MCQs on Menopause

Written by Dr. Priya Menon (MBBS, FRANZCOG) – Obstetrician and Gynaecologist

Question 1

Margaret, a 52-year-old woman, presents to her GP with a history of irregular menstrual cycles over the past year, hot flushes, and night sweats. Her last menstrual period was 14 months ago. She is otherwise healthy, takes no regular medications, and does not smoke. She asks if she needs a blood test to “confirm” menopause.

Which of the following is the most appropriate next step?

A) Order serum FSH and estradiol levels to confirm menopause
B) Diagnose menopause based on her history, without further testing
C) Arrange a pelvic ultrasound to assess ovarian volume
D) Perform a progesterone challenge test
E) Test serum anti-Müllerian hormone (AMH) level

Correct Answer: B) Diagnose menopause based on her history, without further testing

Explanation:
Menopause is defined as the permanent cessation of menstruation for at least 12 consecutive months, due to loss of ovarian function. In women over 45 with typical symptoms and menstrual history, diagnosis is made clinically and no hormonal testing is required. FSH and estradiol levels fluctuate widely during the perimenopause and are not reliable in this age group.

Option A: FSH and estradiol testing is not indicated in women >45 with typical symptoms; it may be useful in suspected premature menopause (<40 years).
Option C: Pelvic ultrasound does not diagnose menopause and is not routinely indicated.
Option D: Progesterone challenge testing is outdated and not used for menopause diagnosis.
Option E: AMH testing is not validated for diagnosing menopause; it may be used in fertility contexts.

In the Australian primary care setting, for women over 45 with symptoms and menstrual history consistent with menopause, the diagnosis should be made clinically, and management should focus on symptom relief, lifestyle, and long-term health risks (osteoporosis, cardiovascular health).

Question 2

Lisa, a 47-year-old school teacher, presents with complaints of irregular menstrual cycles over the past 8 months, hot flushes several times a day, trouble sleeping, and occasional mood swings. She has no significant past medical history, is a non-smoker, and drinks alcohol socially. She is concerned that she may be “too young” for menopause and wonders what is happening.

Which of the following is the most likely diagnosis?

A) Primary ovarian insufficiency
B) Perimenopause
C) Menopause
D) Hypothyroidism
E) Polycystic ovary syndrome

Correct Answer: B) Perimenopause

Explanation:
Perimenopause refers to the transition phase leading up to menopause, characterised by changes in menstrual cycle length and fluctuating hormone levels that cause vasomotor symptoms (hot flushes, night sweats), sleep disturbances, and mood changes. It typically begins in women aged 45–55 years and can last for several years before menstruation stops completely.

Option A: Primary ovarian insufficiency is menopause before age 40, often with a sudden onset of amenorrhoea.
Option C: Menopause is diagnosed only after 12 consecutive months without menstruation. Lisa is still having irregular periods, so she is in the perimenopausal phase.
Option D: Hypothyroidism can cause fatigue, weight gain, and menstrual irregularities, but vasomotor symptoms are uncommon.
Option E: PCOS presents with irregular periods, but usually begins in adolescence or early adulthood and is associated with hyperandrogenic features.

In the Australian setting, perimenopause is a common presentation in general practice. Management focuses on patient education, reassurance, and symptomatic relief, with consideration of lifestyle measures or hormonal therapy if symptoms are significant.

Question 3

Helen, a 54-year-old woman, presents to her GP with severe hot flushes, night sweats, and difficulty sleeping. She went through menopause 3 years ago. Her past medical history includes hypertension (well controlled with medication) and a deep vein thrombosis (DVT) 5 years ago after a long-haul flight. She is otherwise healthy and exercises regularly. She has read online about hormone replacement therapy and asks if she is a candidate.

Which of the following is the most appropriate advice?

A) HRT is recommended because she is within 10 years of menopause onset
B) HRT is contraindicated due to her history of DVT
C) HRT can be used if given in low doses and monitored closely
D) Vaginal estrogen therapy is the safest option for vasomotor symptoms in her case
E) Start combined oral contraceptive pills instead of HRT

Correct Answer: B) HRT is contraindicated due to her history of DVT

Explanation:
Systemic estrogen therapy (oral or transdermal) increases the risk of venous thromboembolism (VTE). A history of previous DVT or pulmonary embolism is an absolute contraindication to systemic HRT unless anticoagulation is ongoing and risk–benefit assessment is exceptional.

Option A: Being within 10 years of menopause onset reduces cardiovascular risk with HRT, but her clotting history outweighs this benefit.
Option C: Even low-dose HRT carries VTE risk in women with a prior clot.
Option D: Vaginal estrogen is safe for urogenital symptoms, but it does not relieve systemic vasomotor symptoms.
Option E: Combined oral contraceptive pills also increase VTE risk and are not appropriate post-menopause.

In Australia, women with significant vasomotor symptoms and a contraindication to HRT may be offered non-hormonal therapies such as SSRIs, SNRIs, gabapentin, or lifestyle modifications. If urogenital symptoms are present, local vaginal estrogen may be considered because it has minimal systemic absorption and does not increase VTE risk.

Previous Next

14. Gynecology Module

14.1 Abnormal Uterine Bleeding

14.2 Amenorrhea

14.3 Subfertility

14.4 Contraception

14.5 Menopause

14.6 Gynecological Oncology

14.7 Other Gynecological Disorders

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