Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

Menopausal Transition

21–1. The menopausal transition is a progressive endocrino-logic continuum that takes reproductive-aged women from regular, cyclic, predictable menses characteristic of ovulatory cycles to ovarian senescence and menopause. Most women can now expect to live what percentage of their lifetime in menopause?

a. 15

b. 20

c. 25

d. 33

21–2. Premature ovarian failure is associated with a persistently elevated follicle-stimulating hormone (FSH) level and refers to the cessation of menses before which of the following ages?

a. 35 years

b. 40 years

c. 45 years

d. 51 years

21–3. Characteristically, menopause begins with cycle irregularity that extends to 1 year after permanent cessation of menses. The more correct, scientific terminology for this time is menopausal transition, and it typically takes place over a span of how many years?

a. 1 to 2 years

b. 2 to 3 years

c. 4 to 7 years

d. 5 to 10 years

21–4. A number of environmental, genetic, and surgical influences may alter ovarian aging. Which of the following has been found to INCREASE the age of menopause?

a. Smoking

b. Chemotherapy

c. Ovarian surgery

d. Pelvic radiation

21–5. During the reproductive life of a woman, gonadotropin-releasing hormone is released in a pulsatile fashion from which of the following?

a. Corpus luteum

b. Ovarian follicle

c. Pituitary gonadotropes

d. Arcuate nucleus of the medial basal hypothalamus

21–6. With ovarian failure during menopausal transition, the negative-feedback loop is opened by cessation of ovarian steroid hormone release. This causes which of the following?

a. A rise in luteinizing hormone (LH) levels

b. A rise in follicle-stimulating hormone (FSH) levels

c. A maximal increase in the frequency and amplitude of gonadotropin-releasing hormone secretion

d. All of the above

21–7. This photomicrograph illustrates which of the following?


Reproduced, with permission, from Bradshaw KD: Menopausal transition. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 21-3C.

a. Multiple corpora lutea

b. Multiple corpora albicans

c. Multiple primordial follicles

d. None of the above

21–8. An average woman is expected to experience how many ovulatory events during her reproductive lifetime?

a. 100

b. 400

c. 700,000

d. 6 to 7 million

21–9. Which of the following transvaginal sonographic images best illustrates a premenopausal ovary?


a. A

b. B

c. A and B

d. None of the above

21–10. In postmenopausal women, unopposed estrogen may be derived from which of the following sources?

a. Exogenous estrogen

b. Extragonadal endogenous estrogen production

c. Decreased sex hormone-binding globulin levels

d. All of the above

21–11. In the postmenopausal woman with uterine bleeding, evaluation of the endometrium may be accomplished by endometrial biopsy, hysteroscopy, or transvaginal sonography. Which of the following sonographic endometrial thickness measurements is commonly used as a threshold to indicate a low risk for endometrial hyperplasia or cancer?


a. 1mm

b. 5mm

c. 7mm

d. 10mm

21–12. Less than 10 percent of postmenopausal women with abnormal uterine bleeding cannot be adequately evaluated by office biopsy, usually due to difficulty entering the uterine cavity. Which of the following pretreatment strategies may be warranted?

a. Motrin, 400-mg dose taken orally the evening before the procedure

b. Hydrocortisone, 25-mg vaginal suppository inserted the evening before the procedure

c. Prostaglandin E1 analog, misoprostol, 400-mg dose taken orally the night before the procedure

d. Conjugated equine estrogen cream, 1-g dose inserted vaginally the evening before the procedure

21–13. What is the most common medical complaint of women during menopausal transition?

a. Depression

b. Painful intercourse

c. Urinary incontinence

d. Vasomotor symptoms characterized as hot flashes

21–14. A tabulation of published epidemiologic studies determined that up to what percent of menstruating women develop vasomotor symptoms during menopausal transition?

a. 60

b. 70

c. 80

d. 90

21–15. Thermoregulatory changes that accompany a hot flash have been well documented. An individual hot flash generally lasts which of the following?

a. <1 minute

b. 1 to 5 minutes

c. 6 minutes

d. 6 to 10 minutes

21–16. Hot flashes may be accompanied by which of the following?

a. Panic

b. Anxiety

c. Palpitations

d. All of the above

21–17. Physiologic increases during a hot flash include all EXCEPT which of the following?

a. Core body temperature

b. Mean skin temperature

c. Respiratory exchange ratio

d. Plasma levels of estradiol

21–18. Osteopenia and osteoporosis are disorders characterized by a progressive reduction in bone mass and predispose patients to fractures in the spine, hips, and other sites. What is the estimated mortality rate (percent) from hip fracture alone?

a. 10

b. 30

c. 50

d. 70

21–19. Bone mineral density (BMD) values for sex, age, and ethnicity have been determined. For diagnostic purposes, results of BMD testing are reported as T-scores. What T-score value is associated with osteopenia?

a. T-score between + 2.5 and –1.0

b. T-score between + 1.0 and –1.0

c. T-score between + 1.0 and –2.5

d. T-score between − 1.0 and –2.5

21–20. Which of the following are secondary causes of osteoporosis that should be screened for in any patient with osteoporosis?

a. Hypothyroidism

b. Hypoparathyroidism

c. Chronic renal disease

d. None of the above

21–21. Before menopausal transition, women have a much lower risk for cardiovascular events compared with men the same age. Reasons for protection from cardiovascular disease in premenopausal women are complex. However, a significant contribution can be assigned to an effect of estrogen that results in which of the following?

a. Increased low-density lipoprotein levels

b. Increased high-density lipoprotein levels

c. Decreased high-density lipoprotein levels

d. Increased total cholesterol and low-density lipoprotein levels

21–22. Weight gain during menopausal transition is associated with fat deposition in the abdomen, which increases the likelihood of developing which of the following metabolic changes?

a. Diabetes mellitus

b. Insulin resistance

c. Cardiovascular disease

d. All of the above

21–23. Decreasing estrogen levels seen in late menopausal transition result in which of the following dental changes?

a. Increased salivation

b. Buccal epithelium atrophy

c. Increased oral alveolar bone osteoblasts

d. All of the above

21–24. Estrogen receptors have been identified in the vulva, vagina, urethra, pelvic floor musculature, and endopelvic fascia. Which of the following is a result of the decreased estrogen trophic influence?

a. Vaginal pH greater than 4.5

b. Higher rates of abnormal Pap smear cytology

c. Increased vaginal concentrations of lactobacilli

d. Higher rates of Bartholin gland duct abscess formation

21–25. All EXCEPT which of the following changes is found during menopausal transition?

a. Cognitive decline

b. Skin thinning and wrinkling

c. Decreased introital flexibility

d. Predominance of cytologic parabasal cells

Chapter 21 ANSWER KEY