Menstrual Disorders, Amenorrhea and Menopause MCQs

Obstetrics & Gynaecology · 109 free questions with answers & explanations.

A 17-year-old girl presents with primary amenorrhea. She has normal secondary sexual characteristics with Tanner V breast development and pubic hair. She reports cyclic lower abdominal pain every month. Examination reveals a bluish membrane at the vaginal introitus with no vaginal opening. What is the MOST likely diagnosis and treatment?
A 24-year-old woman presents with primary amenorrhoea. Examination reveals blind vaginal pouch, absent uterus, normally developed secondary sexual characteristics, and scant axillary/pubic hair. Karyotype is 46,XY. The MOST likely diagnosis is:
A 52-year-old woman has been menopausal for 2 years. She has moderate vasomotor symptoms, no uterus (previous hysterectomy for fibroids), and no personal or family history of breast cancer or thromboembolic events. The MOST appropriate hormone therapy is:
A 22-year-old woman has primary amenorrhea. Examination shows normal female external genitalia, blind vaginal pouch, absent uterus, normal breast development, and bilateral inguinal masses. Karyotype is 46,XY. What is the MOST likely diagnosis?
A 48-year-old woman presents with hot flushes, night sweats, mood changes, and irregular periods for 8 months. Her FSH is 62 IU/L and estradiol is 22 pmol/L. She has no contraindications to HRT. She has an intact uterus. What is the APPROPRIATE hormone replacement therapy regimen?
A 22-year-old athlete with intense training has secondary amenorrhea for 8 months. Serum FSH 3 IU/L, LH 2 IU/L, estradiol 18 pg/mL, prolactin and thyroid function normal. This hormonal profile is consistent with hypogonadotropic hypogonadism. The pathophysiology involves which primary neuroendocrine mechanism?
The SWAN (Study of Women's Health Across the Nation) and MWS (Million Women Study) provided evidence on hormone replacement therapy (HRT) risks. Which specific HRT formulation has been shown to have the LOWEST risk of breast cancer compared to other formulations?
A 19-year-old with primary amenorrhoea has breast development (Tanner stage IV), no pubic or axillary hair, and a blind-ending vaginal pouch of 4 cm depth. Karyotype is 46,XY. Testosterone level is 6.8 nmol/L (normal male range 8–30). FSH and LH are normal male range. What is the diagnosis and its critical medico-legal implication?
A 52-year-old postmenopausal woman has vasomotor symptoms severely affecting quality of life and requests menopausal hormone therapy (MHT). She has an intact uterus and no personal history of breast cancer or thromboembolism. Her 10-year FRAX score for major osteoporotic fracture is 18%. Which MHT regimen is most appropriate?
According to the PALM-COEIN classification of abnormal uterine bleeding (AUB) by FIGO 2011 and updated 2018, which of the following is correctly classified as a structural cause?
A 19-year-old woman presents with primary amenorrhea, absent axillary and pubic hair, normal female phenotype, and blind-ending vagina. Serum testosterone is in the male range. The karyotype is 46,XY. What is the underlying molecular defect?
The PALM-COEIN classification (FIGO 2011, updated 2018) for abnormal uterine bleeding (AUB) categorizes causes into structural (PALM) and non-structural (COEIN). A 38-year-old woman has AUB with heavy menstrual bleeding. Hysteroscopy shows no intrauterine pathology; endometrial biopsy shows secretory endometrium. CBC shows platelet count 82,000/µL; prothrombin time and aPTT are normal; ristocetin cofactor assay is decreased. What is the COEIN category, and what is the diagnosis?
A 25-year-old woman presents with primary amenorrhea. Examination shows female external genitalia, normal breast development (Tanner stage 5), absent axillary and pubic hair, and a short vagina ending blindly. Karyotype is 46,XY. LH is elevated, testosterone is in the normal male range. MRI shows no uterus, no ovaries, but bilateral inguinal testes. What is the diagnosis, and what is the underlying molecular defect?
Kisspeptin-GnRH neuroscience: In hypothalamic amenorrhea (HA) due to energy deficiency (e.g., athletes), the primary neuroendocrine defect is at which level?
