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Menopause, by definition, is the final menstrual period. It is diagnosed after 12 months of amenorrhea and is characterized by a myriad of symptoms that include, but are not limited to, changes from regular, predictable menses; vasomotor and urogenital symptoms, such as vaginal dryness and dyspareunia; and sleep and mood dysfunction.

Do you know the best practices to help treat menopausal women? Test yourself with our quiz.

Which of the following is the most common change in menstrual cyclicity that occurs during the menstrual transition in women with no pelvic pathology who continue to be ovulatory?

Longer menstrual cycle (> 30 days)

Shorter menstrual cycle (< 25 days)

Heavier menstrual flow

Lighter menstrual flow

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Which of the following is the most common change in menstrual cyclicity that occurs during the menstrual transition in women with no pelvic pathology who continue to be ovulatory?

A shorter menstrual cycle (< 25 days) is the most common change in menstrual cyclicity that occurs during the menstrual transition in women who have no pelvic pathology and who continue to be ovulatory. Because functional follicles, which are stimulated by follicle-stimulating hormone (FSH) during the first part of the menstrual cycle, have declined in number, less recruitment of oocytes occurs, and the follicular phase shortens accordingly. However, once ovulation occurs, the luteal phase remains fairly constant, at 14 days.

For more on the physiology of menopause, read verview#showall">here.

Which of the following is the most common symptom during menstrual transition?

Urinary frequency

Palpitations

Vertigo

Hot flashes or flushes

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Which of the following is the most common symptom during menstrual transition?

During the menopausal transition, physiologic changes in responsiveness to gonadotropins and their secretions occur, with wide variations in hormone levels. Women often experience a range of symptoms, including the following:

·         Hot flashes or flushes (most common)

·         Insomnia

·         Weight gain and bloating

·         Mood changes

·         Irregular menses

·         Mastodynia

·         Depression

·         Headache

For more on the presentation of menopause, read verview#showall">here.

Which of the following is most helpful in assessing the menopausal transition?

FSH assay

Anti-Müllerian hormone measurement

Endometrial biopsy

Luteinizing hormone (LH) measurement

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Which of the following is most helpful in assessing the menopausal transition?

Gonadotropin secretion increases dramatically after menopause. FSH levels are higher than LH levels, and both rise to even higher values than those seen in the surge during the menstrual cycle. The FSH rise precedes the LH rise. FSH is the diagnostic marker for ovarian failure. LH is not necessary to make the diagnosis.

Other markers of ovarian aging include anti-Müllerian hormone and Müllerian-inhibiting substance, which are produced by granulosa cells of all follicles. Assessment of these markers may be the earliest and most effective way of measuring progress toward menopause. At present, however, testing is not sufficiently developed to be considered a standard of care. Consequently, an increase in serum FSH and decreases in estradiol and inhibin are the major endocrine changes that indicate the transition to menopause.

Endometrial biopsy can show a range of endometrial appearances, from mildly proliferate to atrophic. No secretory changes are observed after menopause, because no ovulation occurs and therefore no corpus luteum forms to produce progesterone.

For more on the assessment of menstrual transition, read verview#showall">here.

Which of the following is the most useful pharmacologic intervention in postmenopausal women with osteoporosis?

Bisphosphonates

Estrogen

Raloxifene

Vitamin D

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Which of the following is the most useful pharmacologic intervention in postmenopausal women with osteoporosis?

With proper intervention, osteoporosis is a largely preventable sequela of menopause. Bisphosphonates (alendronate, etidronate, ibandronate, risedronate, and zoledronic acid) are the most useful pharmacologic intervention. Most of them prevent vertebral fractures, as do raloxifene and estrogen; however, raloxifene and estrogen have been shown to increase risk for thromboembolic events. Some bisphosphonates (alendronate, risedronate, and zoledronic acid) prevent hip and other nonvertebral fractures.

For more on osteoporosis as a sequela of menopause, read verview#aw2aab6b6">here.

Which of the following is not recommended in the treatment of menopausal women?

Estrogen plus progestin

Selective serotonin reuptake inhibitors

Progestin monotherapy

Norepinephrine reuptake inhibitors

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Which of the following is not recommended in the treatment of menopausal women?

In January 2014, the American College of Obstetricians and Gynecologists released an updated Practice Bulletin following:

·         Systemic hormone therapy with estrogen or estrogen plus progestin is the most effective treatment for vasomotor symptoms.

·         Low-dose estrogen and ultra-low systemic doses of estrogen have a better adverse effect profile than standard doses.

·         Alternatives to hormone therapy for vasomotor symptoms include selective serotonin reuptake inhibitors, selective serotonin and norepinephrine reuptake inhibitors, clonidine, and gabapentin.

·         Use of progestin alone, testosterone, compounded bioidentical hormones, phytoestrogens, herbal supplements, and lifestyle modifications are not supported by the data.

For more on treatment of menopause-related symptoms, read verview#showall">here.

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