Menstrual cycle MCQs With Answer

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Mastering the menstrual cycle is essential for B.Pharm students studying reproductive pharmacology, endocrine regulation, and clinical therapeutics. This focused set of Menstrual cycle MCQs With Answer covers menstrual physiology, hormonal regulation by the hypothalamic–pituitary–ovarian axis, endometrial changes, ovulation timing, common disorders (dysmenorrhea, PCOS, amenorrhea), and pharmacological interventions such as oral contraceptives, GnRH analogs, NSAIDs, and ovulation-inducing agents. Each question emphasizes mechanisms, drug actions, diagnostic markers, and therapeutic implications to build clinical reasoning and exam readiness. Answers include concise explanations where relevant to deepen understanding and retention. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the average length of a normal menstrual cycle in days?

  • 21 days
  • 28 days
  • 35 days
  • 42 days

Correct Answer: 28 days

Q2. Which phase of the menstrual cycle is dominated by rising estrogen and follicle growth?

  • Luteal phase
  • Menstrual phase
  • Follicular (proliferative) phase
  • Secretory phase

Correct Answer: Follicular (proliferative) phase

Q3. Which hormone surge directly triggers ovulation?

  • FSH surge
  • Prolactin surge
  • hCG surge
  • LH surge

Correct Answer: LH surge

Q4. The corpus luteum primarily secretes which hormone after ovulation?

  • Estrogen
  • Progesterone
  • Androgen
  • Prolactin

Correct Answer: Progesterone

Q5. Which ovarian cells contain aromatase activity converting androgens to estrogens?

  • Theca interna cells
  • Granulosa cells
  • Stromal fibroblasts
  • Surface epithelium

Correct Answer: Granulosa cells

Q6. In a 28-day cycle, ovulation typically occurs around which day?

  • Day 7
  • Day 14
  • Day 21
  • Day 28

Correct Answer: Day 14

Q7. Which hormone inhibits FSH secretion and is produced by granulosa cells?

  • Activin
  • Inhibin
  • Relaxin
  • Adrenocorticotropic hormone

Correct Answer: Inhibin

Q8. A sustained high level of progesterone characterizes which endometrial phase?

  • Proliferative phase
  • Secretory phase
  • Menstrual phase
  • Ischemic phase

Correct Answer: Secretory phase

Q9. Basal body temperature increases after ovulation due to which hormone?

  • Estrogen
  • Progesterone
  • LH
  • FSH

Correct Answer: Progesterone

Q10. The drop in which hormones triggers menstrual bleeding?

  • FSH and LH
  • Estrogen and progesterone
  • Prolactin and oxytocin
  • hCG and estrogen

Correct Answer: Estrogen and progesterone

Q11. Which axis regulates the menstrual cycle?

  • Hypothalamic–pituitary–adrenal axis
  • Hypothalamic–pituitary–ovarian axis
  • Renin–angiotensin–aldosterone system
  • Thyroid–pituitary axis

Correct Answer: Hypothalamic–pituitary–ovarian axis

Q12. Pulsatile release of which hypothalamic hormone is essential for normal menstrual cyclicity?

  • TRH
  • GHRH
  • GnRH
  • Somatostatin

Correct Answer: GnRH

Q13. Which condition is characterized by chronic anovulation, hyperandrogenism, and polycystic ovaries?

  • Endometriosis
  • Premature ovarian failure
  • Polycystic ovary syndrome (PCOS)
  • Asherman’s syndrome

Correct Answer: Polycystic ovary syndrome (PCOS)

Q14. Primary dysmenorrhea is mainly mediated by elevated levels of which local factors?

  • Prostaglandins
  • Cytokines only
  • Estrogens only
  • Leukotrienes only

Correct Answer: Prostaglandins

Q15. Which class of drug is first-line for treating primary dysmenorrhea by inhibiting prostaglandin synthesis?

  • Beta-blockers
  • NSAIDs
  • SSRIs
  • Antifungals

Correct Answer: NSAIDs

Q16. Combined oral contraceptives prevent pregnancy primarily by which mechanism?

  • Blocking sperm motility
  • Inhibiting implantation only
  • Suppressing ovulation via negative feedback
  • Inducing cervical inflammation

Correct Answer: Suppressing ovulation via negative feedback

Q17. Progestin-only pills mainly prevent pregnancy by which effect?

  • Thinning endometrium only
  • Thickening cervical mucus and sometimes inhibiting ovulation
  • Blocking FSH release permanently
  • Inducing permanent amenorrhea

Correct Answer: Thickening cervical mucus and sometimes inhibiting ovulation

Q18. Levonorgestrel emergency contraception works primarily by which action?

