Gynecological disorders: dysmenorrhea and hormone replacement MCQs With Answer

Introduction:

This quiz collection on Gynecological disorders: dysmenorrhea and hormone replacement is tailored for M.Pharm students preparing Pharmacotherapeutics II (MPP 202T). It highlights core pharmacology, mechanisms, clinical indications, dosing concepts, adverse effects, contraindications and monitoring strategies relevant to management of primary and secondary dysmenorrhea and menopausal hormone therapy. Questions are designed to deepen understanding beyond memorization — integrating pathophysiology (prostaglandin-mediated uterine hypercontractility), rational drug choice (NSAIDs, hormonal options, GnRH analogues) and HRT selection (formulations, routes, risks such as VTE and breast cancer, and endometrial protection). Use these MCQs to test and refine clinical-pharmacologic reasoning for patient-centered therapy.

Q1. What is the primary pathophysiologic mechanism underlying primary dysmenorrhea?

• Increased prostaglandin F2α production causing uterine hypercontractility
• Decreased prostaglandin synthesis leading to uterine atony
• Autoimmune inflammation of endometrial glands
• Hyperplasia of the myometrium due to estrogen excess

Correct Answer: Increased prostaglandin F2α production causing uterine hypercontractility

Q2. What is the first-line pharmacologic treatment for most cases of primary dysmenorrhea?

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen
• Gonadotropin-releasing hormone (GnRH) agonists
• Danazol
• High-dose systemic corticosteroids

Correct Answer: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen

Q3. By what primary mechanism do NSAIDs relieve dysmenorrhea?

• Inhibition of cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis
• Blockade of estrogen receptors in the endometrium
• Stimulation of uterine β-adrenergic receptors to relax myometrium
• Direct antagonism of oxytocin receptors

Correct Answer: Inhibition of cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis

Q4. What is the principal therapeutic effect of combined oral contraceptives (COCs) in treating dysmenorrhea?

• Suppression of ovulation and endometrial proliferation, reducing prostaglandin production
• Direct antagonism of prostaglandin receptors in the myometrium
• Increasing uterine blood flow to reduce ischemic pain
• Stimulating endometrial regeneration to normalize cycles

Correct Answer: Suppression of ovulation and endometrial proliferation, reducing prostaglandin production

Q5. For severe dysmenorrhea attributable to endometriosis, which class of drugs is commonly used to induce a hypoestrogenic state as second-line therapy?

• Gonadotropin-releasing hormone (GnRH) agonists (e.g., leuprolide)
• Aromatase inhibitors (e.g., anastrozole) as monotherapy
• Synthetic progestins only (no further therapy needed)
• Topical NSAIDs applied intrauterinely

Correct Answer: Gonadotropin-releasing hormone (GnRH) agonists (e.g., leuprolide)

Q6. Which of the following is a commonly used dosing regimen for mefenamic acid in dysmenorrhea?

• 500 mg loading dose followed by 250 mg every 6–8 hours (maximum ~1000 mg/day)
• 50 mg once daily for 5 days
• 1000 mg loading dose then 500 mg every 12 hours indefinitely
• 10 mg subcutaneously at onset of menses

Correct Answer: 500 mg loading dose followed by 250 mg every 6–8 hours (maximum ~1000 mg/day)

Q7. Which contraceptive device provides effective endometrial protection and often reduces menstrual bleeding and dysmenorrhea when inserted?

• Levonorgestrel-releasing intrauterine system (LNG-IUS)
• Copper intrauterine device (IUD)
• Subdermal etonogestrel implant only
• Barrier methods such as diaphragms

Correct Answer: Levonorgestrel-releasing intrauterine system (LNG-IUS)

Q8. Which condition is considered an absolute contraindication to estrogen-containing hormone replacement therapy (HRT)?

• Active or recent estrogen-dependent breast cancer
• Well-controlled hypothyroidism
• History of mild migraine without aura
• Osteopenia without fractures

Correct Answer: Active or recent estrogen-dependent breast cancer

Q9. In women with an intact uterus, why is progestin routinely combined with estrogen in HRT?

• To prevent endometrial hyperplasia and carcinoma by opposing estrogen-stimulated endometrial proliferation
• To increase circulating estrogen levels for better symptom control
• To enhance oral bioavailability of estradiol
• To reduce hepatic metabolism of estrogen and lower cost

Correct Answer: To prevent endometrial hyperplasia and carcinoma by opposing estrogen-stimulated endometrial proliferation

Q10. Which route of estrogen administration is preferred in menopausal women with a history of venous thromboembolism (VTE) due to lower VTE risk?

