A 51-year-old woman with an intact uterus starts oestrogen HRT for severe vasomotor symptoms. What else is required?

Answer and explanation

Correct answer: C. A progestogen to protect the endometrium

  1. Step 1: Unopposed oestrogen stimulates the endometrium.
  2. Step 2: Women with a uterus need a progestogen alongside systemic oestrogen to reduce endometrial hyperplasia and cancer risk.
Answer
A progestogen to protect the endometrium.
Why not the others: Nothing further, since oestrogen alone is safe in women who still have a uterus: Unopposed oestrogen is unsafe with a uterus. Testosterone gel, which is needed to protect the breast tissue from oestrogen: Testosterone is for low libido. A bisphosphonate, which is needed to protect the bones from oestrogen: Bisphosphonates are for osteoporosis.

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