Understanding the physiology of menstruation is essential for B.Pharm students studying reproductive pharmacology, endocrine regulation, and clinical therapeutics. This concise, SEO-focused introduction covers hormonal control of the menstrual cycle, ovarian and endometrial changes, feedback mechanisms involving GnRH, LH, FSH, estrogen, progesterone, and local mediators like prostaglandins and inhibin. It highlights phases—follicular, ovulatory, luteal—and common menstrual disorders relevant to pharmacotherapy, such as dysmenorrhea, amenorrhea, and luteal phase deficiency. Keywords include physiology of menstruation, menstrual cycle, hormonal regulation, ovulation, and B.Pharm MCQs to aid exam preparation and drug-related decision-making. The MCQs emphasize mechanism, drug interactions, diagnostic markers and therapeutic approaches. Now let’s test your knowledge with 50 MCQs on this topic.
Q1. Which hormone surge directly triggers ovulation?
- FSH surge
- Estrogen surge
- LH surge
- Progesterone surge
Correct Answer: LH surge
Q2. Which phase of the endometrium corresponds to progesterone-dominated changes?
- Proliferative phase
- Secretory phase
- Menstrual phase
- Follicular phase
Correct Answer: Secretory phase
Q3. What is the primary ovarian structure that secretes progesterone after ovulation?
- Primordial follicle
- Graafian follicle
- Corpus luteum
- Theca interna
Correct Answer: Corpus luteum
Q4. Which hormone is primarily responsible for endometrial proliferation during the follicular phase?
- Progesterone
- Estrogen (estradiol)
- Inhibin
- Relaxin
Correct Answer: Estrogen (estradiol)
Q5. Gonadotropin-releasing hormone (GnRH) is secreted from which hypothalamic nucleus region?
- Paraventricular nucleus
- Arcuate and preoptic areas
- Suprachiasmatic nucleus
- Lateral hypothalamus
Correct Answer: Arcuate and preoptic areas
Q6. Which feedback action does high mid-cycle estrogen exert on the pituitary to cause the LH surge?
- Negative feedback on LH secretion
- Positive feedback on GnRH and LH secretion
- Negative feedback on FSH only
- No effect on hypothalamic-pituitary axis
Correct Answer: Positive feedback on GnRH and LH secretion
Q7. Inhibin produced by granulosa cells primarily suppresses which hormone?
- LH
- GnRH
- FSH
- Progesterone
Correct Answer: FSH
Q8. Which cell type in the ovary synthesizes androgens under LH stimulation?
- Granulosa cells
- Theca interna cells
- Cumulus oophorus
- Stromal fibroblasts
Correct Answer: Theca interna cells
Q9. Aromatase in granulosa cells converts which substrate into estradiol?
- Progesterone
- Testosterone
- Cortisol
- DHEA
Correct Answer: Testosterone
Q10. Which marker is commonly used to estimate ovarian reserve in clinical practice?
- FSH on day 14
- Estradiol on day 1
- Anti-Müllerian hormone (AMH)
- Prolactin level
Correct Answer: Anti-Müllerian hormone (AMH)
Q11. Luteal phase deficiency can lead to which reproductive problem?
- Excessive follicular development
- Failure of implantation and early miscarriage
- Polycystic ovary formation
- Increased ovulation frequency
Correct Answer: Failure of implantation and early miscarriage
Q12. Which prostaglandin is most implicated in primary dysmenorrhea via uterine contractions?
- Prostaglandin E2 (PGE2)
- Prostaglandin F2α (PGF2α)
- Thromboxane A2
- Prostacyclin (PGI2)
Correct Answer: Prostaglandin F2α (PGF2α)
Q13. Basal body temperature rises after ovulation due to which hormone?
- Estrogen
- Progesterone
- FSH
- Inhibin
Correct Answer: Progesterone
Q14. The menstrual phase is characterized histologically by which endometrial change?
- Endometrial gland proliferation
- Secretory transformation of glands
- Decidual breakdown and bleeding
- Formation of spiral arteries
Correct Answer: Decidual breakdown and bleeding
Q15. Which testicular/ovarian axis peptide is directly responsible for pulsatile GnRH secretion modulation?
- Kisspeptin
- Oxytocin
- Leptin
- Somatostatin
Correct Answer: Kisspeptin
Q16. Anovulatory cycles are most likely to present with which menstrual pattern?
- Regular menses with mid-cycle pain
- Irregular menstrual bleeding or amenorrhea
- Monthly ovulatory bleeding
- Consistently short luteal phase
Correct Answer: Irregular menstrual bleeding or amenorrhea
Q17. Which hormone is measured to confirm ovulation in a clinical or lab setting?
