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Menstrual Disorders and Infertility

Total questions: 60

Worksheet time: 30mins

Name
Class
Date
1.

Amenorrhea is defined as:

a)

Absence of menses for 60 days in any female

b)

Absence of menstrual bleeding for a 90-day period

c)

Periods lasting longer than 7 days

d)

Absence of ovulation for two consecutive cycles

2.

Which of the following treatments is considered first-line for many menstrual-related disorders due to hormone regulation and cycle control?

a)

Danazol

b)

Aromatase inhibitors

c)

Combined hormonal contraceptives

d)

GnRH antagonists

3.

For secondary amenorrhea, which pharmacologic option is used to induce withdrawal bleeding?

a)

Dopamine agonists

b)

Progestins

c)

Estradiol patches

d)

GnRH antagonists

4.

The most effective long-term option for heavy menstrual bleeding when fertility is not an immediate goal is:

a)

Oral tranexamic acid

b)

Levonorgestrel IUS

c)

Celecoxib

d)

Aspirin

5.

What pharmacologic therapy for dysmenorrhea is most effective if started 1-2 days prior to menses and continued through day 2-3?

a)

GnRH agonists

b)

SSRIs

c)

NSAIDs

d)

Danazol

6.

For PMS/PMDD, the preferred pharmacologic therapy for affective symptoms is:

a)

NSAIDs

b)

SSRIs

c)

CHCs only

d)

Tranexamic Acid

7.

Which treatment is used for metabolic features of PCOS when lifestyle changes are insufficient?

a)

Progestin-only pills

b)

Metformin

c)

Tranexamic acid

d)

GnRH agonists

8.

The first-line treatments for endometriosis include all of the following except:

a)

CHCs

b)

NSAIDs

c)

Progestins

d)

Aromatase inhibitors

9.

GnRH agonists initially cause which effect upon initiation?

a)

Immediate suppression of LH/FSH

b)

Estrogen flare due to increased LH/FSH

c)

Bone mineralization

d)

Ovulation induction

10.

Danazol carries boxed warnings for all of the following except:

a)

Thromboembolism

b)

Teratogenicity

c)

Severe intracranial hypertension

d)

Osteoporosis

11.

Tranexamic acid is preferred over NSAIDs for HMB in patients with:

a)

History of thrombosis

b)

Bleeding disorders such as von Willebrand disease

c)

Severe PMS symptoms

d)

Metabolic syndrome

12.

Which CHC product is FDA-approved for PMS/PMDD?

a)

Ortho-Tri-Cyclen

b)

Natazia

c)

Yaz

d)

NuvaRing

13.

In dysmenorrhea, NSAIDs work by:

a)

Stabilizing fibrin clots

b)

Inhibiting COX to reduce prostaglandins

c)

Increasing uterine contractility

d)

Increasing estrogen levels

14.

Endometriosis diagnosis is definitively confirmed by:

a)

Transvaginal ultrasound alone

b)

MRI results

c)

Histologic exam from surgically removed lesions

d)

Hormone panel testing

15.

Which hormone is most responsible for mood changes during the luteal phase by influencing neurotransmitters such as serotonin?

a)

Testosterone

b)

Estrogen and progesterone

c)

Follicle-stimulating hormone

d)

Prolactin

16.

Which medication class may cause hyperprolactinemia, contributing to amenorrhea?

a)

SSRIs

b)

CHCs

c)

Antipsychotics

d)

NSAIDs

17.

Which of the following is an adverse effect of tranexamic acid?

a)

Renal failure

b)

Hypoglycemia

c)

Ocular changes

d)

Irreversible infertility

18.

Which nonpharmacologic therapy is recommended for PMS/PMDD?

a)

High-protein diet

b)

Vitamin B6 and calcium supplementation

c)

Weight lifting only

d)

Avoidance of all carbohydrates

19.

A 29-year-old patient has significant PMDD symptoms and also wants contraception. She prefers a hormonal option.

Which therapy is MOST appropriate?

a)

Yaz

b)

Levonorgestrel IUD

c)

Tranexamic acid

d)

Aromatase inhibitor

20.

A 23-year-old woman with AUB-O has irregular menses, acne, and hirsutism. She wants contraception and improvement in androgenic features.

Best medication choice if there are no contraindications?

a)

Levonorgestrel IUS

b)

CHC containing norgestimate or desogestrel

c)

Progestin-only pill

d)

NSAIDs

21.

