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Menopause HRT counselling — DRCOG MCQ

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HardGynaecologyMenopause HRT counsellingDRCOG

A healthy 50-year-old with an intact uterus has 8 months of irregular periods and typical hot flushes. Pregnancy is excluded and she takes no hormonal contraception. She asks for hormone tests before discussing HRT. What is the best approach?

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Correct answer: D — Diagnose perimenopause clinically without routine FSH testing

The best answer is “Diagnose perimenopause clinically without routine FSH testing”. In a person aged 45 or over with typical vasomotor symptoms and menstrual change, perimenopause is diagnosed clinically. Routine FSH, AMH and imaging do not improve diagnosis. Treatment discussion must still cover her uterus, because systemic oestrogen requires adequate progestogen protection, along with individual risks and preferences.

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