Amenorrhoea, menopause and reproductive endocrinology

52 NEET-PG practice questions on Amenorrhoea, menopause and reproductive endocrinology, part of Obstetrics & Gynaecology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Easy

   Which inborn error of metabolism causes premature ovarian insufficiency in most affected girls despite good diet control?

   1. AClassic galactosaemia
   2. BMaple syrup urine disease
   3. CPhenylketonuria
   4. DGaucher disease

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   Answer: A · Classic galactosaemia

   In classic galactosaemia (GALT deficiency), toxic galactose metabolites damage ovarian follicles, and most girls develop POI even when the diet is well controlled.

   • B: MSUD does not typically cause POI.
   • C: PKU does not cause POI when treated.
   • D: Gaucher disease does not typically cause POI.

   Remember this

   Classic galactosaemia causes POI in most affected girls despite diet.

2. Question 2 · Easy

   Premature ovarian insufficiency has been confirmed in a schoolteacher aged 29. For how long is hormone replacement usually advised?

   1. AOnly while hot flushes persist
   2. BFor 2 years, then stopped
   3. CUntil about the average age of natural menopause
   4. DOnly if bone density is low

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   Answer: C · Until about the average age of natural menopause

   Women with POI lose ovarian oestrogen decades early, which raises the risk of osteoporosis, cardiovascular disease and genitourinary atrophy. Hormone therapy here replaces a missing hormone rather than treating menopause, so it is continued at least until the average age of natural menopause, about 50-51 years. A progestogen is added when the uterus is present, and a combined pill is an acceptable alternative.

   • A: Treatment is for long-term health, not only for symptom relief.
   • B: Two years is far too short; the oestrogen deficit lasts until the usual age of menopause.
   • D: Waiting for low bone density allows avoidable bone loss; replacement is advised for all.

   Remember this

   In POI, give hormone replacement until about the natural age of menopause to protect bone, heart and urogenital tissue.

3. Question 3 · Medium

   A girl brought from a village near Madurai has never had a period. Her breasts are well developed, but pubic and axillary hair is almost absent. There are bilateral inguinal swellings, and the vagina is short and blind. Which investigation will give the diagnosis?

   1. AThyroid function tests
   2. BMRI of the pituitary
   3. CKaryotype
   4. DSerum prolactin

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   Answer: C · Karyotype

   Breasts without pubic or axillary hair, a blind vagina and inguinal gonads suggest complete androgen insensitivity syndrome. Testes make testosterone, which is aromatised to estradiol to form breasts, but androgen receptors do not respond, so there is no hair. A karyotype showing 46,XY confirms it and separates it from MRKH.

   • A: Thyroid disease does not cause absent pubic hair with inguinal testes.
   • B: Pituitary imaging is for low gonadotropins, which is not this picture.
   • D: Prolactin does not explain the absent hair and gonads.

   Remember this

   Breasts with absent pubic hair, a blind vagina and inguinal gonads mean CAIS; a 46,XY karyotype confirms it.

4. Question 4 · Hard

   At the oncology unit, a woman of 27 with newly diagnosed Hodgkin lymphoma is to start a regimen containing an alkylating drug next week. She is married and wants children in future. Her AMH is normal for age. Which fertility-preservation step has the best established results before chemotherapy?

   1. AOocyte or embryo cryopreservation
   2. BOvarian transposition
   3. CCombined pill during chemotherapy
   4. DGnRH agonist alone during chemotherapy

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   Answer: A · Oocyte or embryo cryopreservation

   Alkylating drugs such as cyclophosphamide and procarbazine are the most toxic to ovarian follicles. Cryopreserving mature oocytes or embryos after a short stimulation, which can start at any phase of the cycle, is the established method. GnRH agonist protection is optional and less certain, and transposition protects only against pelvic radiation.

   • B: Transposition is for pelvic radiotherapy, not chemotherapy.
   • C: The pill does not protect follicles.
   • D: GnRH agonists may reduce POI but do not replace cryopreservation.

   Remember this

   Before gonadotoxic chemotherapy, oocyte or embryo freezing is the established fertility-preservation method.

5. Question 5 · Hard

   Visual field charting shows bitemporal superior quadrantanopia in a woman with a year of amenorrhoea and galactorrhoea. Prolactin is 1,850 ng/mL (normal under 25), and MRI shows a 2.4 cm pituitary adenoma lifting the optic chiasm, with no haemorrhage. Her vision has been stable for months and she has no sudden headache. What is the first-line treatment?