A 35-year-old woman with PCOS has irregular menses, increasing waist circumference, and fasting glucose of 115 mg/dL. Lifestyle modifications have not improved her symptoms.

What is the BEST addition?

a)

SSRIs

b)

Metformin

c)

GnRH antagonist

d)

Tranexamic acid

22.

A 30-year-old patient presents with chronic pelvic pain and dysmenorrhea. NSAIDs and CHCs have been ineffective.

Which therapy is MOST appropriate next?

a)

GnRH agonist

b)

Danazol first

c)

Aromatase inhibitor

d)

Copper IUD

23.

A 34-year-old patient requires hormone suppression for endometriosis but previously experienced worsening pain when starting a GnRH agonist due to flare.

Which option avoids the estrogen flare?

a)

Leuprolide

b)

Nafarelin

c)

Elagolix

d)

Danazol

24.

A 33-year-old woman with endometriosis is considering danazol. She has a history of DVT and elevated lipids.

What should you recommend?

a)

Start danazol now

b)

Avoid danazol due to thromboembolic risk

c)

Use aromatase inhibitors instead because they are first-line

d)

Switch to tranexamic acid

25.

Why does tranexamic acid reduce menstrual blood loss?

a)

It decreases vaginal blood flow

b)

It stabilizes fibrin clots by inhibiting fibrinolysis

c)

It reduces estrogen production

d)

It reduces uterine contractility

26.

Why are estrogen-containing contraceptives avoided in smokers over 35?

a)

They decrease endometrial thinning

b)

Increases clot and cardiovascular risks

c)

Reduces estrogen effectiveness

d)

Lower progesterone levels

27.

Which medication option works primarily by suppressing ovulation and reducing hormone fluctuations, making it useful across many menstrual disorders?

a)

NSAIDs

b)

Combined hormonal contraceptives

c)

Tranexamic acid

d)

Danazol

28.

Which medication is MOST effective for reducing menstrual blood loss in heavy menstrual bleeding (HMB)?

a)

NSAIDs

b)

Tranexamic acid

c)

Levonorgestrel IUS

d)

CHCs

29.

Which treatment is considered first-line for endometriosis pain?

a)

GnRH agonists

b)

CHCs or progestins

c)

Danazol

d)

Aromatase inhibitors

30.

Which endometriosis treatment is highly effective but has significant androgenic adverse effects such as hirsutism, acne and increased risk of ASCVD?

a)

Elagolix

b)

Levonorgestrel IUS

c)

Ibuprofen

d)
Danazol
31.

Infertility is defined as the inability to conceive after how long of regular, unprotected intercourse?

a)

3 months

b)

6 months

c)

12 months

d)

24 months

32.

Which hormone surge directly triggers ovulation?

a)

FSH

b)

Estrogen

c)

Progesterone

d)

LH

33.

A biphasic basal body temperature with an increase of 0.5–1°F indicates:

a)

PCOS

b)

Ovulation

c)

Tubal obstruction

d)

Hyperprolactinemia

34.

Elevated testosterone leading to cyst development and anovulation is characteristic of:

a)

Hyperprolactinemia

b)

PCOS

c)

Hypothalamic dysfunction

d)

Premature ovarian insufficiency

35.

Evaluation for infertility should begin after 6 months (instead of 12) when:

a)

The male partner is over 40

b)

The female partner is ≥ 35

c)

There is a history of PCOS

d)

The woman has regular cycles

36.

Which limitation of ART in older women was emphasized?

a)

ART increases miscarriages

b)

ART cannot overcome age-related oocyte aneuploidy

c)

IVF success rates do not vary with age

d)

IUI is more effective than IVF

37.

First-line pharmacologic options for ovulation induction include:

a)

Gonadotropins

b)

IVF only

c)

Clomiphene or letrozole

d)

GnRH antagonists only

38.

Clomiphene’s mechanism involves:

a)

Blocking LH receptors

b)

Aromatase inhibition

c)

Downregulating estrogen receptors

d)

Replacing endogenous progesterone

39.

Letrozole is preferred over clomiphene in which condition?

a)

Hyperprolactinemia

b)

PCOS with anovulatory infertility

c)

Tubal factor infertility

d)

Premature ovarian insufficiency

40.

