment, but they do not make a thoughtful menopause consultation impossible. NICE advises considering transdermal rather than oral HRT for people at increased VTE risk; a person with a uterus also needs adequate progestogen for endometrial protection when systemic oestrogen is used.

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