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/ (AY21/22 Updated) Menopause

(AY21/22 Updated) Menopause

1.
What is the approach to determine whether a woman has reach menopause?

Perform serum FSH/LH after no menses for 6 months

Perform serum FSH/LH on day 14 of her menstrual cycle

Perform serum FSH/LH/Estradiol on day 1 of menstrual cycle

Menopause is determined retrospectively after 12 consecutive months of the cessation of menstrual

period

Menses will stop after 2 years of typical hot flushes and mood swings

2.
The treatment of choice for severe menopausal symptoms and hot flushes, which
affects activities of daily living, is:

Offer bio-identical hormones as treatment for her symptoms as it is safer than conventional hormone
therapy

Reassure patient that hot flushes will get better and advise patient to endure in the mean time.

Hormone therapy should be offered to her even though she is at high risk of breast cancer as that is
the only treatment available.

Offer hormone therapy after assessing that patient does not have contraindication at the lowest dose
and the shortest duration possible to manage patient’s symptoms.

Advise her to take phyto-estrogen supplement as it is very effective and has no risk.

3.
A 49 year old woman with no past medical or surgical history approaches you in
the clinic as she has been having regular, troublesome hot flushes for past 6
months. Her last period was 2 weeks ago and they are regular.
Which is the most suitable type of HRT to start her on?

 
Continuous combined HRT

Estrogen only HRT - oral tablets

Mirena IUS

Estrogen only HRT - patches

Sequential combined HRT

4. Which of the following diseases is HRT protective against?
Stroke

Endometrial cancer

Venous thromboembolism

Breast cancer

Bowel cancer

5.
Hormone Therapy should not be used in the following:

Women with vaginal bleeding of unknown etiology

Breast cancer survivors

Patients with active liver disease

History of venous thromboembolism

All of the above

6.
A 45 year old woman approaches you in the menopause clinic. Her mother died
at the age of 48 from acute myocardial infarction.
She wants more information on the use of HRT and other medications to prevent
coronary heart disease (CHD).
 
Which of the following statements is correct?

 
Aspirin should be taken regularly after the age of 50 years to prevent CHD

Estrogen does not reduce the risk of CHD in women with premature menopause

Estrogen may have a protective role in CHD prevention in menopausal women aged 50–59 years

HRT is as good as the combination of lifestyle measures in the prevention of CHD in menopausal
diabetic women

Estrogen is protective against CHD only if started after 60 years of age

7. A 45 year old woman who had hysterectomy and bilateral salpingo oophorectomy
1 year ago complains of severe menopausal symptoms. She is requesting for HRT.
What is the MOST appropriate management for her?
Continuous combined HRT

Mirena IUS

Estrogen only

Sequential HRT

Herbal therapies

8. Which of the following is true about Tibolone?

 Risk of stroke doubles with use beyond 60 years

It has estrogenic and progestogenic effects only and has no androgenic effects.

It is a non-steroid

It is not effective against hot flushes

Can only be used in a woman with a uterus

9.
A 48 year old woman attends menopausal clinic as she is having severe hot
flushes and mood changes for the past 6 months. Her last periods was 12
months ago. She is requesting for hormone replacement therapy. She is sexually
active and wishes to know about contraception while she is on HRT. What is the
most appropriate advice you will give her?

She does not require HRT as she will be taking estrogen and progesterone

She needs to use additional contraception for 2 years from her last menses

Advice abstinence as long as she takes HRT.

Barrier methods are very effective methods when on HRT.

She needs to use additional contraception for 1 year from her last menses

10.
A 30 year old woman attends gynaecology clinic complaining of absence of
menstruation for 9 months. She had regular periods previously. She had 1 child at
the age of 25 years. You have excluded pregnancy. Amenorrhea panel was
done.  The results are given below:
•           FSH 58 IU/l
•           LH 70 IU/l
•           E2 <50 nmol
•           Prolactin normal
•           TFT normal

What is the most likely diagnosis?

 
Pituitary tumour

Asherman’s syndrome

PCOS

Premature ovarian insufficiency

Cervical stenosis

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