Endocrinology and management of hormone therapy in older women—Pretest (optional)

The editors of Sexuality, Reproduction & Menopause would like insight into your current knowledge of HT in older women. Your answers to these questions are anonymous and are not linked to your name or CME posttest score.

1) Which of the following hormones is consistently undetectable after a woman’s final menstrual period?

EstradiolTestosteroneInhibinProgesteroneAndrostenedione

2) Which of the following mathematical properties of reproductive hormones are predictive of symptoms in perimenopausal women?

Mean levelsStandard deviationLogarithmSquare root

3) Which of the following characteristics predicts more vasomotor symptoms in premenopausal women?

High BMIModerate exerciseHigh educational levelHigh family income

4) Which of the following patterns of menstrual flow are expected in the typical transition?

Progressively lighter flowHeavier flow, followed by lighter flowIntermittently heavy flowHeavy flow and more irregularity

5) Which of the following symptoms is NOT linked with good evidence to the menopausal transition?

Vaginal drynessDepressionPoor sleepMigraine headache

6) Compared to oral estrogens, transdermal estradiol provides advantages that include each of the following except:

No effect on hepatic production of clotting factorsNo effect on inflammatory hepatic proteinsLower estrogen dosing required for adequate hot flash of hot flashesNo requirement for progestin suppression of endometrial hyperplasiaNo effect on hepatic lipoprotein production

7) Transdermal testosterone delivered at a dose of 300 ug per day:

Significantly increases sexual desire in oophorectomized womenCommonly produces virlization in postmenopausal womenSignificantly increases serum triglyceridesAccelerates bone resorption, particularly in opposition to estrogensCommonly increases serum alkaline phosphatase

8) Adverse effects associated with transdermal estradiol administration include each of the following except:

Skin irritationBreast tendernessDeep vein thrombosisEndometrial hyperplasiaIrregular vaginal bleeding

9) A 53-year-old G0 underwent a hysterectomy with salpingoophorectomy two months ago and suffered a postoperative pulmonary embolism. She is seen in your office two months postoperatively and is having severe hot flashes and is unable to sleep. Her primary physician has placed her on antidepressants, and her symptoms are not improving. You would prescribe:

Conjugated estrogens/medroxyprogesterone acetate 0.325 mg continuouslyConjugated estrogen 0.325 mg continuouslyMicronized estradiol 1.0 mg per dayEstradiol patch delivering 0.0375 mg per dayMedroxyprogesterone acetate tabs 5 mg per day continuously

10) The Women’s Health Initiative studies published in 2002 reported a small increase in the risk of breast cancer and no protection against cardiovascular disease in postmenopausal women using an estrogen-containing preparation. The preparation reported in this study was:

Conjugated estrogensConjugated estrogens/medroxyprogesterone acetateEstradiol matrix patchEstradiol gelEstradiol spray