- Mid-luteal progesterone
- Baseline FSH
- Day 1 estradiol
- AMH
Correct Answer: Mid-luteal progesterone
Q18. Oral combined contraceptives prevent ovulation primarily by which mechanism?
- Blocking estrogen receptors on ovaries
- Providing continuous progesterone only effects
- Suppressing GnRH, LH and FSH via negative feedback
- Enhancing follicular aromatase activity
Correct Answer: Suppressing GnRH, LH and FSH via negative feedback
Q19. Which cell adhesion and decidualization change is essential for embryo implantation?
- Increased expression of E-cadherin
- Decreased stromal cell differentiation
- Decidualization of endometrial stromal cells
- Thinning of endometrial epithelium
Correct Answer: Decidualization of endometrial stromal cells
Q20. Human chorionic gonadotropin (hCG) rescues the corpus luteum by mimicking which hormone?
- FSH
- LH
- Prolactin
- GnRH
Correct Answer: LH
Q21. Which hormone pattern is typical during the early follicular phase?
- High progesterone, low estrogen
- Low estrogen, low progesterone, rising FSH
- High LH and high estrogen
- High prolactin and high testosterone
Correct Answer: Low estrogen, low progesterone, rising FSH
Q22. The dominant follicle selection is influenced by which local factor produced by follicles?
- Relaxin
- Inhibin B
- Oxytocin
- Prolactin
Correct Answer: Inhibin B
Q23. Which layer of the endometrium is shed during menstruation?
- Basalis layer
- Myometrium
- Functionalis layer
- Perimetrium
Correct Answer: Functionalis layer
Q24. Which imaging modality and finding are most useful to identify ovulation clinically?
- Pelvic MRI showing endometrial thickness
- Transvaginal ultrasound showing dominant follicle rupture
- Abdominal X-ray showing ovarian calcification
- CT scan showing corpus luteum density
Correct Answer: Transvaginal ultrasound showing dominant follicle rupture
Q25. Which hormone decreases cervical mucus viscosity around ovulation enhancing sperm penetration?
- Progesterone
- Estrogen
- Prolactin
- LH
Correct Answer: Estrogen
Q26. In polycystic ovary syndrome (PCOS), which hormonal pattern is commonly observed?
- Low androgens, high FSH
- High androgens, insulin resistance, elevated LH:FSH ratio
- High progesterone and high estrogen
- Elevated AMH with low androgen levels
Correct Answer: High androgens, insulin resistance, elevated LH:FSH ratio
Q27. Menarche typically follows which endocrine milestone?
- Pubertal activation of pulsatile GnRH secretion
- Menopause onset
- First ovulation only
- Complete arrest of ovarian follicles
Correct Answer: Pubertal activation of pulsatile GnRH secretion
Q28. Which enzyme is key for progesterone synthesis in luteal cells?
- Aromatase
- 17β-Hydroxysteroid dehydrogenase
- 3β-Hydroxysteroid dehydrogenase (3β-HSD)
- CYP11A1 only in adrenal cortex
Correct Answer: 3β-Hydroxysteroid dehydrogenase (3β-HSD)
Q29. Which condition is characterized by painful menses without pelvic pathology?
- Secondary dysmenorrhea
- Endometriosis
- Primary dysmenorrhea
- Pelvic inflammatory disease
Correct Answer: Primary dysmenorrhea
Q30. Which of the following best describes the luteal phase lifespan in a normal cycle?
- Variable between 5–15 days, often around 14 days from ovulation
- Consistently 28 days
- Routinely 7 days only
- Indeterminate and unrelated to ovulation
Correct Answer: Variable between 5–15 days, often around 14 days from ovulation
Q31. Which physiological change reduces FSH secretion in the late follicular phase?
- Rising inhibin and estradiol levels
- Decreased estrogen and increased progesterone
- HCG surge from corpus luteum
- Increased GnRH pulse frequency only
Correct Answer: Rising inhibin and estradiol levels
Q32. Which laboratory test can indicate persistent anovulation in women with irregular cycles?
- Low mid-luteal progesterone for several cycles
- High cyclical LH every month
- Regular biphasic basal body temperature
- Normal ovulatory urinary LH surge
Correct Answer: Low mid-luteal progesterone for several cycles
Q33. What is the role of prostaglandin synthesis inhibitors in menstrual therapy?
- They increase prostaglandin levels to stimulate menstruation
- They reduce uterine contractions and relieve dysmenorrhea
- They stimulate LH surge to induce ovulation
- They act as estrogen receptor agonists
Correct Answer: They reduce uterine contractions and relieve dysmenorrhea
Q34. Which hormone decline initiates menstruation if pregnancy does not occur?
