Menopause: genitourinary syndrome: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Menopause: genitourinary syndrome

Sample item

A 56-year-old woman, 5 years after menopause, complains only of vaginal dryness and painful intercourse. There are no hot flushes. Pelvic examination shows pale, thin vaginal mucosa with loss of rugae. What is the most appropriate first-line treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Low-dose topical vaginal oestrogen

Isolated genitourinary symptoms of menopause respond best to local oestrogen, which restores the epithelium with minimal systemic absorption. Systemic therapy is reserved for those who also have vasomotor symptoms. Non-hormonal lubricants and moisturisers are an alternative when oestrogen is not wanted.

Option by option

  • A. Oral clonidine

    Clonidine is a non-hormonal option for hot flushes and does not treat vaginal atrophy.

  • B. Systemic combined hormone therapy

    Systemic therapy exposes her to avoidable systemic risk when only local symptoms are present.

  • C. Vaginal metronidazole gel

    There are no features of bacterial vaginosis, so an antimicrobial gel has no role.

  • D. Low-dose topical vaginal oestrogen (correct)

    Correct. Local oestrogen is first line for symptoms limited to the vagina.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Low-dose topical vaginal oestrogen. Isolated genitourinary symptoms of menopause respond best to local oestrogen, which restores the epithelium with minimal systemic absorption.

Why is "Oral clonidine" not the answer?

Clonidine is a non-hormonal option for hot flushes and does not treat vaginal atrophy.

Why is "Systemic combined hormone therapy" not the answer?

Systemic therapy exposes her to avoidable systemic risk when only local symptoms are present.

Why is "Vaginal metronidazole gel" not the answer?

There are no features of bacterial vaginosis, so an antimicrobial gel has no role.

What concept does this question test?

It tests Menopause: genitourinary syndrome in OBG. Systemic therapy is reserved for those who also have vasomotor symptoms. Non-hormonal lubricants and moisturisers are an alternative when oestrogen is not wanted.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Menopause: genitourinary syndrome?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.