MENOPAUSE EXAM QUESTIONS & CORRECT
ANSWERS LATEST 2026/2027
A 39-year-old woman who was found to have a BRCA 1 genetic mutation presents
to you before RRBSO for amenopause consultation. She is concerned about the
symptoms she may experience and risks associated with treatment options.
Because of an extensive family history of cancer and CVD, she prefers a more
“natural” approachto treatment. How would you counsel this patient?
Discuss ideal timing of RRBSO based on family history of age at onset of cancer
diagnosis and completion of
childbearing. Relay risks associated with early menopause and recommended
treatment of systemic HT until the natural age of menopause to minimize risks of
osteoporosis, CVD, and cognitive decline.
What is the recommended age for RRBSO in individuals with BRCA 1 mutations?
Between the ages of 35 and 40 years.
What is the recommended age for RRBSO in individuals with BRCA 2 mutations?
Between the ages of 40 and 45 years.
What is the standard of care regarding RRBSO after childbearing?
To offer RRBSO (with or without hysterectomy) as soon as possible after
childbearing is complete, ideally by mid-40s.
What are some severe menopause-related symptoms associated with early
menopause?
Vasomotor symptoms (VMS), genitourinary syndrome of menopause (GSM),
mood and cognitive changes, and sleep disturbances.
What health consequences are associated with early menopause?
Increased risk of cardiovascular disease (CVD), stroke, osteoporosis, and all-cause
mortality.
,Does systemic hormone therapy (HT) increase breast cancer risk in individuals
with BRCA 1 or 2 after RRBSO?
No, it has not been found to increase the risk of developing breast cancer.
Until what age should systemic hormone therapy be continued for those with
BRCA mutations after RRBSO?
Until the average age of natural menopause.
What is the association of Bilateral Salpingectomy (BS) with retention of ovaries
in patients with gene mutations?
It is associated with decreased ovarian cancer risk.
Does Bilateral Salpingectomy (BS) provide the same risk reduction for breast
cancer as it does for ovarian cancer?
No, it may not afford the same risk reduction for breast cancer.
A 56-year-old woman was diagnosed with left breast ductal carcinoma in situ at
age 45 and treated with lumpectomy, local radiation, and 5 years of tamoxifen. She
has no family history of the disease. Since her last menstrual period at
age 50, she has experienced nightly VMS that disrupt her sleep, as well as
dyspareunia and urge incontinence.
Various botanicals and SSRIs have been ineffective. The patient desires ET for her
symptoms. Shared decision-
making should include which of the following statements?
TSEC oral tablet (SERM + CEE) has been shown in preclinical trials to have
antitumor effects.
What did the HABITS trial demonstrate regarding hormonal replacement therapy
after breast cancer?
It showed an increased risk of local or contralateral recurrence, but not distant
recurrence.
Did any of the studies reviewed report increased breast cancer mortality associated
with hormonal therapy?
No, none reported increased breast cancer mortality.
What is a TSEC and what has been shown in preclinical studies?
,A TSEC is a combination of a SERM with estrogen, which has demonstrated
antitumor effects.
What issue is often underrecognized and undertreated in breast cancer survivors?
Genitourinary syndrome of menopause (GSM), which affects intimacy.
What are the first-line treatments for GSM in breast cancer survivors?
Nonhormone options.
What FDA-approved treatments are available for dyspareunia in breast cancer
survivors?
Intravaginal DHEA and oral ospemifene, though safety in survivors is not
established.
What may be considered if non-hormone therapies fail to alleviate symptoms in
breast cancer survivors?
Use of systemic hormonal therapy (Combining estrogen with MP
(medroxyprogesterone).) at the lowest effective dose with input from oncology.
What combination of hormones may pose less risk than synthetic progestogen
according to case-control studies for breast cancer survivors after non-hormone
therapies fail to alleviate symptoms?
Combining estrogen with MP (medroxyprogesterone).
should a post-menopausal patient who is newly being treated for Hyperthyroidism
also be treated for low bone mineral density? or should you wait until
hyperthyroidism has stabilized to reassess?
Although studies have shown that bone turnover markers will normalize within 1
month of any treatment of hyperthyroidism may not return to the normal range for
up to 3 to 5 years.
What diet is recommended for menopausal women to help maintain a healthy
weight?
The Mediterranean diet.
What is the recommended duration and intensity of exercise for menopausal
women?
Moderate intensity exercise for 60 to 90 minutes most days of the week.
, What types of exercise should menopausal women include in their routine?
Cardio and weight training.
What is perimenopause depression characterized by?
A combination of psychosocial stress, menopause, and depressive symptoms.
What is the gold-standard treatment for vasomotor symptoms (VMS) during
perimenopause?
Hormone therapy (HT).
Is hormone therapy FDA approved for treating perimenopause depression?
No, it is not FDA approved to treat this condition.
What is the gold standard treatment for vasomotor symptoms (VMS)?
Hormone Therapy (HT)
What alternative treatment may help with sleep when hormone therapy is
contraindicated or not preferred?
Melatonin may help with sleep.
What is the most effective treatment for management of Genitourinary Syndrome
of Menopause (GSM)?
Low-dose, local vaginal estrogen therapy (ET)
Why can low-dose, local vaginal ET be used in patients with a history of VTE,
stroke, CVD, or estrogen-responsive cancers?
It has minimal systemic absorption.
What treatment is FDA approved for postmenopausal dyspareunia besides estrogen
therapy?
Ospemifene and intravaginal DHEA.
What risk is associated with ospemifene?
A slight increased risk of blood clots.
Why are laser and radiofrequency procedures not recommended for treating GSM?
