Chapter 6 Amenorrhea
1. If amenorrhea is reported by the female patient, the clinician should attribute this to until proven otherwise.
A. Pregnancy
B. Ovarian failure
C. Lack of progesterone
D. Menopause
2. A 17-year-old female patient complains of amenorrhea for the last 8 months, weight gain, excessive hair growth on the arms
and chest, and development of acne. Pelvic examination is normal. The clinician should recognize these are signs of:
A. Ovarian cancer
B. Endometriosis
C. Hormonal imbalance
D. Stress-induced anovulation
3.. A 55-year-old woman complains of amenorrhea and hot flashes for the last 3 months. Pregnancy test is negative. The
clinician should recognize that menopause is defined as the absence of menses for:
A. 3 months
B. 6 months
C. 1 year
D. 18 months
4. To confirm the diagnosis of amenorrhea due to menopause, blood should be drawn for hormones. Which are the changes
that occur with menopause?
A. FSH rises
B. LH decreases
C. LH rises
D. A & C
1. ANS: A
Last menstrual period is one of the most important questions to ask, particularly when prescribing medications, because many
are contraindicated in pregnancy. If menstrual cycles are not regular, pregnancy should be ruled out first, and then other
diagnoses can be considered. The menstrual history includes any episodes of amenorrhea, menorrhagia (excessive bleeding at
the time of
the menstrual cycle), metrorrhagia (bleeding at irregular noncyclic intervals), dysmenorrhea, and postmenopausal bleeding.
Amenorrhea has many causes, including pregnancy; anorexia nervosa; excessive exercise; low body fat; and disorders or
tumors of the hypothalamus, pituitary gland, ovary, uterus, and thyroid gland.
2.. ANS: C
Anovulation may present with amenorrhea but also may present with dysfunctional uterine bleeding, polymenorrhea, or
menorrhagia. The symptoms vary with the cause. Overweight may be seen with several of the causes, including
hypothyroidism, polycystic ovarian syndrome, and pituitary and adrenal dysfunction. Underweight is seen in anorexia nervosa,
excessive exercise,
hyperthyroidism, or stress-induced anovulation. Hirsutism, acne, and other skin changes can be seen with imbalances in
LH, FSH, and androgens, as seen in polycystic ovary disease. Delayed puberty or regression of sexual characteristics is
seen in hypopituitarism; galactorrhea can be the presenting symptom in pituitary tumors.
PTS: 1
3.. ANS: B
Menopause is the absence of menses for at least 6 months. Age of menopause varies greatly, although age 50 to 55 is the typical
range of onset. Although the absence of menses in a woman around the age of 50 years is diagnostic for
menopause, measurement of FSH, LH, and estradiol levels are helpful in confirming the diagnosis.
PTS: 1
4.. ANS: D
In menopause, FSH rises first and then LH rises, both greater than 100 mU/mL. A fall in estradiol is the last hormonal change
that occurs with the decline of ovarian function. An estradiol level of less than 30 pg/mL indicates loss of ovarian function.
1. If amenorrhea is reported by the female patient, the clinician should attribute this to until proven otherwise.
A. Pregnancy
B. Ovarian failure
C. Lack of progesterone
D. Menopause
2. A 17-year-old female patient complains of amenorrhea for the last 8 months, weight gain, excessive hair growth on the arms
and chest, and development of acne. Pelvic examination is normal. The clinician should recognize these are signs of:
A. Ovarian cancer
B. Endometriosis
C. Hormonal imbalance
D. Stress-induced anovulation
3.. A 55-year-old woman complains of amenorrhea and hot flashes for the last 3 months. Pregnancy test is negative. The
clinician should recognize that menopause is defined as the absence of menses for:
A. 3 months
B. 6 months
C. 1 year
D. 18 months
4. To confirm the diagnosis of amenorrhea due to menopause, blood should be drawn for hormones. Which are the changes
that occur with menopause?
A. FSH rises
B. LH decreases
C. LH rises
D. A & C
1. ANS: A
Last menstrual period is one of the most important questions to ask, particularly when prescribing medications, because many
are contraindicated in pregnancy. If menstrual cycles are not regular, pregnancy should be ruled out first, and then other
diagnoses can be considered. The menstrual history includes any episodes of amenorrhea, menorrhagia (excessive bleeding at
the time of
the menstrual cycle), metrorrhagia (bleeding at irregular noncyclic intervals), dysmenorrhea, and postmenopausal bleeding.
Amenorrhea has many causes, including pregnancy; anorexia nervosa; excessive exercise; low body fat; and disorders or
tumors of the hypothalamus, pituitary gland, ovary, uterus, and thyroid gland.
2.. ANS: C
Anovulation may present with amenorrhea but also may present with dysfunctional uterine bleeding, polymenorrhea, or
menorrhagia. The symptoms vary with the cause. Overweight may be seen with several of the causes, including
hypothyroidism, polycystic ovarian syndrome, and pituitary and adrenal dysfunction. Underweight is seen in anorexia nervosa,
excessive exercise,
hyperthyroidism, or stress-induced anovulation. Hirsutism, acne, and other skin changes can be seen with imbalances in
LH, FSH, and androgens, as seen in polycystic ovary disease. Delayed puberty or regression of sexual characteristics is
seen in hypopituitarism; galactorrhea can be the presenting symptom in pituitary tumors.
PTS: 1
3.. ANS: B
Menopause is the absence of menses for at least 6 months. Age of menopause varies greatly, although age 50 to 55 is the typical
range of onset. Although the absence of menses in a woman around the age of 50 years is diagnostic for
menopause, measurement of FSH, LH, and estradiol levels are helpful in confirming the diagnosis.
PTS: 1
4.. ANS: D
In menopause, FSH rises first and then LH rises, both greater than 100 mU/mL. A fall in estradiol is the last hormonal change
that occurs with the decline of ovarian function. An estradiol level of less than 30 pg/mL indicates loss of ovarian function.
