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Chapter 50. Hormone Therapy in Menopause

Student Questions

Which of the following statements regarding menopause is true?

A. Menopause is diagnosed after a series of increasing FSH concentrations.

B. The primary symptom of menopause is vulvovaginal atrophy.

C. Women who undergo surgical menopause experience similar vasomotor symptom severity as women who undergo natural menopause.

D. The perimenopausal period is characterized by an increase in cycle interval and a decrease in cycle length.

Answer: D

Option A: Incorrect. FSH concentrations can fluctuate. An increased FSH concentration along with clinical symptoms of menopause is necessary to diagnose menopause. However, a diagnosis can be made based on clinical symptoms alone.

Option B: Incorrect. The primary symptom of menopause is VMS.

Option C: Incorrect. Women who undergo surgical menopause often experience more severe VMS due to the rapidity in which estrogen concentrations decline.

Option D: Correct. This is the correct definition of perimenopause.

A 48-year-old woman wants to know about the overall use of hormones based upon data from clinical studies, including WHI and HERS. The most accurate statement would be:

A. Estrogen with and without progesterone has been shown to increase heart attacks and breast cancer in postmenopausal women.

B. Estrogen and progesterone increased the risk of invasive breast cancer in postmenopausal women, but estrogen alone did not.

C. Evidence indicates that topical and compounded products are safer than oral products because absorption is minimal and cardiovascular risks have not been shown to be significantly increased.

D. Evidence had demonstrated an increase in cardiovascular events in postmenopausal women who started estrogen regardless of time since initiation.

Answer: B

Option A: Incorrect. Only estrogen plus progestogen has been shown to increase heart attacks and breast cancer.

Option B: Correct. Estrogen and progestogen did increase the risk of invasive breast cancer in the WHI, and the estrogen alone arm did not.

Option C: Incorrect. There is no evidence that custom-compounded or topical products decrease cardiovascular risks or are safer than oral products.

Option D: Incorrect. There is increase cardiovascular risk if HT is initiated 10 years or more after menopause.

A healthy 43-year-old woman recently had a hysterectomy because of uncontrolled dysfunctional uterine bleeding and has been using an estrogen transdermal patch for 3 months to control menopausal symptoms with success. ...

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