- Estrogen only
- Progesterone and estrogen from corpus luteum
- FSH decline
- hCG decline
Correct Answer: Progesterone and estrogen from corpus luteum
Q35. Which of the following best describes the secretory endometrium?
- Thin, stromal-dense with short glands
- Edematous stroma with tortuous, secretory glands under progesterone influence
- Poorly vascularized and atrophic
- Characterized by proliferating stromal cells only
Correct Answer: Edematous stroma with tortuous, secretory glands under progesterone influence
Q36. Which pharmacologic agent is commonly used to induce ovulation by stimulating endogenous gonadotropins?
- Combined oral contraceptive pill
- Clomiphene citrate
- Progestin-only implant
- NSAIDs like ibuprofen
Correct Answer: Clomiphene citrate
Q37. The LH surge leads to which rapid morphological event in the follicle?
- Follicular atresia only
- Resumption of meiosis in the oocyte and follicle rupture
- Immediate corpus luteum formation without ovulation
- Suppression of granulosa cell function
Correct Answer: Resumption of meiosis in the oocyte and follicle rupture
Q38. Which vascular change occurs in the endometrium during the secretory phase?
- Regression of spiral arteries
- Coiling and elongation of spiral arteries
- Complete thrombosis of endometrial vessels
- Dilation of uterine veins only
Correct Answer: Coiling and elongation of spiral arteries
Q39. Which endometrial receptor upregulation is important for implantation?
- Progesterone receptor A and B in stromal cells
- Testosterone receptors in glands
- Insulin receptors only
- Glucocorticoid receptors in epithelium
Correct Answer: Progesterone receptor A and B in stromal cells
Q40. Secondary amenorrhea is defined as:
- No menses by age 15
- Absence of menses for three cycles or six months after established menses
- Painful menses only
- Excessively heavy menses
Correct Answer: Absence of menses for three cycles or six months after established menses
Q41. Which endocrine disorder often leads to secondary amenorrhea via hyperprolactinemia?
- Hypothyroidism only
- Prolactinoma (pituitary adenoma)
- Adrenal insufficiency
- PCOS without hyperprolactinemia
Correct Answer: Prolactinoma (pituitary adenoma)
Q42. Which pharmacological intervention is appropriate for heavy menstrual bleeding due to anovulatory cycles?
- Short course of high-dose estrogen to stabilize endometrium
- Immediate hysterectomy
- No treatment as it resolves spontaneously
- Testosterone supplementation
Correct Answer: Short course of high-dose estrogen to stabilize endometrium
Q43. Which molecule from the embryo signals maternal recognition of pregnancy to the corpus luteum?
- Estrogen
- Progesterone
- Human chorionic gonadotropin (hCG)
- Prostaglandin E2
Correct Answer: Human chorionic gonadotropin (hCG)
Q44. Which change in GnRH pulsatility favors luteinizing hormone (LH) secretion over FSH?
- Slower low-frequency pulses
- Faster high-frequency pulses
- Complete absence of pulses
- Random irregular pulses with no pattern
Correct Answer: Faster high-frequency pulses
Q45. Which of the following is a local intraovarian regulator that promotes follicle growth?
- Activin
- Glucagon
- Aldosterone
- Adrenaline
Correct Answer: Activin
Q46. Which drug class is used to treat heavy menstrual bleeding by reducing endometrial proliferation via progesterone receptor agonism?
- NSAIDs
- Selective progesterone receptor modulators (SPRMs) like ulipristal
- SSRIs
- Beta-blockers
Correct Answer: Selective progesterone receptor modulators (SPRMs) like ulipristal
Q47. Which lab pattern suggests ovarian failure (menopause) in a woman with amenorrhea?
- High FSH, high LH, low estradiol
- Low FSH, high estradiol
- High progesterone, low LH
- Normal gonadotropins with high AMH
Correct Answer: High FSH, high LH, low estradiol
Q48. During the follicular phase, which event decreases as a dominant follicle is selected?
- Granulosa cell aromatase activity
- Circulating inhibin B from subordinate follicles
- FSH concentration due to negative feedback
- Vascularization of theca layer
Correct Answer: FSH concentration due to negative feedback
Q49. Which uterine reflex is stimulated by prostaglandins and contributes to menstrual pain?
- Increased uterine peristalsis and vasoconstriction
- Relaxation of uterine smooth muscle
- Systemic vasodilation without uterine effects
- Inhibition of COX enzymes naturally
Correct Answer: Increased uterine peristalsis and vasoconstriction
Q50. Which therapeutic hormone is used in luteal phase support during assisted reproductive techniques?
- High-dose FSH
- Progesterone supplementation
- Clomiphene citrate
- Aromatase inhibitors only
Correct Answer: Progesterone supplementation
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
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