American Board of Internal Medicine (ABIM) Certification Practice Exam

For postmenopausal women with noninfectious genitourinary symptoms that are not relieved by over-the-counter therapies, what treatment should be considered?

1. Oral hormone replacement therapy

2. Low-dose vaginal estrogen

3. Antidepressants

4. Systemic glucocorticoids

The correct answer is: Low-dose vaginal estrogen

In postmenopausal women experiencing noninfectious genitourinary symptoms, low-dose vaginal estrogen is considered an appropriate treatment option when over-the-counter therapies do not provide relief. This approach directly addresses local symptoms such as vaginal dryness, irritation, and urinary incontinence by delivering estrogen directly to the vaginal tissues. Low-dose vaginal estrogen effectively alleviates these symptoms while minimizing systemic absorption and therefore reducing the risk of systemic side effects often associated with hormone replacement therapy. This localized treatment is particularly beneficial for women who may have contraindications to systemic hormone therapy or those concerned about the potential risks associated with it, such as an increased risk of thromboembolic events or certain cancers. Other treatments, while they may have their own indications, do not directly target the genitourinary symptoms as effectively as vaginal estrogen. For instance, oral hormone replacement therapy is more systemic and might not be appropriate for all patients, particularly those with certain risk factors. Antidepressants could be helpful in managing mood disorders but are not effective for treating the specific symptoms associated with genitourinary syndrome. Systemic glucocorticoids are generally not indicated for this purpose and could lead to unwanted side effects if used long-term. Therefore, low-dose vaginal estrogen is the