American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the proper treatment for a patient who cannot tolerate lubricants for menopausal symptoms?

1. Vaginal estrogen therapy

2. Oral contraceptives

3. Over-the-counter remedies

4. Topical hormone therapy

The correct answer is: Vaginal estrogen therapy

In the management of menopausal symptoms, particularly vaginal dryness and dyspareunia, vaginal estrogen therapy is often considered the first-line approach for women who cannot tolerate lubricants. This treatment directly targets the tissues of the vagina, delivering estrogen locally, which helps to restore the vaginal mucosa and alleviate symptoms. Vaginal estrogen therapy is effective in increasing vaginal elasticity, hydration, and overall health of the epithelium, resulting in significant improvements in comfort during intercourse and daily activities. Unlike systemic estrogen that may have broader effects and potential side effects, vaginal estrogen minimizes systemic absorption while still addressing localized issues effectively. Other options like oral contraceptives are generally less appropriate for menopausal symptoms as they are designed primarily for birth control and hormonal regulation rather than for treating vaginal dryness. Similarly, over-the-counter remedies may provide temporary relief but are less effective compared to targeted hormone therapies, and topical hormone therapy often refers to creams or ointments used on external genitalia but may not provide the same direct beneficial effects as vaginal estrogen. Thus, for patients who experience discomfort with lubricants, vaginal estrogen therapy is the best option to alleviate those specific menopausal symptoms.