Question

A 54-year-old G2P2 presents to your office for a health maintenance examination. Her last menstrual period was eight months ago. She complains of severe vasomotor symptoms, vaginal dryness, and dyspareunia, and she desires treatment for her symptoms. She has otherwise been in good health and has no significant past medical or surgical history. Her family history is significant for a mother who has severe osteoporosis at the age of 75 and a grandmother who died of breast cancer at the age of 79. She does not report any smoking, alcohol or drug use. On physical exam her BP=130/78, Pulse=84, BMI=26. The remainder of her exam is within normal limits except for severe vaginal atrophy noted on the pelvic examination. The best recommendation for this patient would include which of the following?

A. Lowest effective dose of combination hormone replacement therapy for the shortest duration possible
B. Long term hormone replacement therapy to treat her vasomotor symptoms and prevention of osteoporosis
C. Testosterone cream
D. Progesterone cream
E. Biosphophonates

Answer 1

The optimal treatment for the patient's menopausal symptoms is the lowest effective dose of combination hormone replacement therapy for the shortest duration possible, taking into account her personal and family medical history. The Correct Answer is Option.A.

Step-by-step explanation:

The best recommendation for a 54-year-old G2P2 patient presenting with severe vasomotor symptoms, vaginal dryness, and dyspareunia would be A. the lowest effective dose of combination hormone replacement therapy for the shortest duration possible. Given her family history of osteoporosis and breast cancer, prolonged hormone replacement therapy could present additional risks.

Combination hormone replacement therapy (HRT), which includes both estrogen and progesterone, helps alleviate the symptoms of menopause and may offer some protection against endometrial hyperplasia, which is a concern when using estrogen alone. It's important to note that HRT is recommended in the lowest effective dose and for the shortest duration necessary to manage symptoms, with regular monitoring, which typically suggests no more than 5 years of use.

Options such as long-term hormone replacement therapy are not recommended due to increased risks of various cancers and cardiovascular disease. Testosterone cream and progesterone cream are not standard treatments for vasomotor symptoms of menopause, and bisphosphonates are used for the treatment and prevention of osteoporosis but would not address the vasomotor symptoms or vaginal issues that the patient is experiencing.