The MENQOL questionnaire and Greene Climacteric Scale are validated tools for assessing menopause-related quality of life. According to MHT (menopausal hormone therapy) prescribing in India (Indian Menopause Society 2022 position statement), which is the recommended first-line MHT for a 52-year-old woman with an intact uterus experiencing severe vasomotor symptoms?
In the PALM-COEIN classification (FIGO 2011) for abnormal uterine bleeding, the 'C' in COEIN stands for 'coagulopathy.' Von Willebrand disease (VWD) is the most common systemic coagulation disorder causing heavy menstrual bleeding. The VWD subtype that paradoxically has normal platelet count but requires platelet-directed therapy (DDAVP) rather than factor replacement is:
Kisspeptin neurons in the hypothalamus play a central role in GnRH pulse regulation. In hypothalamic amenorrhea (functional hypothalamic amenorrhea, FHA) due to energy deficit or stress, kisspeptin neuronal activity is:
The PALM-COEIN classification system (FIGO 2011, revised 2018) for abnormal uterine bleeding (AUB) classifies 'coagulopathy' as:
Regarding the NICE 2015 guideline on menopause management, which statement about hormone replacement therapy (HRT) and breast cancer risk is most accurate?
Functional hypothalamic amenorrhea (FHA) is characterized by all of the following EXCEPT:
A 38-year-old woman is commenced on hormone replacement therapy (HRT) with continuous combined estradiol 2 mg + dydrogesterone 10 mg daily for perimenopausal symptoms. She had a 6-year history of taking a combined oral contraceptive pill (COC) in her 30s. She asks about her breast cancer risk with HRT. The MOST accurate evidence-based counseling point from the WHI and Million Women Study data is:
A 22-year-old woman presents with primary amenorrhea. On examination, she is 165 cm, has normal female secondary sexual characteristics (Tanner Stage 5 breast and pubic hair), but on pelvic examination has a blind-ending vagina and no palpable uterus. Karyotype returns as 46, XY. Serum testosterone is 45 nmol/L (normal male range 10–35 nmol/L). LH is elevated. What is the MOST likely diagnosis?
A 17-year-old girl with primary amenorrhoea, normal breast development, absent pubic and axillary hair, vaginal length 2 cm with no cervix or uterus on MRI, and a 46,XY karyotype is diagnosed with Complete Androgen Insensitivity Syndrome (CAIS). What is the recommended timing for gonadectomy in CAIS?
The MRS (Menopause Rating Scale) and the Greene Climacteric Scale measure menopausal symptoms. Genitourinary syndrome of menopause (GSM) was defined in 2014 as a replacement for the term 'vulvovaginal atrophy'. Which of the following treatments for GSM is considered preferred over systemic HRT because it achieves efficacy with minimal systemic oestrogen absorption?
A 22-year-old athlete presents with secondary amenorrhoea, low bone density (Z-score −2.3), and disordered eating. She is diagnosed with the Female Athlete Triad. The 2014 IOC Consensus Statement renamed this condition. Under the updated nomenclature, what is the foundational physiological mechanism driving all three components?
The WISDOM trial and the WHI (Women's Health Initiative) studied HRT in postmenopausal women. Regarding the risk-benefit profile of combined estrogen-progestogen HRT versus estrogen-only HRT (in hysterectomised women), which specific malignancy risk reversal is central to current prescribing guidance?
A 22-year-old woman presents with primary amenorrhea. Examination reveals normal secondary sexual characteristics (Tanner stage V breast development), absent uterus and upper vagina, and normal karyotype 46,XX. FSH and LH are normal. What is the most likely diagnosis and what is the embryological basis of this condition?
A 52-year-old perimenopausal woman with intact uterus has moderate-severe vasomotor symptoms significantly affecting quality of life. She has no contraindications to hormone therapy. According to the NICE 2023 menopause guidelines and the evidence base, which regimen is most appropriate as first-line HRT?
A 17-year-old with primary amenorrhoea has a 46,XY karyotype, normal female external genitalia, absent uterus, and absent axillary/pubic hair. Serum testosterone is in the male normal range. Serum oestradiol is low-normal. What is the molecular mechanism underlying this condition?
The Women's Health Initiative (WHI) trial changed the landscape of menopausal hormone therapy (MHT). The combined oestrogen-progestogen arm was stopped early in 2002. What was the relative risk of breast cancer found, and what follow-up data from the same trial subsequently modified this interpretation?