   1. ATranssphenoidal surgery
   2. BLong-acting octreotide
   3. CPituitary radiotherapy
   4. DOral cabergoline

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   Answer: D · Oral cabergoline

   A prolactin above about 500 ng/mL with a large adenoma is a macroprolactinoma, and dopamine agonists are first-line even when the chiasm is compressed. Cabergoline shrinks most prolactinomas within weeks and often restores the visual fields, so it is started with close repeat field charting and prolactin levels. Surgery is kept for apoplexy, worsening vision despite treatment, resistance or intolerance.

   • A: Surgery is second-line for prolactinomas; it is first-line for most other pituitary adenomas.
   • B: Octreotide is a somatostatin analogue for acromegaly, not for prolactinoma.
   • C: Radiotherapy is reserved for tumours resistant to drugs and surgery.

   Remember this

   Macroprolactinoma with a field defect: start cabergoline first; surgery only for apoplexy, failure or intolerance.

6. Question 6 · Medium

   Ultrasound shows more than 20 follicles in each ovary in a woman with 5 months of amenorrhoea, acne and hirsutism. Pregnancy test, TSH and prolactin are normal, and 17-hydroxyprogesterone is normal. By the Rotterdam criteria, what is the diagnosis?

   1. ANon-classic congenital adrenal hyperplasia
   2. BCushing syndrome
   3. CPremature ovarian insufficiency
   4. DPolycystic ovary syndrome

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   Consider these statements on when a girl should be evaluated for primary amenorrhoea. 1. No menses by 15 years with normal secondary sexual characteristics. 2. No breast development by 13 years. 3. No menses 3 years after breast development began. 4. No menses by 12 years even with normal growth. Which are correct?

   1. A1 and 2 only
   2. B1, 3 and 4 only
   3. C2 and 4 only
   4. D1, 2 and 3 only

   Answer and explanation in LearnFree account

8. Question 8 · Easy

   In a woman of reproductive age with secondary amenorrhoea, which test comes first?

   1. APelvic ultrasound
   2. BPregnancy test
   3. CSerum prolactin
   4. DSerum FSH

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9. Question 9 · Medium

   Lanugo hair, a pulse of 52/min and a BMI of 14.8 kg/m2 are found in a college student with 8 months of amenorrhoea and a fear of gaining weight. What is the mechanism of her amenorrhoea?

   1. ASuppressed hypothalamic GnRH pulses
   2. BEndometrial atrophy from scarring
   3. CRaised prolactin from the pituitary
   4. DPrimary ovarian failure

   Answer and explanation in LearnFree account

10. Question 10 · Medium

    Turner syndrome (45,X) is newly diagnosed in a 13-year-old with short stature and absent breast development. Which test should be done at diagnosis for the most serious associated risk?

    1. ASerum AMH
    2. BEchocardiography
    3. CBone age X-ray
    4. DPelvic MRI

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11. Question 11 · Easy

    Secondary amenorrhoea in a woman with previously regular cycles is defined as no menses for how long?

    1. A12 months
    2. B2 months
    3. C1 month
    4. D3 months

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12. Question 12 · Medium

    Three months after a check curettage for retained products following a miscarriage, a woman has had no periods. Pregnancy test is negative and estrogen-progestogen withdrawal fails. Which investigation is the gold standard?

    1. AHysterosalpingography
    2. BEndometrial biopsy
    3. CHysteroscopy
    4. DTransvaginal ultrasound

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13. Question 13 · Medium

    Autoimmune premature ovarian insufficiency is suspected in a woman with vitiligo and a normal karyotype and FMR1 test. Which antibody test is recommended because its result changes her safety?

    1. AAntinuclear antibodies
    2. BAnti-ovarian antibodies
    3. C21-hydroxylase (adrenal) antibodies
    4. DAnti-Mullerian hormone antibodies

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14. Question 14 · Medium

    After a negative pregnancy test in a woman with 5 months of secondary amenorrhoea and no hirsutism, which blood tests form the first-line hormonal work-up?

    1. ATSH, prolactin and FSH
    2. BAMH, inhibin B and testosterone
    3. CInsulin, cortisol and growth hormone
    4. DLH, estradiol and cortisol

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15. Question 15 · Medium

    Eight months after stopping the combined oral contraceptive pill, which she took for 6 years, a clerk has had no periods. Her pregnancy test is negative. Her mother says this is 'post-pill amenorrhoea' and will settle. What should be done?

