Menstrual Disorders & Infertility

Topics in this chapter

• Abnormal Uterine Bleeding and Dysmenorrhea
• Amenorrhea, Menopause, and Ovarian Failure
• Anovulation, PCOS, and Hyperprolactinemia
• Disorders of Sexual Development
• Infertility Evaluation and Tubal Factors
• Ovulation Induction and Assisted Reproduction

Practice questions

1. Question 1Q-FA88A6

   A 28-year-old nulliparous woman presents with secondary amenorrhea and infertility of 2 years duration, following a dilatation and curettage (D&C) done for postpartum hemorrhage after her first delivery. Hormonal profile (FSH, LH, TSH, Prolactin) is entirely normal. Hysteroscopy reveals extensive intrauterine adhesions. What is the most appropriate management for this patient?

   1. A.Hysteroscopic adhesiolysis followed by high-dose estrogen-progesterone therapy to promote endometrial growth
   2. B.Gonadotropin-releasing hormone (GnRH) agonist therapy for 6 months alone
   3. C.Bilateral wedge resection of ovaries
   4. D.In vitro fertilization (IVF) with surrogate uterus directly
   See the answer and solution
2. Question 2Q-1E0369

   A 32-year-old woman presents with primary infertility and oligomenorrhea. Her BMI is $32 \text{ kg/m}^2$. Clinical examination reveals acanthosis nigricans and mild hirsutism. Ultrasound of the pelvis shows polycystic ovaries. Laboratory investigations show normal prolactin and TSH, an elevated LH/FSH ratio (>2:1), and normal to elevated testosterone. Which of the following is the first-line medical therapy for ovulation induction in this patient for treating her infertility?

   1. A.Clomiphene citrate
   2. B.Metformin monotherapy
   3. C.HMG (Human Menopausal Gonadotropin) injections
   4. D.Combined oral contraceptive pills
   See the answer and solution
3. Question 3Q-3AB994

   A 25-year-old woman presents with primary amenorrhea, normal breast development, but absent uterus and upper vagina on pelvic examination and ultrasound. Her serum testosterone level is in the normal male reference range, and her karyotype is 46,XY. What is the diagnosis?

   1. A.Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome
   2. B.Androgen Insensitivity Syndrome (AIS)
   3. C.Turner syndrome
   4. D.Pure gonadal dysgenesis
   See the answer and solution
4. Question 4Q-9B971F

   A 34-year-old woman with a history of regular cycles presents with secondary amenorrhea for 6 months. Her serum prolactin level is significantly elevated at $120 \text{ ng/mL}$ (normal < $20 \text{ ng/mL}$). She is not taking any medications and her TSH is normal. Magnetic resonance imaging (MRI) of the brain reveals a microadenoma of the pituitary gland ($6 \text{ mm}$). What is the most appropriate initial treatment?

   1. A.Transsphenoidal surgical resection
   2. B.Dopamine agonist therapy (e.g., Cabergoline or Bromocriptine)
   3. C.Observation and repeat MRI in 5 years
   4. D.External beam radiation therapy
   See the answer and solution
5. Question 5Q-86EA43

   According to the PALM-COEIN classification system for causes of abnormal uterine bleeding (AUB) in non-gravid reproductive-aged women, which of the following falls under the 'STRUCTURAL' (PALM) category?

   1. A.Coagulopathy
   2. B.Ovulatory dysfunction
   3. C.Adenomyosis
   4. D.Iatrogenic
   See the answer and solution