Menopause — MCQs
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Which of the following is an established benefit of Hormone Replacement Therapy (HRT)?
Gonadotrophins remain elevated after menopause for :
Which of the following is a beneficial effect of hormone replacement therapy in early menopause?
A Post-Menopausal woman complains of spotting per vaginum after 5 years of menopause. USG reveals endometrial thickness of 7 mm and an intramural fibroid of size 3cm. Next step in management is?
A 62-year-old woman presents for annual examination. Her last spontaneous menstrual period was 9 years ago, and she has been reluctant to use postmenopausal hormone replacement because of a strong family history of breast cancer. She now complains of diminished interest in sexual activity. Which of the following is the most likely cause of her complaint?
Hormone Replacement Therapy (HRT) in postmenopausal women is beneficial in all these except
A 46-year-old woman presents for her annual examination. Her main complaint is frequent sweating episodes with a sensation of intense heat starting at her upper chest and spreading up to her head. These have been intermittent for the past 6 to 9 months but are gradually worsening. She has three to four flushing/sweating episodes during the day and two to three at night. She occasionally feels her heart race for about a second, but when she checks her pulse it is normal. She reports feeling more tired and has difficulty with sleep due to sweating. She denies major life stressors. She also denies weight loss, weight gain, or change in bowel habit. Her last menstrual cycle was 3 months ago. Physical examination is normal. Which treatment is most appropriate in alleviating this woman's symptoms?
Which of the following is NOT effective in controlling the hot flushes of menopause in a woman?
Senile vaginitis is due to :
Which of the following is NOT characteristic of menopause?
Menopause Indian Medical PG Practice Questions and MCQs
Question 71: Which of the following is an established benefit of Hormone Replacement Therapy (HRT)?
- A. Decreased risk of endometrial cancer
- B. Decreased risk of breast cancer
- C. Decreased risk of colon cancer
- D. Decreased risk of vertebral fracture (Correct Answer)
Explanation: ***Decreased risk of vertebral fracture*** - HRT is **one of the most well-established benefits** for **prevention of osteoporosis and fractures**, including vertebral fractures. - Estrogen plays a crucial role in maintaining **bone mineral density** by inhibiting osteoclast activity and promoting osteoblast function. - Multiple studies, including the **Women's Health Initiative (WHI)**, have demonstrated a **significant reduction in hip, vertebral, and other osteoporotic fractures** in women taking HRT. - This benefit is recognized by **ACOG, NAMS, and international menopause societies** as a primary indication for HRT in appropriate candidates. *Decreased risk of endometrial cancer* - **Unopposed estrogen therapy** actually **increases the risk of endometrial cancer** due to hyperplasia of the endometrium. - To counteract this, **progestin is added** in women with a uterus receiving HRT, which reduces but does not eliminate the risk increase. - Combined HRT does not provide a net decreased risk below baseline. *Decreased risk of breast cancer* - Combined **estrogen-progestin HRT** has been consistently associated with an **increased risk of breast cancer**, especially with longer durations of use (>5 years). - This was clearly demonstrated in the **WHI trial** and remains a major consideration when prescribing HRT. - Estrogen-only HRT might have a neutral or slightly increased risk, but never a decreased risk. *Decreased risk of colon cancer* - While some observational studies and the **WHI trial** initially showed a reduced incidence of colorectal cancer with HRT, this is **not considered an established or primary indication** for HRT. - Subsequent analyses have shown **inconsistent results**, and any benefit is offset by increased risks. - Current guidelines do **not recommend HRT** for colorectal cancer prevention.
Question 72: Gonadotrophins remain elevated after menopause for :
- A. Rest of life (Correct Answer)
- B. 5 years
- C. 10 years
- D. 2 years
Explanation: **Correct Answer: Rest of life** - Following menopause, the ovaries cease to produce significant amounts of **estrogen** and **progesterone**. - This lack of negative feedback on the **hypothalamic-pituitary axis** leads to persistently elevated levels of **gonadotropins (FSH and LH)** throughout the remainder of a woman's life. - The **ovarian failure** and subsequent lack of estrogen production are irreversible, resulting in permanent elevation of gonadotropins. *Incorrect: 5 years* - While gonadotropin levels are high during this period, they do not normalize or significantly decrease after 5 years post-menopause. - The hormonal changes of menopause are permanent, not transient. *Incorrect: 10 years* - Similar to the 5-year period, gonadotropin levels remain elevated and do not revert to pre-menopausal levels after 10 years. - The physiological shift is permanent. *Incorrect: 2 years* - The initial years immediately following menopause (**perimenopause** and early post-menopause) are marked by significantly elevated gonadotropin levels. - However, these levels remain high indefinitely, indicating a permanent physiological shift, not a temporary elevation that resolves after only 2 years.