  • Blocking implantation of a fertilized ovum
  • Preventing fertilization by degrading sperm DNA
  • Inhibiting or delaying ovulation
  • Inducing immediate menstruation

Correct Answer: Inhibiting or delaying ovulation

Q19. GnRH agonists used chronically cause what effect on gonadotropin secretion?

  • Sustained stimulation of LH and FSH
  • Initial flare then downregulation and suppression
  • No effect on gonadotropins
  • Pulsatile increase in FSH only

Correct Answer: Initial flare then downregulation and suppression

Q20. Which diagnostic marker measured in the mid-luteal phase indicates recent ovulation?

  • Low estradiol
  • High mid-luteal progesterone
  • High FSH only
  • Low LH only

Correct Answer: High mid-luteal progesterone

Q21. Which drug is a selective estrogen receptor modulator (SERM) commonly used to induce ovulation?

  • Metformin
  • Clomiphene citrate
  • Letrozole
  • Leuprolide

Correct Answer: Clomiphene citrate

Q22. Aromatase inhibitors like letrozole induce ovulation by which mechanism?

  • Increasing peripheral estrogen production
  • Blocking androgen receptors
  • Reducing estrogen synthesis to enhance FSH release
  • Directly stimulating ovarian follicles

Correct Answer: Reducing estrogen synthesis to enhance FSH release

Q23. Which enzyme catalyzes cholesterol conversion to pregnenolone, the first step in steroidogenesis?

  • Aromatase (CYP19A1)
  • 17β-HSD
  • P450scc (CYP11A1)
  • 5α-reductase

Correct Answer: P450scc (CYP11A1)

Q24. hCG supports the corpus luteum in early pregnancy by mimicking which hormone?

  • FSH
  • Prolactin
  • LH
  • TSH

Correct Answer: LH

Q25. What defines secondary amenorrhea?

  • No menses by age 16
  • Absence of menses for 3 months in previously regular cycles or 6 months if irregular
  • Bleeding lasting more than 10 days
  • Excessive uterine bleeding volume

Correct Answer: Absence of menses for 3 months in previously regular cycles or 6 months if irregular

Q26. Luteal phase defect is typically characterized by which feature?

  • Luteal phase longer than 20 days
  • Short luteal phase with inadequate progesterone support
  • Excessive progesterone secretion
  • Continuous bleeding throughout cycle

Correct Answer: Short luteal phase with inadequate progesterone support

Q27. Which tool detects the urinary LH surge and is used to predict ovulation?

  • Basal body temperature chart
  • Ovulation predictor kit (OPK)
  • Serum estradiol assay at home
  • Ultrasound mucus test

Correct Answer: Ovulation predictor kit (OPK)

Q28. Which ovarian structure contains the mature Graafian follicle prior to ovulation?

  • Primordial follicle
  • Primary follicle
  • Antral (tertiary) follicle
  • Atretic follicle

Correct Answer: Antral (tertiary) follicle

Q29. Which hormone exerts a positive feedback effect on the hypothalamus–pituitary to produce the pre-ovulatory LH surge?

  • Progesterone
  • Estrogen (sustained high estradiol)
  • Inhibin
  • Relaxin

Correct Answer: Estrogen (sustained high estradiol)

Q30. Which condition is an important cause of secondary dysmenorrhea due to ectopic endometrial tissue?

  • PCOS
  • Endometriosis
  • Turner syndrome
  • Müllerian agenesis

Correct Answer: Endometriosis

Q31. Heavy menstrual bleeding (menorrhagia) is best described as which clinical finding?

  • Bleeding at irregular intervals only
  • Excessive menstrual blood loss or prolonged bleeding
  • Absence of menses for six months
  • Painful menstruation without increased blood loss

Correct Answer: Excessive menstrual blood loss or prolonged bleeding

Q32. Hyperprolactinemia can cause amenorrhea by inhibiting secretion of which hormone?

  • FSH
  • GnRH
  • TSH
  • Insulin

Correct Answer: GnRH

Q33. Which medication class used in infertility protocols prevents premature LH surge by competitive antagonism at GnRH receptors?

  • GnRH agonists
  • GnRH antagonists
  • Progestins
  • Aromatase inhibitors

Correct Answer: GnRH antagonists

Q34. Which diagnostic sign on endometrium indicates the secretory transformation under progesterone influence?

  • Proliferation of glands without secretion
  • Glandular coiling and secretory vacuoles
  • Complete stromal atrophy
  • Absence of spiral arteries

Correct Answer: Glandular coiling and secretory vacuoles

Q35. Which estrogen form predominates during the reproductive years and is most potent on reproductive tissues?