There is a lack of data showing efficacy and long-term safety.
ANSWERS LATEST 2026/2027
A 39-year-old woman who was found to have a BRCA 1 genetic mutation presents
to you before RRBSO for amenopause consultation. She is concerned about the
symptoms she may experience and risks associated with treatment options.
Because of an extensive family history of cancer and CVD, she prefers a more
“natural” approachto treatment. How would you counsel this patient?
Discuss ideal timing of RRBSO based on family history of age at onset of cancer
diagnosis and completion of
childbearing. Relay risks associated with early menopause and recommended
treatment of systemic HT until the natural age of menopause to minimize risks of
osteoporosis, CVD, and cognitive decline.
What is the recommended age for RRBSO in individuals with BRCA 1 mutations?
Between the ages of 35 and 40 years.
What is the recommended age for RRBSO in individuals with BRCA 2 mutations?
Between the ages of 40 and 45 years.
What is the standard of care regarding RRBSO after childbearing?
To offer RRBSO (with or without hysterectomy) as soon as possible after
childbearing is complete, ideally by mid-40s.
What are some severe menopause-related symptoms associated with early
menopause?
Vasomotor symptoms (VMS), genitourinary syndrome of menopause (GSM),
mood and cognitive changes, and sleep disturbances.
What health consequences are associated with early menopause?
Increased risk of cardiovascular disease (CVD), stroke, osteoporosis, and all-cause
mortality.
,Does systemic hormone therapy (HT) increase breast cancer risk in individuals
with BRCA 1 or 2 after RRBSO?
No, it has not been found to increase the risk of developing breast cancer.
Until what age should systemic hormone therapy be continued for those with
BRCA mutations after RRBSO?
Until the average age of natural menopause.
What is the association of Bilateral Salpingectomy (BS) with retention of ovaries
in patients with gene mutations?
It is associated with decreased ovarian cancer risk.
Does Bilateral Salpingectomy (BS) provide the same risk reduction for breast
cancer as it does for ovarian cancer?
No, it may not afford the same risk reduction for breast cancer.
A 56-year-old woman was diagnosed with left breast ductal carcinoma in situ at
age 45 and treated with lumpectomy, local radiation, and 5 years of tamoxifen. She
has no family history of the disease. Since her last menstrual period at
age 50, she has experienced nightly VMS that disrupt her sleep, as well as
dyspareunia and urge incontinence.
Various botanicals and SSRIs have been ineffective. The patient desires ET for her
symptoms. Shared decision-
making should include which of the following statements?
TSEC oral tablet (SERM + CEE) has been shown in preclinical trials to have
antitumor effects.
What did the HABITS trial demonstrate regarding hormonal replacement therapy
after breast cancer?
It showed an increased risk of local or contralateral recurrence, but not distant
recurrence.
Did any of the studies reviewed report increased breast cancer mortality associated
with hormonal therapy?
No, none reported increased breast cancer mortality.
What is a TSEC and what has been shown in preclinical studies?
,A TSEC is a combination of a SERM with estrogen, which has demonstrated
antitumor effects.
What issue is often underrecognized and undertreated in breast cancer survivors?
Genitourinary syndrome of menopause (GSM), which affects intimacy.
What are the first-line treatments for GSM in breast cancer survivors?
Nonhormone options.
What FDA-approved treatments are available for dyspareunia in breast cancer
survivors?
Intravaginal DHEA and oral ospemifene, though safety in survivors is not
established.
What may be considered if non-hormone therapies fail to alleviate symptoms in
breast cancer survivors?
Use of systemic hormonal therapy (Combining estrogen with MP
(medroxyprogesterone).) at the lowest effective dose with input from oncology.
What combination of hormones may pose less risk than synthetic progestogen
according to case-control studies for breast cancer survivors after non-hormone
therapies fail to alleviate symptoms?
Combining estrogen with MP (medroxyprogesterone).
should a post-menopausal patient who is newly being treated for Hyperthyroidism
also be treated for low bone mineral density? or should you wait until
hyperthyroidism has stabilized to reassess?
Although studies have shown that bone turnover markers will normalize within 1
month of any treatment of hyperthyroidism may not return to the normal range for
up to 3 to 5 years.
What diet is recommended for menopausal women to help maintain a healthy
weight?
The Mediterranean diet.
What is the recommended duration and intensity of exercise for menopausal
women?
Moderate intensity exercise for 60 to 90 minutes most days of the week.
, What types of exercise should menopausal women include in their routine?
Cardio and weight training.
What is perimenopause depression characterized by?
A combination of psychosocial stress, menopause, and depressive symptoms.
What is the gold-standard treatment for vasomotor symptoms (VMS) during
perimenopause?
Hormone therapy (HT).
Is hormone therapy FDA approved for treating perimenopause depression?
No, it is not FDA approved to treat this condition.
What is the gold standard treatment for vasomotor symptoms (VMS)?
Hormone Therapy (HT)
What alternative treatment may help with sleep when hormone therapy is
contraindicated or not preferred?
Melatonin may help with sleep.
What is the most effective treatment for management of Genitourinary Syndrome
of Menopause (GSM)?
Low-dose, local vaginal estrogen therapy (ET)
Why can low-dose, local vaginal ET be used in patients with a history of VTE,
stroke, CVD, or estrogen-responsive cancers?
It has minimal systemic absorption.
What treatment is FDA approved for postmenopausal dyspareunia besides estrogen
therapy?
Ospemifene and intravaginal DHEA.
What risk is associated with ospemifene?
A slight increased risk of blood clots.
Why are laser and radiofrequency procedures not recommended for treating GSM?
There is a lack of data showing efficacy and long-term safety.