A 20-year-old woman has primary amenorrhoea. She has normal female secondary sexual characteristics, a blind-ending vagina on examination, and no uterus on MRI. Karyotype returns 46,XY. Which diagnosis best explains this presentation and what is the mechanism?
The Women's Health Initiative (WHI) trial fundamentally altered HRT prescribing after publication. Which specific finding from the WHI combined HRT (oestrogen + progestogen) arm is now considered overestimated due to design limitations?
In PALM-COEIN classification of abnormal uterine bleeding (AUB), the acronym PALM represents structural causes. A 38-year-old with AUB found to have an intracavitary pedunculated fibroid causing submucous involvement of >50% of its diameter is classified as:
The Women's Health Initiative (WHI) trial results changed prescribing patterns for hormone therapy (HT) in menopause. A 52-year-old woman with an intact uterus experiencing severe menopausal symptoms seeks HT. The optimal regimen to balance symptomatic benefit with endometrial protection is:
The STRAW+10 staging system for the menopausal transition defines late menopausal transition (Stage -1) based on which specific criterion?
A 28-year-old woman presents with primary amenorrhea, phenotypically female, breast development present (Tanner stage IV), absent pubic and axillary hair, and absent uterus on ultrasound. Karyotype is 46XY. Serum testosterone is in the normal male range. This is most consistent with:
The Women's Health Initiative (WHI) trial findings regarding hormone replacement therapy (HRT) caused major changes in prescribing practice. A 52-year-old woman 2 years post-natural menopause, with significant vasomotor symptoms and no contraindications, seeks HRT advice. Which statement about current evidence-based HRT guidance is MOST accurate?
A 32-year-old woman with regular 28-day cycles presents with perimenstrual dysphoria, irritability, food cravings, and breast tenderness for 10 days before each period, with complete symptom resolution within 4 days of menstrual onset. There is no history of major depression. The most likely diagnosis and first-line pharmacological treatment are:
A 22-year-old woman with primary amenorrhea has normal female external genitalia, absent uterus, blind vaginal pouch, and no axillary or pubic hair. FSH is 9 IU/L, LH 8 IU/L, testosterone 65 nmol/L (markedly elevated above female range). Her karyotype is 46,XY. This is BEST classified as:
The STRAW+10 staging system for reproductive aging classifies the menopausal transition. Stage -2 (early menopausal transition) is characterized by which specific criterion?
The SWAN (Study of Women's Health Across the Nation) and KEEPS (Kronos Early Estrogen Prevention Study) trials both investigated menopausal hormone therapy. The KEEPS trial specifically evaluated oral versus transdermal estradiol in women within 3 years of menopause onset. The primary finding regarding cardiovascular risk markers was:
A 17-year-old presents with primary amenorrhoea. Breast development is Tanner stage 4. She has no pubic or axillary hair. On examination, the vagina ends as a blind pouch. Karyotype is 46,XY. Serum testosterone is in the male range. The most likely diagnosis is:
A 52-year-old perimenopausal woman complains of severe vasomotor symptoms (12+ hot flushes per day), vaginal dryness, and mood instability for 8 months. She had a hysterectomy 5 years ago for fibroids; both ovaries were conserved. Her last period was 9 months ago. The most effective and appropriate hormonal therapy is:
A 19-year-old woman presents with primary amenorrhoea. She has normal breast development (Tanner stage 4) and absent pubic/axillary hair. External genitalia appear female with a blind-ending vaginal pouch. Serum testosterone is 6.8 nmol/L (normal male range 8–29 nmol/L). Karyotype is 46,XY. The MOST likely diagnosis is:
A 52-year-old woman, 18 months post-menopause, presents with significant vasomotor symptoms and genitourinary syndrome of menopause (GSM). She has no contraindications to HRT. She has an intact uterus. According to current guidelines (NICE 2024/NAMS 2022), the MOST appropriate HRT regimen is:
The E3N cohort study, WISDOM trial, and Women's Health Initiative (WHI) collectively established that the risk of breast cancer with combined (oestrogen + progestogen) HRT is primarily attributable to:
A 24-year-old woman has secondary amenorrhoea for 8 months. Serum FSH is 55 IU/L, LH is 42 IU/L, oestradiol is 32 pmol/L, prolactin is normal, TSH is normal. Pregnancy test is negative. The MOST likely diagnosis is:
Regarding heavy menstrual bleeding (HMB), the first-line pharmacological treatment recommended by NICE CG44 (updated 2018) for women who do not desire immediate fertility and have no structural pathology is:
A 28-year-old woman has not menstruated for 8 months. Investigations show FSH 78 IU/L, LH 65 IU/L, estradiol 22 pmol/L, and normal TSH/prolactin. What is the MOST likely diagnosis?