Question 73: Which of the following is a beneficial effect of hormone replacement therapy in early menopause?
- A. Increased Endothelin
- B. Increased TNF-α
- C. Increased Nitric oxide (Correct Answer)
- D. Decreased COX-2
Explanation: ***Increased Nitric oxide*** - **Estrogen** in HRT increases the production and bioavailability of **nitric oxide (NO)** by upregulating endothelial nitric oxide synthase (eNOS). - Increased NO leads to **vasodilation**, contributing to cardiovascular benefits and improved endothelial function. *Increased Endothelin* - **Endothelin-1** is a potent vasoconstrictor, and increased levels are generally associated with **endothelial dysfunction** and cardiovascular risk. - HRT, particularly estrogen, tends to decrease endothelin-1 levels or counteract its effects, leading to beneficial vascular responses. *Increased TNF-α* - **Tumor Necrosis Factor-alpha (TNF-α)** is a pro-inflammatory cytokine, and elevated levels are linked to chronic inflammation and increased risk of various diseases. - HRT, especially estrogen, typically has **anti-inflammatory effects**, potentially reducing TNF-α levels or mitigating its inflammatory actions. *Decreased COX-2* - **Cyclooxygenase-2 (COX-2)** is an enzyme involved in inflammation and pain pathways; its decrease is generally anti-inflammatory. - However, the primary beneficial vascular effect of HRT is not through direct inhibition of COX-2 but rather through mechanisms like increasing nitric oxide.
Question 74: A Post-Menopausal woman complains of spotting per vaginum after 5 years of menopause. USG reveals endometrial thickness of 7 mm and an intramural fibroid of size 3cm. Next step in management is?
- A. CA 125 levels
- B. Paps smear and follow up
- C. Myomectomy
- D. Endometrial biopsy (Correct Answer)
Explanation: ***Endometrial biopsy*** - Post-menopausal **vaginal bleeding** or spotting, especially with an **endometrial thickness of ≥ 4-5 mm** on ultrasound, is highly suspicious for endometrial hyperplasia or carcinoma and warrants an endometrial biopsy for definitive diagnosis. - An endometrial biopsy is crucial to rule out endometrial malignancy, as this is the primary concern in such presentations. *CA 125 levels* - **CA 125** is primarily used as a tumor marker for **ovarian cancer** surveillance and response to treatment, not for initial diagnosis of post-menopausal bleeding or endometrial pathology. - Elevated CA 125 can be found in various benign conditions as well and is not specific enough to guide the initial management of post-menopausal bleeding without tissue sampling. *Paps smear and follow up* - A **Pap smear** screens for **cervical abnormalities** and **cervical cancer**, not endometrial pathology. - While it's part of routine gynecological care, it will not address the investigation of post-menopausal bleeding originating from the uterus. *Myomectomy* - **Myomectomy** is a surgical procedure to remove **uterine fibroids**, typically when they are causing symptoms like heavy menstrual bleeding or pressure. - In a post-menopausal woman with spotting, the intramural fibroid may or may not be directly responsible, and the priority is to exclude **endometrial cancer** before considering fibroid-specific interventions.
Question 75: A 62-year-old woman presents for annual examination. Her last spontaneous menstrual period was 9 years ago, and she has been reluctant to use postmenopausal hormone replacement because of a strong family history of breast cancer. She now complains of diminished interest in sexual activity. Which of the following is the most likely cause of her complaint?
- A. Decreased vaginal length
- B. Untreatable sexual dysfunction
- C. Decreased ovarian function (Correct Answer)
- D. Alienation from her partner
Explanation: ***Decreased ovarian function*** - The woman's age and history of menopause 9 years prior strongly suggest **decreased ovarian function**, leading to **estrogen deficiency**. - **Estrogen deficiency** causes vaginal atrophy, dryness, and dyspareunia, which can significantly diminish interest in sexual activity. *Decreased vaginal length* - While vaginal atrophy can occur with menopause, leading to a narrower and less elastic vagina, a significant "decreased vaginal length" is less common as a primary cause of diminished sexual interest. - The primary physiological change affecting sexual interest due to estrogen loss is **vaginal dryness** and **dyspareunia**, rather than an anatomical change in length. *Untreatable sexual dysfunction* - Postmenopausal sexual dysfunction related to estrogen deficiency is often **treatable** with local vaginal estrogen therapy or other interventions. - Assuming it's untreatable without further assessment is premature and inaccurate, especially given the clear physiological changes associated with menopause. *Alienation from her partner* - While relationship issues can certainly affect sexual interest, the clinical history points to a **physiological cause** (postmenopausal estrogen deficiency). - There is no information in the scenario to suggest alienation from her partner, making this answer less likely than a direct physiological cause.