• Transdermal estrogen
• Oral conjugated equine estrogens
• Intramuscular estrogen injections
• Oral esterified estrogen with high first-pass hepatic effect

Correct Answer: Transdermal estrogen

Q11. What does a continuous combined HRT regimen typically consist of?

• Daily estrogen plus daily progestin without a hormone-free interval
• Estrogen only for 21 days, progestin for 7 days cyclically
• Intermittent estrogen patches twice weekly only
• Monthly high-dose estrogen pulses without progestin

Correct Answer: Daily estrogen plus daily progestin without a hormone-free interval

Q12. Which selective estrogen receptor modulator (SERM) is commonly used to prevent osteoporosis without stimulating the endometrium?

• Raloxifene
• Tamoxifen
• Bazedoxifene alone
• Fulvestrant

Correct Answer: Raloxifene

Q13. Which serious adverse event is most consistently associated with systemic estrogen therapy in postmenopausal women?

• Increased risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism)
• Severe chronic kidney disease within weeks of initiation
• Acute pancreatitis in all patients
• Immediate irreversible blindness

Correct Answer: Increased risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism)

Q14. Which class of drug interactions can reduce the effectiveness of oral estrogens used in HRT by increasing their metabolism?

• CYP3A4 enzyme inducers such as rifampin and certain antiepileptics
• MAO inhibitors such as phenelzine
• Proton pump inhibitors such as omeprazole
• Topical antibiotics applied to the skin

Correct Answer: CYP3A4 enzyme inducers such as rifampin and certain antiepileptics

Q15. Which of the following statements about levonorgestrel intrauterine system (LNG-IUS) is true?

• It provides local progestogenic effect, reduces menstrual blood loss, and protects the endometrium
• It increases systemic estrogen levels significantly and requires estrogen coadministration
• It is contraindicated in all nulliparous women
• It acts primarily by releasing copper ions to inhibit implantation

Correct Answer: It provides local progestogenic effect, reduces menstrual blood loss, and protects the endometrium

Q16. Tibolone is best described as which of the following?

• A synthetic steroid with estrogenic, progestogenic and weak androgenic activity used for menopausal symptoms
• A pure estrogen receptor antagonist used to treat breast cancer
• An aromatase inhibitor used primarily for pain during menses
• A selective COX-2 inhibitor for dysmenorrhea

Correct Answer: A synthetic steroid with estrogenic, progestogenic and weak androgenic activity used for menopausal symptoms

Q17. What is the primary indication for initiating hormone replacement therapy (HRT) in menopausal women?

• Relief of moderate to severe vasomotor symptoms (hot flashes) and genitourinary atrophy in symptomatic women
• Universal prevention of cardiovascular disease in all postmenopausal women
• Immediate treatment for acute deep vein thrombosis
• First-line therapy for active breast cancer

Correct Answer: Relief of moderate to severe vasomotor symptoms (hot flashes) and genitourinary atrophy in symptomatic women

Q18. Which monitoring is routinely recommended for a woman on systemic HRT?

• Baseline and regular breast screening (clinical exam and mammography as per age guidelines), blood pressure checks and assessment of symptom benefit vs risk
• Daily liver biopsy for the first month
• Monthly bone marrow biopsy
• No monitoring is required once therapy is started

Correct Answer: Baseline and regular breast screening (clinical exam and mammography as per age guidelines), blood pressure checks and assessment of symptom benefit vs risk

Q19. Which of the following is an absolute contraindication to GnRH agonist therapy?

• Pregnancy
• Mild controlled hypertension
• History of primary dysmenorrhea only
• Use of NSAIDs for breakthrough pain

Correct Answer: Pregnancy

Q20. In the initial medical management of symptomatic endometriosis-associated dysmenorrhea in a young woman who does not currently desire pregnancy, what is typically recommended as first-line therapy?

• Combined oral contraceptives or continuous progestin therapy to suppress menstruation and lesion activity
• Immediate bilateral oophorectomy
• High-dose systemic corticosteroids for long-term suppression
• Daily aspirin monotherapy only

Correct Answer: Combined oral contraceptives or continuous progestin therapy to suppress menstruation and lesion activity

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