  • Estriol (E3)
  • Estrone (E1)
  • Estradiol (E2)
  • Estetrol (E4)

Correct Answer: Estradiol (E2)

Q36. What is the primary mechanism by which enzyme-inducing drugs (e.g., rifampicin) affect combined oral contraceptives?

  • Increase ovarian sensitivity to hormones
  • Enhance hepatic metabolism of contraceptive steroids, reducing efficacy
  • Directly antagonize estrogen receptors
  • Prevent absorption of oral pills by binding in the gut

Correct Answer: Enhance hepatic metabolism of contraceptive steroids, reducing efficacy

Q37. Which of the following is a hallmark biochemical pattern in PCOS?

  • Elevated SHBG leading to low free androgens
  • Elevated LH:FSH ratio and hyperandrogenism
  • Very high prolactin only
  • Low insulin levels

Correct Answer: Elevated LH:FSH ratio and hyperandrogenism

Q38. Which process describes follicular atresia?

  • Progesterone-driven hypertrophy
  • Apoptosis-mediated degeneration of follicles
  • Ovulation of all follicles simultaneously
  • Conversion of follicles into cysts only

Correct Answer: Apoptosis-mediated degeneration of follicles

Q39. Which of the following is an indicator of ovulatory dysfunction rather than uterine bleeding disorder?

  • Endometrial polyp on ultrasound
  • Low mid-luteal progesterone
  • Fibroid detected on pelvic exam
  • Coagulation disorder on labs

Correct Answer: Low mid-luteal progesterone

Q40. Which clinical syndrome involves severe premenstrual mood disturbances that impair functioning?

  • Premenstrual syndrome (PMS)
  • Premenstrual dysphoric disorder (PMDD)
  • Panic disorder
  • Major depressive disorder unrelated to cycle

Correct Answer: Premenstrual dysphoric disorder (PMDD)

Q41. Which uterine arterial change occurs in the late secretory phase preparing for menstruation?

  • Dilation of sinusoids only
  • Spiral artery constriction leading to ischemia
  • Permanent remodeling to increase blood flow
  • Formation of new radial arteries

Correct Answer: Spiral artery constriction leading to ischemia

Q42. Which pharmacologic agent is commonly used to treat heavy menstrual bleeding due to its antifibrinolytic action?

  • Tranexamic acid
  • Metronidazole
  • Mifepristone
  • Clomiphene citrate

Correct Answer: Tranexamic acid

Q43. Which of the following best describes primary amenorrhea?

  • Absence of menarche by age 15 with normal secondary sexual characteristics
  • Absence of menses for 3 months in previously regular cycles
  • Bleeding lasting longer than 8 days
  • Menstrual cycles shorter than 21 days

Correct Answer: Absence of menarche by age 15 with normal secondary sexual characteristics

Q44. Which cells in the corpus luteum mainly produce progesterone?

  • Granulosa-lutein cells
  • Theca interna only
  • Surface epithelial cells
  • Stromal macrophages

Correct Answer: Granulosa-lutein cells

Q45. Which hormone pattern is typical at mid-cycle in a normal ovulatory cycle?

  • Low estradiol, low LH
  • High estradiol and LH surge
  • High progesterone and low estradiol
  • High prolactin and high FSH

Correct Answer: High estradiol and LH surge

Q46. Which medication class increases the risk of venous thromboembolism when used as combined oral contraceptives?

  • Progestin-only pills
  • Combined estrogen–progestin contraceptives
  • Topical estrogen creams only
  • Non-hormonal IUDs

Correct Answer: Combined estrogen–progestin contraceptives

Q47. In reproductive pharmacology, what is the principal therapeutic goal of using GnRH agonists for endometriosis?

  • Stimulate ovarian estrogen production
  • Suppress ovarian steroidogenesis by downregulating GnRH receptors
  • Increase prostaglandin synthesis
  • Enhance implantation

Correct Answer: Suppress ovarian steroidogenesis by downregulating GnRH receptors

Q48. Which local mediator produced during menstruation contributes to uterine contractility and pain?

  • Serotonin
  • Prostaglandin F2α
  • Insulin
  • Growth hormone

Correct Answer: Prostaglandin F2α

Q49. Which laboratory finding is most consistent with ovarian failure (menopause)?

  • Low FSH and high estradiol
  • High FSH and low estradiol
  • High progesterone and low LH
  • High inhibin B and high estradiol

Correct Answer: High FSH and low estradiol

Q50. Which pharmacologic agent is used to antagonize progesterone receptors for medical termination of early pregnancy?

  • Mifepristone (RU-486)
  • Levonorgestrel
  • Ethinylestradiol
  • Clomiphene citrate

Correct Answer: Mifepristone (RU-486)

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