The WHI (Women's Health Initiative) trial assessed combined estrogen-progestogen HRT and found it to be associated with which significant adverse outcome that led to early trial termination?
According to FIGO 2018 classification of causes of abnormal uterine bleeding (AUB) using the PALM-COEIN acronym, which of the following is classified under 'COEIN' (non-structural causes)?
A 20-year-old woman presents with primary amenorrhea. She has normal female secondary sexual characteristics (breast development, female hair distribution) and height 165 cm. Examination reveals absent uterus and short, blind-ending vagina. Karyotype is 46,XY. The underlying diagnosis and the primary reason for normal breast development are:
The Women's Health Initiative (WHI) trial published in 2002 reported the risks of combined estrogen-progestogen hormone replacement therapy (HRT). Which of the following is an accurate summary of WHI findings that influenced global prescribing practice?
A 19-year-old athlete (marathon runner) presents with secondary amenorrhea for 8 months, stress fractures, and eating behaviour suggesting caloric restriction. FSH and LH are low, estradiol is low, BMD is reduced. This triad is best described as:
A 52-year-old woman 18 months postmenopause presents with hot flushes, genitourinary syndrome of menopause (GSM), and dyspareunia. She has a history of estrogen receptor-positive breast cancer treated with tamoxifen 3 years ago, currently in remission. The safest first-line treatment for her genitourinary symptoms is:
A 28-year-old woman presents with secondary amenorrhoea for 8 months, low FSH, low LH, low oestrogen, and MRI shows an empty sella. Which of the following conditions most likely explains this combination?
A 22-year-old woman presents with primary amenorrhoea. She has normal secondary sexual characteristics, 46,XY karyotype, and bilateral testes in the inguinal canals. Serum testosterone is in the male range. The most likely diagnosis is:
The WHI (Women's Health Initiative) trial of combined continuous HRT (conjugated equine oestrogen + medroxyprogesterone acetate) showed increased risk of which specific complication that led to its premature termination?
Heavy menstrual bleeding (HMB) is defined as menstrual blood loss exceeding what threshold in contemporary NICE/FIGO classification?
Fezolinetant (Veoza) was approved by the FDA in 2023 for vasomotor symptoms of menopause. Its mechanism of action is:
A 16-year-old girl has primary amenorrhoea with normal breast development (Tanner stage IV), no pubic or axillary hair, absent uterus on ultrasound, and bilateral inguinal swellings. Karyotype is 46,XY. The most likely diagnosis is:
A 48-year-old perimenopausal woman with an intact uterus requests HRT for hot flushes and sleep disturbance. Which HRT regimen is mandatory to protect the endometrium?
A 22-year-old woman presents with secondary amenorrhoea for 8 months. Serum prolactin is 72 ng/mL, TSH is 8.2 mIU/L, and T4 is low. What is the MOST LIKELY mechanism of her hyperprolactinaemia?
The WHI (Women's Health Initiative) trial that reported increased breast cancer risk with HRT used which specific regimen?
A 22-year-old woman presents with primary amenorrhea. Examination reveals normal secondary sexual characteristics with breast development (Tanner V), absence of pubic and axillary hair, and a blind-ending vagina on examination. Karyotype is 46,XY. The diagnosis is androgen insensitivity syndrome (AIS). Regarding gonadal management, the most important consideration is:
A 50-year-old woman presents with hot flushes, night sweats, and moderate vasomotor symptoms. She had a hysterectomy for fibroids 5 years ago. She has no personal or family history of breast cancer, DVT, or cardiovascular disease. Her BMI is 23. What is the MOST appropriate hormone replacement therapy (HRT)?
