Menopause vasomotor symptoms — DRCOG MCQ

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HardGynaecologyMenopause vasomotor symptomsDRCOG

A 51-year-old with troublesome hot flushes and night sweats still has irregular periods and has a uterus. She has no contraindication to HRT. What is the most appropriate management?

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Correct answer: B — Discuss sequential combined HRT after individual risk assessment

The best answer is “Discuss sequential combined HRT after individual risk assessment”. Because she is perimenopausal and has a uterus, sequential combined HRT provides oestrogen for symptoms and progestogen for endometrial protection while allowing a scheduled withdrawal bleed. Continuous combined HRT is generally used after menopause because starting it during ongoing ovarian activity commonly produces irregular bleeding. Treatment need not be delayed when symptoms are troublesome. HRT choice depends on whether the uterus is present, menopausal stage, bleeding pattern and vascular or cancer risk. Oestrogen-only treatment is appropriate after total hysterectomy, whereas an intact uterus needs endometrial protection. Transdermal oestrogen is generally preferred when venous thromboembolism risk is increased, with specialist input where risk is substantial.

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