,USMLE Step 2 – Gynecology | 2025 Clinical
Q&A Guide with Reproductive Physiology,
Contraception, and Hormonal Disorders
(350+ Questions).
At what age does breast development (Thelarche) usually occur?
8-11
At what age does first period (Menarche) usually occur?
10-16
Which phase of the ovarian cycle is typically variable?
Follicular phase
How long does the follicular phase usually last?
13 days
What happens hormonally during the follicular phase?
FSH stimulates follicle growth, producing estrogen. Estrogen stimulates development of straight glands
and thin secretions in the uterus. (proliferative phase)
What happens hormonally during the luteal phase?
Corpus luteum survives 14 days, due to lack of LH stimulation
During this time it secretes estrogen and progesterone, allowing the endometrial lining to develop thick
endometrial glands with thick secretions. (secretory phase)
What is the average age of onset of menopause?
51 yrs
What are the symptoms of menopause?
Psychiatric - depression/anxiety, loss of libedo, irritability
Vasomotor - Hot flushes
Estrogen - dry vagina, dysparenuria, reduced bone density
Constitutional - insomnia, aches
At what age is menopause defined as premature?
Less than 40
,Although menopause is normally a clinical diagnosis, what labs will help you identify it?
FSH and LH up (disinhibition from low estrogen)
Estrogen down
Lipid panel (cholesterol up, HDL down)
What is the main indication for HRT?
Vasomotor symptoms
What is contained in HRT?
Estrogen and Progestin
What are the main risks associated with HRT?
Breast cancer
CVS mortality/morbidity (so thromboembolism)
In which patients is HRT contraindicated?
Vaginal bleeding
Untreated endometrial cancer
Breast cancer
Hx of VTE
Hypertriglycerideaemia
Chronic liver disease (due to enhanced risk of cholestasis, but poor evidence)
What are some HRT alternatives for hot flushes?
What are the non-pharmacologic treatments for hot flushes?
SSRI/SNRI
Clonidine
Gabapentin
Keep cool/avoid triggers
Weight loss/exercise
Pace respiration
What non-HRT treatments are available to alleviate the Sx of menopause?
SSRI/SNRI
Clonidine
Gabapentin
(all of these reduce the frequency of hot flushes)
Topical estrogen (best for vaginal atrophy)
Calcium + Vit D supplementation +/- bisphosphonates (osteoporosis)
, What are the odds of falling pregnant within one year if not using contraception (and if regularly
sexually active)
85% of women who are sexually active will become pregnant within one year if not using contraception
What are the three non-surgical options with >99% effectiveness as a contraception, and how long does
each last?
Implanon - 3yrs
Mirena - 5yrs
Copper IUD - 10yrs
What are some possible disadvantages to using implanon?
Irregular periods
Headache
Weight gain
Depression/Emotional Lability
Acne
What are the pros and cons of using mirena?
Pros:
Immediate fertility once removed
Safe w/ breastfeeding
(these are both applicable to implanon and copper IUD also)
Lighter periods, less cramping
Cons:
Spotting
1/1000 risk of uterine puncture
What is the main disadvantage of a copper IUD not possessed by Mirena?
Exacerbates periods/more cramping.
(Also carries risk of uterine puncture)
What is the most effective irreversible contraceptive option?
Tube tying/vasectomy (this needs 2 negative post-op samples to be considered a success)
Distinguish between the mechanisms and thus effectiveness of the COC and Progestin-only pills
COCP - Oestrogen + Progesterone. Inhibits FSH and LHG release + thickens mucus and decidualizes
endometrium.
POP - Thickens cervical mucus, hence less effective (however, safe with breastfeeding - COCP passes
oestrogen to baby)
Q&A Guide with Reproductive Physiology,
Contraception, and Hormonal Disorders
(350+ Questions).
At what age does breast development (Thelarche) usually occur?
8-11
At what age does first period (Menarche) usually occur?
10-16
Which phase of the ovarian cycle is typically variable?
Follicular phase
How long does the follicular phase usually last?
13 days
What happens hormonally during the follicular phase?
FSH stimulates follicle growth, producing estrogen. Estrogen stimulates development of straight glands
and thin secretions in the uterus. (proliferative phase)
What happens hormonally during the luteal phase?
Corpus luteum survives 14 days, due to lack of LH stimulation
During this time it secretes estrogen and progesterone, allowing the endometrial lining to develop thick
endometrial glands with thick secretions. (secretory phase)
What is the average age of onset of menopause?
51 yrs
What are the symptoms of menopause?
Psychiatric - depression/anxiety, loss of libedo, irritability
Vasomotor - Hot flushes
Estrogen - dry vagina, dysparenuria, reduced bone density
Constitutional - insomnia, aches
At what age is menopause defined as premature?
Less than 40
,Although menopause is normally a clinical diagnosis, what labs will help you identify it?
FSH and LH up (disinhibition from low estrogen)
Estrogen down
Lipid panel (cholesterol up, HDL down)
What is the main indication for HRT?
Vasomotor symptoms
What is contained in HRT?
Estrogen and Progestin
What are the main risks associated with HRT?
Breast cancer
CVS mortality/morbidity (so thromboembolism)
In which patients is HRT contraindicated?
Vaginal bleeding
Untreated endometrial cancer
Breast cancer
Hx of VTE
Hypertriglycerideaemia
Chronic liver disease (due to enhanced risk of cholestasis, but poor evidence)
What are some HRT alternatives for hot flushes?
What are the non-pharmacologic treatments for hot flushes?
SSRI/SNRI
Clonidine
Gabapentin
Keep cool/avoid triggers
Weight loss/exercise
Pace respiration
What non-HRT treatments are available to alleviate the Sx of menopause?
SSRI/SNRI
Clonidine
Gabapentin
(all of these reduce the frequency of hot flushes)
Topical estrogen (best for vaginal atrophy)
Calcium + Vit D supplementation +/- bisphosphonates (osteoporosis)
, What are the odds of falling pregnant within one year if not using contraception (and if regularly
sexually active)
85% of women who are sexually active will become pregnant within one year if not using contraception
What are the three non-surgical options with >99% effectiveness as a contraception, and how long does
each last?
Implanon - 3yrs
Mirena - 5yrs
Copper IUD - 10yrs
What are some possible disadvantages to using implanon?
Irregular periods
Headache
Weight gain
Depression/Emotional Lability
Acne
What are the pros and cons of using mirena?
Pros:
Immediate fertility once removed
Safe w/ breastfeeding
(these are both applicable to implanon and copper IUD also)
Lighter periods, less cramping
Cons:
Spotting
1/1000 risk of uterine puncture
What is the main disadvantage of a copper IUD not possessed by Mirena?
Exacerbates periods/more cramping.
(Also carries risk of uterine puncture)
What is the most effective irreversible contraceptive option?
Tube tying/vasectomy (this needs 2 negative post-op samples to be considered a success)
Distinguish between the mechanisms and thus effectiveness of the COC and Progestin-only pills
COCP - Oestrogen + Progesterone. Inhibits FSH and LHG release + thickens mucus and decidualizes
endometrium.
POP - Thickens cervical mucus, hence less effective (however, safe with breastfeeding - COCP passes
oestrogen to baby)
