Menopause — MCQs

Question 1: Hormone replacement therapy can increase the risk of which of the following conditions?

• A. Osteoporosis
• B. Breast carcinoma (Correct Answer)
• C. Alzheimer's disease
• D. Colorectal cancer

Explanation: **Explanation:** The correct answer is **Breast carcinoma**. Hormone Replacement Therapy (HRT), specifically the combined estrogen-progestogen regimen, is associated with an increased risk of breast cancer. This risk is duration-dependent, typically becoming significant after 3–5 years of use. Estrogen promotes the proliferation of mammary epithelial cells, and the addition of progestogen further enhances this mitogenic effect, potentially promoting the growth of pre-existing occult tumors. **Analysis of Incorrect Options:** * **A. Osteoporosis:** HRT is actually **protective** against osteoporosis. Estrogen inhibits osteoclast activity and reduces bone resorption, thereby increasing bone mineral density and reducing the risk of fractures. * **C. Alzheimer’s Disease:** Current evidence suggests HRT does not increase the risk; some studies even suggest a "window of opportunity" where early initiation may be neuroprotective, though it is not indicated for dementia prevention. * **D. Colorectal Cancer:** Combined HRT has been shown to **decrease** the risk of colorectal cancer (by approximately 30% according to the Women's Health Initiative study). **High-Yield Clinical Pearls for NEET-PG:** * **WHI Study Findings:** HRT increases the risk of **Breast Cancer, Stroke, Venous Thromboembolism (VTE), and Coronary Heart Disease (CHD)**. * **Protective Effects:** HRT decreases the risk of **Osteoporotic fractures and Colorectal cancer**. * **Endometrial Cancer:** Unopposed estrogen increases the risk of endometrial cancer; therefore, progestogen must be added in women with an intact uterus. * **Indications:** The primary indication for HRT is the management of moderate-to-severe vasomotor symptoms (hot flashes) and urogenital atrophy.