GP Vivas · womens-health
Menopause and HRT — structured viva
Structured oral on menopause: defending clinical diagnosis, reframing the WHI legacy with absolute numbers, arguing route and progestogen from meta-analysis evidence, and defending no-arbitrary-stop review with annual re-consent.
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Prompt
The examiner opens: 'A local menopause clinic advertises that WHI was wrong and HRT is risk-free if you start young — and another colleague says it causes breast cancer so nobody should take it. Where do you stand?' The viva branches through diagnosis, trial interpretation, regimen craft, non-hormonal options, GSM and testosterone, and duration.
Stem
You are the GP caught between two extremes about hormone therapy. [1]
References11ShowHide
- [1]Manson JE, Chlebowski RT, Stefanick ML et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA, 2013.PMID 24084921
- [4]Johnson KA, Martin N, Nappi RE et al. Efficacy and Safety of Fezolinetant in Moderate to Severe Vasomotor Symptoms Associated With Menopause: A Phase 3 RCT. The Journal of clinical endocrinology & metabolism, 2023.PMID 36734148
- [5]Kagan R, Cano A, Nappi RE et al. Safety of Fezolinetant for Treatment of Moderate to Severe Vasomotor Symptoms Due to Menopause: Pooled Analysis of Three Randomized Phase 3 Studies. Advances in therapy, 2025.PMID 39739195
- [7]Rovinski D, Ramos RB, Fighera TM et al. Risk of venous thromboembolism events in postmenopausal women using oral versus non-oral hormone therapy: A systematic review and meta-analysis. Thrombosis research, 2018.PMID 29936403
- [8]Scarabin PY Progestogens and venous thromboembolism in menopausal women: an updated oral versus transdermal estrogen meta-analysis. Climacteric, 2018.PMID 29570359
- [10]Fournier A, Berrino F, Clavel-Chapelon F Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast cancer research and treatment, 2008.PMID 17333341
- [13]Fornili M, Perduca V, Fournier A et al. Association between menopausal hormone therapy, mammographic density and breast cancer risk: results from the E3N cohort study. Breast cancer research, 2021.PMID 33865453
- [15]Avis NE, Crawford SL, Greendale G et al. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA internal medicine, 2015.PMID 25686030
- [16]Davis SR, Baber R, Panay N et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. The Journal of clinical endocrinology & metabolism, 2019.PMID 31498871
- [17]The North American Menopause Society The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 2022.PMID 35797481
- [18]Marjoribanks J, Farquhar C, Roberts H et al. Long-term hormone therapy for perimenopausal and postmenopausal women. The Cochrane database of systematic reviews, 2017.PMID 28093732