WEEK 6 MENOPAUSE, BREAST
CONDITIONS, AND OSTEOPOROSIS
EXAM 2025 QUESTIONS AND ANSWERS
What is menopause - ANS the permanent cessation of menstruation and ovulation
●Retrospective diagnosis- can be made after 12 months of amenorrhea with no other
identifiable cause
●Menopause can occur naturally or it can be induced
total hysterectomy with BSO, chemotherapy, radiation therapy
what is estradiol? - ANS the most potent estrogen secreted by the dominant follicle and
corpus luteum in the premenopausal years
●Normal levels prior to menopause range 100's-800's depending on phase of menstrual cycle
Postmenopausalestridollevels are
menopause occurs in response to changes in the_____ - ANS HPO axis
what remains high/ low in menopause - ANS FSH/LH remain HIGH
E/P remain LOW
1
what is natural menopause? - ANS ∙Age range for menopause is 40-58 yrs, (average 52 yrs)
Page
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, ∙Gradual process as estrogen levels drop- perimenopause
○changes in menstrual cycle/length, changes in volume of blood flow and duration of bleeding,
can have missed cycles as well
○90% of women experience 4-8 years of menstrual changes before the final menstrual period
(average is 4 yrs)
what factors contribute to early menopause? - ANS ●Smoking
●low socioeconomic status
●low body weight BMI <19
●Nulliparity
●No OCP use
●Mother with early menopause (6x risk)
how do you Dx menopause? - ANS ∙Thorough history and PE- confirm absence of menses x
12 months
∙Skip the LABS- FSH/LH levels are erratic and fluctuate for the first 5 years. Labs can help to rule
out other ddx
∙Still need to consider other causes of AUB
what are differentials to consider instead of menopause? - ANS ●***PREGNANCY
●Diabetes
●HTN
●Arrhythmias
●Thyroid disease
●Anemia
●Depression
2
S/S of menopause - ANS The primary cause of symptoms is the dramatic decline in
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ESTROGEN levels:
@COPYRIGHT SIRJOEL 2025/2026
, ● Hot flashes- Most common symptom, also called vasomotor symptoms (VMS)
● Genitourinary changes- vaginal dryness, urinary incontinence, pelvic floor dysfunction
● Mood changes- irritability, depression
● Sleep disruption- insomnia, difficulty falling asleep, fatigue
● Changes in sexual function and lowered libido
what are some nonmusical Tx for VMS? - ANS ∙Phytoestrogens- Soy Isoflavones , Red Clover
∙Herbal supplements- Black Cohosh, St John's Wort
∙Clothing/environment- dress in layers, use a fan, keep room cool
∙Lifestyle changes- smoking cessation, exercise, maintaining healthy BMI, stress reduction
∙Dietary changes- avoid or reduce trigger foods: hot drinks, caffeine, ETOH, chocolate, spicy
foods
∙Yoga/meditation
Acupuncture
what are some medications to Tx VMS? - ANS Antihypertensive: Clonidine (catapres) patches
gabapentin
SSRI
venlafaxine
paroxetine
what is the women's health initiative study? - ANS ●Large multi-million dollar, multi-year
project started in 1991 by NHLBI that focused on strategies to prevent heart disease, breast and
colorectal cancer, and osteoporosis in postmenopausal women
3
●One aspect was to look at effects HT had on these diseases in healthy postmenopausal
Page
women aged 50-79 years- conducted a randomized blinded placebo-controlled hormone trial
@COPYRIGHT SIRJOEL 2025/2026
CONDITIONS, AND OSTEOPOROSIS
EXAM 2025 QUESTIONS AND ANSWERS
What is menopause - ANS the permanent cessation of menstruation and ovulation
●Retrospective diagnosis- can be made after 12 months of amenorrhea with no other
identifiable cause
●Menopause can occur naturally or it can be induced
total hysterectomy with BSO, chemotherapy, radiation therapy
what is estradiol? - ANS the most potent estrogen secreted by the dominant follicle and
corpus luteum in the premenopausal years
●Normal levels prior to menopause range 100's-800's depending on phase of menstrual cycle
Postmenopausalestridollevels are
menopause occurs in response to changes in the_____ - ANS HPO axis
what remains high/ low in menopause - ANS FSH/LH remain HIGH
E/P remain LOW
1
what is natural menopause? - ANS ∙Age range for menopause is 40-58 yrs, (average 52 yrs)
Page
@COPYRIGHT SIRJOEL 2025/2026
, ∙Gradual process as estrogen levels drop- perimenopause
○changes in menstrual cycle/length, changes in volume of blood flow and duration of bleeding,
can have missed cycles as well
○90% of women experience 4-8 years of menstrual changes before the final menstrual period
(average is 4 yrs)
what factors contribute to early menopause? - ANS ●Smoking
●low socioeconomic status
●low body weight BMI <19
●Nulliparity
●No OCP use
●Mother with early menopause (6x risk)
how do you Dx menopause? - ANS ∙Thorough history and PE- confirm absence of menses x
12 months
∙Skip the LABS- FSH/LH levels are erratic and fluctuate for the first 5 years. Labs can help to rule
out other ddx
∙Still need to consider other causes of AUB
what are differentials to consider instead of menopause? - ANS ●***PREGNANCY
●Diabetes
●HTN
●Arrhythmias
●Thyroid disease
●Anemia
●Depression
2
S/S of menopause - ANS The primary cause of symptoms is the dramatic decline in
Page
ESTROGEN levels:
@COPYRIGHT SIRJOEL 2025/2026
, ● Hot flashes- Most common symptom, also called vasomotor symptoms (VMS)
● Genitourinary changes- vaginal dryness, urinary incontinence, pelvic floor dysfunction
● Mood changes- irritability, depression
● Sleep disruption- insomnia, difficulty falling asleep, fatigue
● Changes in sexual function and lowered libido
what are some nonmusical Tx for VMS? - ANS ∙Phytoestrogens- Soy Isoflavones , Red Clover
∙Herbal supplements- Black Cohosh, St John's Wort
∙Clothing/environment- dress in layers, use a fan, keep room cool
∙Lifestyle changes- smoking cessation, exercise, maintaining healthy BMI, stress reduction
∙Dietary changes- avoid or reduce trigger foods: hot drinks, caffeine, ETOH, chocolate, spicy
foods
∙Yoga/meditation
Acupuncture
what are some medications to Tx VMS? - ANS Antihypertensive: Clonidine (catapres) patches
gabapentin
SSRI
venlafaxine
paroxetine
what is the women's health initiative study? - ANS ●Large multi-million dollar, multi-year
project started in 1991 by NHLBI that focused on strategies to prevent heart disease, breast and
colorectal cancer, and osteoporosis in postmenopausal women
3
●One aspect was to look at effects HT had on these diseases in healthy postmenopausal
Page
women aged 50-79 years- conducted a randomized blinded placebo-controlled hormone trial
@COPYRIGHT SIRJOEL 2025/2026
