skip to main content

Menopausal vasomotor symptoms — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

ModerateWomen's Health/Men's HealthMenopausal vasomotor symptomsABIM Board

A 53-year-old woman has frequent hot flashes and night sweats that substantially disrupt her sleep. She is 1 year into menopause and previously underwent total hysterectomy with ovarian conservation. She has no history of breast cancer, venous thromboembolism, stroke, coronary artery disease, or liver disease. After discussion of treatment benefits and risks, she prefers the most effective pharmacologic therapy. Which of the following is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Initiate systemic estrogen alone

Systemic estrogen alone is the most appropriate treatment. Menopausal hormone therapy is the most effective therapy for vasomotor symptoms, and its benefit-risk profile is generally favorable in a healthy woman younger than 60 years who is within 10 years of menopause and has no contraindication. A progestogen is added to protect the endometrium; it is unnecessary after total hysterectomy and adds avoidable adverse effects. Paroxetine is an effective nonhormonal alternative when hormone therapy is contraindicated or declined but is not the most effective option here. Low-dose vaginal estrogen treats genitourinary symptoms and does not adequately treat systemic vasomotor symptoms. Reassurance alone is inappropriate because her symptoms substantially impair sleep.

Reference: Jin J. Treatment of Menopause Symptoms With Hormone Therapy. JAMA. 2022;327(17):1716. https://jamanetwork.com/journals/jama/fullarticle/2791692