A 52-year-old woman asks about hormone replacement therapy. She has severe hot flushes, night sweats, low mood; intact uterus; last period 8 months ago. Which HRT type is most appropriate?

• A. Sequential HRT (estrogen and progestogen)
• B. Estrogen-only HRT
• C. Progestin-only HRT
• D. Testosterone-containing HRT

Answer: (A)

The key concept is that when the uterus is still present, estrogen therapy must be given with a progestogen to protect the endometrium from estrogen’s proliferative effects. Without the progestogen, the risk of endometrial hyperplasia and cancer increases. Therefore, a regimen that combines estrogen with a progestogen is required to treat vasomotor symptoms like hot flushes and night sweats while safeguarding the uterus.

A sequential combined approach fits this need: it provides estrogen to relieve symptoms and adds progestogen for part of the cycle, producing a withdrawal bleed and protecting the endometrium. Estrogen-only therapy would be inappropriate due to the intact uterus. Progestin-only therapy would not address hot flashes, and testosterone-containing therapy is not a standard treatment for menopausal vasomotor symptoms. So the best choice is a combined regimen that includes both estrogen and progestogen.