A 19-year-old athlete (long-distance runner) presents with primary amenorrhea for 18 months despite menarche at age 14. She trains 6 hours/day and has a BMI of 17. The triad of low energy availability, menstrual dysfunction, and low bone mineral density in female athletes is termed the 'Female Athlete Triad.' The mechanism of hypogonadotropic hypogonadism in this condition is:
A 22-year-old woman presents with primary amenorrhea, short stature (150 cm), webbed neck, widely spaced nipples, and normal female external genitalia. Karyotype is 45,X. Ovarian biopsy shows fibrous streak gonads. What is the endocrine profile and preferred hormone replacement approach?
A 45-year-old woman presents with menorrhagia and secondary dysmenorrhoea for 2 years. Examination reveals a uniformly enlarged, globular, tender uterus of 10-week size. Transvaginal ultrasound shows heterogeneous myometrium with posterior wall predominance, no discrete fibroid. Serum CA-125 is mildly elevated (55 U/mL). What is the MOST likely diagnosis?
The Women's Health Initiative (WHI) trial finding that is MOST relevant to combined (oestrogen-progestogen) HRT prescribing in postmenopausal women is:
A 17-year-old girl presents with primary amenorrhea, Tanner Stage 3 breast development, normal pubic and axillary hair, and a vaginal length of 6 cm on examination. Karyotype is 46,XY. Serum testosterone is in the male range. What is the most likely diagnosis?
A 24-year-old woman presents with secondary amenorrhoea for 8 months, weight 43 kg, BMI 16 kg/m², hair loss, and cold intolerance. FSH 2.1 IU/L, LH 1.4 IU/L, E2 12 pmol/L, normal prolactin. The diagnosis is:
The KEEPS (Kronos Early Estrogen Prevention Study) trial investigated hormone therapy in recently menopausal women. Its primary finding regarding cardiovascular outcomes was:
A 50-year-old woman with severe vasomotor symptoms requests hormone therapy. She had a hysterectomy 5 years ago. She has no contraindications. The most appropriate HRT formulation is:
The World Health Organization classifies female sexual dysfunction related to menopause under which ICD-11 category that specifically captures genitourinary syndrome of menopause (GSM)?
A 22-year-old woman presents with primary amenorrhea, absent uterus on ultrasound, and normal secondary sexual characteristics including breast development and pubic hair. Karyotype is 46,XY. The diagnosis is:
In the Women's Health Initiative (WHI) trial, combined estrogen-progestogen hormone replacement therapy was associated with an increased risk of which outcome compared to placebo?
A 17-year-old athlete presents with amenorrhea for 8 months, BMI 17, and stress fracture of the tibial shaft. Her FSH is low, LH is low, and estradiol is low. The underlying mechanism is:
Asherman syndrome is most commonly caused by which procedure?
A 48-year-old woman with FSH 68 IU/L and amenorrhea for 14 months presents with vasomotor symptoms. She has an intact uterus and requests HRT. The appropriate regimen is:
Which investigation is the gold standard for confirming the diagnosis and grading of severity of Asherman syndrome?
A 22-year-old woman presents with primary amenorrhea, normal secondary sexual characteristics, and normal height. Karyotype is 46,XX. Pelvic ultrasound shows absent uterus. Serum testosterone is normal. Which diagnosis is MOST likely?
The WHI (Women's Health Initiative) estrogen-progestogen trial demonstrated which cardiovascular finding that changed postmenopausal HRT prescribing?
A 28-year-old woman presents with secondary amenorrhea for 6 months. Serum FSH is 52 mIU/mL and LH is 38 mIU/mL. Estradiol is 15 pg/mL. She has no galactorrhea and no symptoms of hypoestrogenism. What is the MOST likely diagnosis?
Heavy menstrual bleeding (HMB) is defined objectively as menstrual blood loss exceeding what volume per cycle?
Asherman syndrome is most commonly caused by which procedure, and what is the confirmatory diagnostic investigation of choice?
The AUB PALM-COEIN classification (FIGO 2011) categorizes causes of abnormal uterine bleeding. Which of the following correctly lists the structural causes (PALM)?
A 38-year-old woman has FSH 42 IU/L, AMH 0.1 ng/mL, and irregular periods for 6 months. She is diagnosed with premature ovarian insufficiency (POI). Which is the MOST IMPORTANT treatment consideration?