Question 76: Hormone Replacement Therapy (HRT) in postmenopausal women is beneficial in all these except
- A. Vaginal atrophy
- B. Osteoporosis
- C. Vasomotor symptoms
- D. Prevention of CAD (Correct Answer)
Explanation: ***Prevention of CAD*** - While HRT was initially thought to be cardioprotective, large-scale studies like the **Women's Health Initiative (WHI)** demonstrated that it does **not prevent coronary artery disease (CAD)** and may even increase the risk of cardiovascular events, especially in older postmenopausal women or those initiating therapy years after menopause. - The potential benefits regarding CAD prevention are outweighed by risks such as **stroke** and **venous thromboembolism**. *Vaginal atrophy* - **Estrogen deficiency** in postmenopausal women leads to thinning, dryness, and inflammation of the vaginal walls, causing symptoms like dryness, irritation, and painful intercourse. - **Local or systemic estrogen therapy** effectively reverses these changes by restoring vaginal tissue health. *Osteoporosis* - **Bone loss** accelerates after menopause due to declining estrogen levels, increasing the risk of osteoporosis and fractures. - HRT, particularly estrogen, is effective in **preventing and treating osteoporosis** by inhibiting bone resorption and preserving bone mineral density. *Vasomotor symptoms* - **Hot flashes** and **night sweats** are common and often debilitating symptoms of menopause, directly linked to fluctuating and declining estrogen levels. - HRT, especially systemic estrogen, is the **most effective treatment** for alleviating these symptoms by stabilizing thermoregulatory control.
Question 77: A 46-year-old woman presents for her annual examination. Her main complaint is frequent sweating episodes with a sensation of intense heat starting at her upper chest and spreading up to her head. These have been intermittent for the past 6 to 9 months but are gradually worsening. She has three to four flushing/sweating episodes during the day and two to three at night. She occasionally feels her heart race for about a second, but when she checks her pulse it is normal. She reports feeling more tired and has difficulty with sleep due to sweating. She denies major life stressors. She also denies weight loss, weight gain, or change in bowel habit. Her last menstrual cycle was 3 months ago. Physical examination is normal. Which treatment is most appropriate in alleviating this woman's symptoms?
- A. Estrogen plus progesterone (Correct Answer)
- B. Citalopram
- C. Estrogen
- D. Levothyroxine
Explanation: ***Estrogen plus progesterone*** - This patient's symptoms (hot flashes, night sweats, fatigue, sleep disturbance, irregular menses) are highly suggestive of **perimenopause/menopause**. **Hormone replacement therapy (HRT)** with estrogen and progesterone is the most effective treatment for managing severe menopausal symptoms. - Adding **progesterone** is crucial for women with an intact uterus to prevent **endometrial hyperplasia** and **endometrial cancer** caused by unopposed estrogen therapy. *Citalopram* - **Selective serotonin reuptake inhibitors (SSRIs)** like citalopram can reduce the frequency and severity of hot flashes, but they are generally reserved for women who cannot take or prefer not to take HRT due to contraindications or concerns. - SSRIs are less effective than HRT for severe vasomotor symptoms and do not address other menopausal symptoms like vaginal dryness or bone loss. *Estrogen* - While estrogen is the primary hormone for alleviating menopausal symptoms, administering **unopposed estrogen** to a woman with an intact uterus significantly increases the risk of **endometrial hyperplasia** and **endometrial carcinoma**. - Progesterone is necessary to counteract the proliferative effects of estrogen on the endometrium, preventing these risks. *Levothyroxine* - **Levothyroxine** is used to treat **hypothyroidism**, a condition that can cause fatigue, weight changes, and menstrual irregularities. - However, the patient's primary symptoms of prominent hot flashes and night sweats are not characteristic of hypothyroidism, and her physical examination is normal, making this diagnosis less likely.
Question 78: Which of the following is NOT effective in controlling the hot flushes of menopause in a woman?