A patient taking clomiphene reports blurred vision and flashing lights. This effect:

a)

Is expected and harmless

b)

Suggests endometrial thinning

c)

May require discontinuation

d)

Indicates impending ovulation

41.

Which agent does not cause antiestrogenic effects on the endometrium?

a)

Clomiphene

b)

Letrozole

c)

hCG

d)

GnRH agonists

42.

One strategy to reduce the risk of OHSS is using which trigger?

a)

hCG only

b)

Natural LH surge monitoring

c)

Leuprolide

d)

Letrozole co-therapy

43.

Which of the following endocrine abnormalities can suppress ovulation by reducing estrogen levels?

a)

Hyperthyroidism

b)

Hyperprolactinemia

c)

Elevated progesterone

d)

Low FSH

44.

Which ART technique bypasses cervical mucus by placing washed sperm directly into the uterine cavity?

a)

IVF

b)

ICSI

c)

IUI

d)

GnRH antagonist protocol

45.

Cultured embryos created via IVF are typically transferred after:

a)

1–2 days

b)

3–5 days

c)

7–10 days

d)

At any time based on patient preference

46.

Clomiphene increases FSH and LH by:

a)

Blocking progesterone receptors

b)

Downregulating estrogen receptors in the hypothalamus

c)

Enhancing LH sensitivity in the ovaries

d)

Directly stimulating GnRH secretion

47.

Letrozole increases LH and FSH levels by:

a)

Blocking FSH inhibition in the pituitary

b)

Inhibiting the aromatase enzyme and lowering estrogen

c)

Mimicking LH surge

d)

Increasing progesterone levels

48.

How are patients taking gonadotropins monitored?

a)

TSH and prolactin

b)

Endometrial thickness only

c)

Serum estradiol and follicle ultrasound

d)

Fasting insulin and AMH

49.

Which agent causes anti-estrogenic effects on the endometrium and may reduce cervical mucus quality?

a)

Letrozole

b)

Gonadotropins

c)

Clomiphene

d)

Progesterone

50.

GnRH agonists initially cause a “flare” effect, which means:

a)

A temporary rise in FSH/LH before suppression

b)

Immediate suppression of LH

c)

Rapid follicle degradation

d)

Premature endometrial sloughing

51.

Which medication is used specifically for hyperprolactinemia-related infertility?

a)

Letrozole

b)

Bromocriptine

c)

Metformin

d)

rFSH

52.

Metformin is used in infertility primarily for patients with:

a)

Diminished ovarian reserve

b)

Pelvic adhesions

c)

PCOS + insulin resistance

d)

Endometrial polyps

53.

Which of the following best describes OHSS?

a)

Endometrial overgrowth and heavy menses

b)

Ovarian enlargement, ascites, and hypercoagulability

c)

Increased thyroid hormone production

d)

Decreased cervical mucus and conception risk

54.

Which safety strategy reduces OHSS risk during IVF?

a)

Increasing gonadotropin doses

b)

Using daily progesterone earlier

c)

Triggering ovulation with leuprolide instead of hCG

d)

Using clomiphene after stimulation

55.

Primary infertility refers to:

a)

Inability to conceive after one live birth

b)

Inability to conceive after a prior pregnancy loss

c)

Inability to conceive with no prior pregnancies

d)

Inability to conceive before age 25

56.

Fecundity is defined as:

a)

Number of follicles remaining in the ovaries

b)

Likelihood of conceiving within a given time period

c)

Ability to ovulate monthly

d)

Probability of carrying a pregnancy to term

57.

Premature ovarian insufficiency leads to infertility primarily due to:

a)

Elevated testosterone

b)

Reduced progesterone only

c)

Decreased hormone production

d)

Chronic LH elevation

58.

A woman that exercises excessively, has low BMI, and reduced GnRH likely has:

a)

Tubal adhesions

b)

Hypothalamic dysfunction

c)

Endometrial polyps

d)

PCOS

59.

Which test directly measures ovarian reserve and can be drawn at any time during the cycle?

a)

Day 3 estradiol

b)

Urinary LH kit

c)

Anti-Müllerian Hormone

d)

Progesterone

60.

IVF is particularly useful for infertility caused by:

a)

Cervical mucus abnormalities

b)

Pelvic adhesions or endometriosis

c)

Mild ovulation disorders

d)

Hyperprolactinemia

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