A 22-year-old woman has primary amenorrhoea, normal breast development, absent uterus on ultrasound, and a 46,XX karyotype. FSH is low. The most likely diagnosis is:
The SWAN (Study of Women's Health Across the Nation) study identified which primary vasomotor symptom characteristic that distinguishes women with the most severe and persistent hot flushes?
The Women's Health Initiative (WHI) trial reassessed the risk-benefit of combined oestrogen-progestogen HRT in postmenopausal women. Its key finding that altered prescribing practice globally was:
A 48-year-old woman with a history of ER-positive breast cancer is experiencing severe menopausal hot flushes after completing adjuvant aromatase inhibitor therapy. Which non-hormonal treatment has the strongest evidence for vasomotor symptom relief in breast cancer survivors?
A 24-year-old woman presents with secondary amenorrhoea of 8 months. She has never been pregnant. Pregnancy test is negative. FSH is 95 IU/L, LH is 88 IU/L, and oestradiol is <20 pg/mL. Which additional test most specifically confirms the most likely diagnosis?
A 22-year-old woman has primary amenorrhea. On examination, she is phenotypically female, has normal breast development, scanty axillary and pubic hair, and a short vagina with no uterus on MRI. Karyotype is 46,XY. The MOST likely diagnosis is:
The WHI (Women's Health Initiative) trial on postmenopausal hormone therapy revealed which of the following key findings that changed prescribing practice?
A 32-year-old woman with secondary amenorrhea for 8 months has FSH 58 IU/L, LH 42 IU/L, estradiol 18 pg/mL, and normal prolactin. Karyotype is 46,XX. The MOST appropriate term for her condition and the PRIMARY fertility treatment option is:
A 45-year-old perimenopausal woman has menorrhagia due to anovulatory cycles with normal uterine anatomy. The MOST appropriate first-line pharmacological management is:
A 22-year-old woman has primary amenorrhoea. She has normal secondary sexual characteristics (Tanner Stage 5 breast development, pubic and axillary hair present) but no uterus on ultrasound. Karyotype is 46,XY. Serum testosterone is in the male range. What is the diagnosis?
The Women's Health Initiative (WHI) trial significantly influenced prescribing of HRT. Which specific finding regarding combined (oestrogen + progestogen) HRT was most impactful?
A 17-year-old girl presents with primary amenorrhea, normal female phenotype, blind-ending vagina (vaginal length 5 cm), absent uterus, and normal female range testosterone. Karyotype is 46,XX. The MOST likely diagnosis is:
The PALM-COEIN classification system (FIGO 2018) categorises causes of abnormal uterine bleeding (AUB). A 40-year-old woman with diffusely enlarged, globular uterus and heavy menstrual bleeding would be classified under which PALM-COEIN category?
The ELITE trial compared early versus late initiation of oestrogen therapy after menopause for cardiovascular outcomes. What was its KEY finding relevant to the 'timing hypothesis'?
A 28-year-old woman presents with primary amenorrhea, absent secondary sexual characteristics, and elevated FSH (68 IU/L). Karyotype is 46,XX. The MOST appropriate next investigation to determine the cause is:
A 16-year-old girl has never menstruated. Examination shows breast development (Tanner stage IV) and pubic hair present. She has a blind-ending vaginal pouch. Karyotype is 46,XY. What is the MOST likely diagnosis?
Genitourinary syndrome of menopause (GSM) — formerly called vulvovaginal atrophy — is associated with all of the following EXCEPT:
A 45-year-old woman presents with irregular heavy menstrual bleeding for 8 months. Endometrial biopsy shows complex hyperplasia with atypia (endometrial intraepithelial neoplasia, EIN). She wishes to preserve fertility. The most appropriate medical management with evidence for regression of EIN is:
The Women's Health Initiative (WHI) trial demonstrated an increased risk of breast cancer with combined (oestrogen + progestogen) HRT. The specific progestogen in the WHI combined arm that carried the breast cancer risk signal was:
A 28-year-old woman has secondary amenorrhea for 8 months. Serum FSH is 68 IU/L (high), LH 52 IU/L (high), estradiol 22 pmol/L (low). Karyotype is 46,XX. The MOST LIKELY diagnosis is:
Endometrial ablation is appropriate for AUB (heavy menstrual bleeding) in a woman who has completed her family. Which condition is an ABSOLUTE CONTRAINDICATION to endometrial ablation?

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