- A. Raloxifene (Correct Answer)
- B. Isoflavones
- C. Hormone replacement therapy
- D. Tibolone
Explanation: ***Raloxifene*** - **Raloxifene** is a selective estrogen receptor modulator (SERM) that acts as an estrogen agonist in bone tissue, helping to prevent osteoporosis, but it is an estrogen antagonist in other tissues and can actually worsen or induce **hot flushes**. - Its primary indications are for the prevention and treatment of **osteoporosis** in postmenopausal women, and for the reduction of risk of invasive breast cancer in high-risk women. *Isoflavones* - **Isoflavones** (e.g., from soy) are phytoestrogens that can have weak estrogenic effects, and some women find them helpful in reducing the frequency and severity of **hot flushes**, though efficacy varies. - They bind to estrogen receptors, potentially mitigating the sudden drops in estrogen that lead to **vasomotor symptoms**. *Hormone replacement therapy* - **Hormone replacement therapy (HRT)**, which involves estrogen with or without progestin, is the most effective treatment for **menopausal hot flushes**. - By replacing declining estrogen levels, HRT directly addresses the underlying cause of **vasomotor instability**. *Tibolone* - **Tibolone** is a synthetic steroid that has estrogenic, progestogenic, and androgenic properties, and it is effective in relieving **menopausal hot flushes**. - It specifically targets estrogen receptors in the hypothalamus, which helps to stabilize **thermoregulatory control** and reduce hot flushes.
Question 79: Senile vaginitis is due to :
- A. Diabetes
- B. Gonococcal infection
- C. Oestrogen deficiency (Correct Answer)
- D. Cancer cervix
Explanation: ***Oestrogen deficiency*** - **Senile vaginitis**, also known as **atrophic vaginitis**, is primarily caused by **decreased oestrogen levels**, particularly after menopause. - Reduced oestrogen leads to thinning and drying of the vaginal walls, making them more susceptible to inflammation and infection. *Diabetes* - While uncontrolled **diabetes** can increase the risk of vaginal infections, such as **candidiasis**, it is not the direct cause of senile vaginitis itself. - Diabetic neuropathy can affect vaginal sensation, but does not cause the atrophic changes observed in senile vaginitis. *Gonococcal infection* - **Gonococcal infection** is a sexually transmitted infection that causes acute inflammation of the mucous membranes, but not the long-term atrophic changes seen in senile vaginitis. - It would present with purulent discharge and dysuria, which are distinct from the symptoms of senile vaginitis. *Cancer cervix* - **Cervical cancer** is a malignancy of the cervix and does not directly cause senile vaginitis. - While it can manifest with abnormal vaginal bleeding or discharge, these symptoms are typically due to the tumor itself and not the atrophic changes characteristic of senile vaginitis.
Question 80: Which of the following is NOT characteristic of menopause?
- A. Systemic vasomotor instability may be present
- B. There may be an increase in FSH secretion by the pituitary gland
- C. There is a marked decrease in adrenal cortical estrogen secretion (Correct Answer)
- D. There is a decrease in skin elasticity
Explanation: ***There is a marked decrease in adrenal cortical estrogen secretion*** - While **estrogen levels** do decrease significantly in **menopause**, the primary source of this drop is the **ovaries**, not the adrenal cortex. - The adrenal cortex primarily produces **androgens** (like DHEA), which can be converted to estrogens in peripheral tissues, but it is not the main source of estrogen and its secretion does not markedly decrease during menopause. *Systemic vasomotor instability may be present* - This is a hallmark symptom of **menopause**, manifesting as **hot flashes** and night sweats due to erratic thermoregulation. - It arises from **estrogen withdrawal**, which affects the hypothalamus's control over body temperature. *There may be an increase in FSH secretion by the pituitary gland* - As ovarian function declines and **estrogen production** decreases, the negative feedback on the **hypothalamic-pituitary axis** is reduced. - This leads to a compensatory **increase in GnRH** from the hypothalamus and subsequently elevated **FSH** and **LH** from the pituitary gland. *There is a decrease in skin elasticity* - **Estrogen deficiency** contributes to reduced collagen synthesis and dermal hydration, leading to **decreased skin elasticity** and increased wrinkles. - This is a common and characteristic dermatological change observed in menopausal women.
Practice by Chapter
Physiology of Menopause
Practice Questions
Perimenopausal Transition
Practice Questions
Menopausal Symptoms and Management
Practice Questions
Hormone Replacement Therapy
Practice Questions
Non-hormonal Management Options
Practice Questions
Osteoporosis Prevention and Management
Practice Questions
Cardiovascular Health in Menopause
Practice Questions
Urogenital Atrophy
Practice Questions
Psychological Aspects of Menopause
Practice Questions
Premature Menopause
Practice Questions
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