HRT HRT for Menopause & Perimenopause 2 — Questions and Answers
Question 1: The WHI study findings regarding combined HRT were MOST applicable to which patient population?
- Older postmenopausal women (average age 63) with pre-existing cardiovascular risk (Correct answer)
- Newly menopausal women under age 55
- Perimenopausal women with no cardiovascular history
- Women with premature ovarian insufficiency
Correct answer: Older postmenopausal women (average age 63) with pre-existing cardiovascular risk
The WHI study enrolled women with an average age of 63 years, many with pre-existing cardiovascular risk factors, limiting applicability to younger, newly menopausal women.
Question 2: The 'timing hypothesis' of HRT suggests that cardiovascular benefits are most likely when HRT is initiated within how many years of menopause onset?
- Within 10 years or before age 60 (Correct answer)
- 20 years after menopause
- Only during perimenopause
- After age 70
Correct answer: Within 10 years or before age 60
The timing hypothesis holds that initiating HRT within 10 years of menopause or before age 60 preserves cardiovascular benefit, while later initiation may increase risk.
Question 3: Which progesterone/progestogen is considered to have the most favorable safety profile regarding breast cancer risk in HRT?
- Micronized progesterone (Prometrium) (Correct answer)
- Medroxyprogesterone acetate (MPA)
- Norethindrone acetate
- Levonorgestrel
Correct answer: Micronized progesterone (Prometrium)
Micronized progesterone has less proliferative effect on breast tissue compared to synthetic progestins like MPA, and observational studies suggest a more favorable breast cancer profile.
Question 4: Which symptom cluster is associated with the genitourinary syndrome of menopause (GSM)?
- Vaginal dryness, dyspareunia, and urinary urgency (Correct answer)
- Hot flashes, night sweats, and palpitations
- Depression, anxiety, and insomnia
- Joint pain, weight gain, and fatigue
Correct answer: Vaginal dryness, dyspareunia, and urinary urgency
GSM encompasses vulvovaginal atrophy and urinary tract changes including dryness, painful intercourse, and urgency due to estrogen loss in genital and lower urinary tract tissues.
Question 5: A perimenopausal woman reports irregular cycles, hot flashes, and low libido with normal FSH levels. What explains the normal FSH?
- FSH fluctuates during perimenopause and a single reading may not reflect overall status (Correct answer)
- She is not actually perimenopausal
- FSH is only elevated after complete menopause
- Hot flashes require elevated FSH to occur
Correct answer: FSH fluctuates during perimenopause and a single reading may not reflect overall status
Perimenopause is characterized by erratic hormonal fluctuation; FSH may be normal or even low on the day of testing despite overall declining ovarian reserve.
Question 6: Non-hormonal pharmacologic options for menopausal hot flashes include which of the following?
- Low-dose SSRIs/SNRIs and gabapentin (Correct answer)
- Testosterone only
- Thyroid hormone
- Metformin
Correct answer: Low-dose SSRIs/SNRIs and gabapentin
Low-dose SSRIs (paroxetine, escitalopram), SNRIs (venlafaxine), and gabapentin are evidence-based non-hormonal options for reducing menopausal vasomotor symptoms.
HRT HRT for Menopause & Perimenopause 2
The WHI study findings regarding combined HRT were MOST applicable to which patient population?