    1. AGive clomiphene to restart ovulation
    2. BInvestigate as for any secondary amenorrhoea
    3. CRestart the pill to regulate cycles
    4. DReassure and review after another year

    Answer and explanation in LearnFree account

16. Question 16 · Medium

    Hot flushes and night sweats have disturbed the sleep of a shopkeeper aged 51 for a year; her last period was 14 months ago. She has migraine without aura, a BMI of 33 kg/m2 and an intact uterus, with no history of breast cancer or thrombosis. Which regimen is most suitable?

    1. AOral conjugated equine oestrogen alone, without progestogen
    2. BVaginal estriol cream alone
    3. CTransdermal estradiol with micronised progesterone
    4. DOral estradiol with norethisterone

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17. Question 17 · Medium

    Consider these statements about functional hypothalamic amenorrhoea. 1. LH is low or low-normal. 2. Estradiol is low. 3. Most women do not bleed after a progestogen challenge. 4. FSH is in the menopausal range. Which are correct?

    1. A1 and 2 only
    2. B1, 3 and 4 only
    3. C1, 2 and 3 only
    4. D2 and 4 only

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18. Question 18 · Medium

    In a woman with 6 months of secondary amenorrhoea, a negative pregnancy test and normal TSH and prolactin, medroxyprogesterone 10 mg is given for 7 days. She bleeds 4 days after the last tablet. What does this show?

    1. AFailing pituitary gonadotropins
    2. BScarred, unresponsive endometrium
    3. CDeficient estrogen priming
    4. DAdequate estrogen with a patent outflow

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19. Question 19 · Medium

    As the gynaecologist following a woman of 29 with confirmed POI, you start estradiol with a progestogen. If there are no contraindications, how long should hormone therapy be continued?

    1. AUntil hot flushes settle
    2. BOnly while bone density is low
    3. CUntil about the age of 50-51
    4. DFor 5 years only

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20. Question 20 · Medium

    Progestogen challenge: no bleed. Estrogen for 21 days with a progestogen added for the last 5: no bleed. Pregnancy test negative, FSH normal. Where is the problem?

    1. AIn the endometrium or outflow tract
    2. BIn the hypothalamus (GnRH)
    3. CIn the anterior pituitary
    4. DIn the ovaries (follicle loss)

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21. Question 21 · Hard

    A school student from Thanjavur was treated for bilateral inguinal hernias in childhood, when the surgeon noted 'gonads in the sacs' and returned them to the abdomen. Now, at 16, she has full breast development but scanty pubic and axillary hair and no periods. Ultrasound shows no uterus. Her karyotype is 46,XY, testosterone is in the normal male range and LH is high. She identifies firmly as a girl, does well at school, and her parents ask whether the gonads must be removed and, if so, when. Which plan is best?

    1. AGonadectomy now, before puberty is complete
    2. BGonadectomy after puberty, then estrogen replacement
    3. CLeave the gonads in place for life with no follow-up
    4. DTestosterone therapy to induce male puberty

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22. Question 22 · Easy

    Premature ovarian insufficiency is defined as loss of ovarian function before what age?

    1. A35 years
    2. B30 years
    3. C40 years
    4. D45 years

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23. Question 23 · Medium

    No sense of smell since childhood, absent breast development and no periods at 17 are found in a tall girl. FSH and LH are low and MRI of the pituitary is normal. What is the underlying defect?

    1. AFailed migration of GnRH neurons
    2. BDestruction of the anterior pituitary
    3. CResistance of the ovary to FSH
    4. DAbsent androgen receptors

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24. Question 24 · Medium

    In the gynaecology OPD, a girl with primary amenorrhoea and cyclic pain has normal breasts and normal external genitalia. The vagina ends about 3 cm in, with no bulge on straining, and rectal examination feels a tense mass above it. Ultrasound shows haematocolpos above the level of the obstruction. What is the most likely diagnosis?

    1. AMullerian agenesis
    2. BTransverse vaginal septum
    3. CImperforate hymen
    4. DComplete androgen insensitivity

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25. Question 25 · Medium

    A couple, the wife with POI and FSH of 90 IU/L, have tried for 2 years. Her husband's semen is normal. What gives them the best chance of pregnancy?

    1. AHigh-dose gonadotropins with her own eggs
    2. BIntrauterine insemination
    3. CClomiphene ovulation induction
    4. DIVF with donor oocytes

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