American Board of Internal Medicine (ABIM) Certification Practice Exam

In managing menopausal vasomotor symptoms, what is true for women who have had a hysterectomy?

1. Progestin therapy is required

2. Transdermal estrogen is preferred to avoid thromboembolic risk

3. Oral estrogen should be avoided

4. Only dietary changes are recommended

The correct answer is: Transdermal estrogen is preferred to avoid thromboembolic risk

Transdermal estrogen is indeed preferred for managing menopausal vasomotor symptoms in women who have undergone a hysterectomy. This preference is largely due to the lower associated risk of thromboembolic events with transdermal administration compared to oral estrogen. When estrogen is administered orally, it undergoes first-pass metabolism in the liver, which can increase the risk of thrombosis. In contrast, transdermal estrogen bypasses the liver, resulting in lower doses needing to be administered and potentially reduced risks for clotting complications. For women who have had a hysterectomy, progestin therapy is not required because there is no need to protect the endometrium from estrogen stimulation, as there is no endometrial tissue to consider. This makes estrogen therapy—particularly in the form of transdermal patches or gels—an appropriate and effective treatment option for alleviating symptoms such as hot flashes and night sweats without the added complication of needing progestins. In contrast, while oral estrogen may be effective, it carries a higher thromboembolic risk. Dietary changes can provide some symptom relief for menopausal women, but they are not sufficient as a standalone treatment for significant vasomotor symptoms like hot flashes. Therefore, the recommendation for