What's Your Menopause IQ? Take Our Quiz and Find Out

If you haven't read the online educational article on menopause before taking this test, and you want to have a reasonable chance of scoring well,
Click here to read about menopause

Educational Objectives

• To be able to define the diagnosis of menopause and its symptoms
• To describe the effect of menopause on sexual desire
• To describe the effect of menopause on heart and vascular disease
• To list other important effects of menopause and hormone replacement
• To understand the current relationship between breast cancer and hormone replacement

The following 5 question quiz will test the above objectives concerning menopause. We hope you have read the accompanying article and learn from this quiz in addition to evaluating what you already have learned.

Read each question carefully and then select the ONE best answer.

Question 1

Which one of the following statements about the menopause is true?

1. Almost women who are menopausal get hot flashes
2. The average age of menopause is approximately 45 years of age
3. A blood test, serum FSH is the gold standard to diagnose menopause
4. Depression is more common during menopause
5. Hot flashes are diagnostic of menopause

Actually only 50% of women have hot flashes during menopause.































Incorrect

The average age of menopause is now approximately 51.

There is a perimenopausal time period before menopause that may be associated with fluctuating estrogen levels. This can cause abnormal menstrual bleeding and sporadic hot flashes. The perimenopause starts, on the average, about 4 years prior to menopause.































Correct

Hot flashes may be due to stress or medications or even foods. Also during the perimenopause, hot flashes may occur. In order be to sure of the diagnosis of menopause, the FSH blood test is often ordered, especially if a woman is considering long term estrogen replacement therapy. There is a hazard of not diagnosing menopause for certain if a woman is going to be started on hormone replacement therapy. Her ovaries will still ovulate, on occasion, producing fluctuating estrogen levels. This in turn will cause irregular uterine bleeding which is falsely attributed to the hormones. The irregular bleeding is likely to discourage a woman from continuing to use the hormones for their long term benefit.































Incorrect

While many women attribute mood changes to the menopause, the incidence of depression is actually less during menopause than at other times in a woman's life. Lack of estrogen at this time may worsen preexisting symptoms of depression or irritability, but it doesn't seem to cause the new occurance of depression.































Incorrect

Hot flashes may be due to stress or medications or even drink and foods. In fact, stress reaction is probably the most common cause of a hot flash. It is hazardous to diagnose menopause on hot flashes alone.

Question 2

Which one of the following statements about sexual functioning during the menopause is true?

1. Fear of pain with intercourse due to vaginal dryness can be improved by using pain medicines
2. Less frequent intercourse will lead to less pain with subsequent intercourse
3. The most common reason for decreased sexual desire after menopause is because of vaginal discomfort
4. There is a natural decrease in sexual desire after menopause even if estrogen is replaced
5. Sexual desire after menopause is usually not related to a woman's partner's desire

Pain medicines often decrease sexual desire and would not be used to treat the vaginal problems. It would be more likely to use estrogen therapy to treat the vaginal discomfort because the skin usually responds very well to it.

Painful intercourse can be more prominent after menopause because decreased estrogens cause a thinning of the skin lining the opening to the vagina (introitus) and the vagina itself. There is decreased lubricating fluid and a loss of elasticity of the vagina also which contributes to discomfort.































Incorrect

Women having frequent intercourse after the menopause (once a week or more) tend to have less problems with vaginal discomfort or pain even if they are not taking estrogen replacement. The frequent vaginal friction seems to forestall skin thinning and a loss of vaginal elasticity that takes place without estrogens. Menopausal women who are having intercourse less than weekly and who are not taking estrogen often have more and more difficulty and pain with vaginal intercourse because the skin is so thin and inelastic around the vaginal opening that it cracks and may even bleed. It becomes like chapped lips and the opening may also decrease in size over time.































Incorrect

In spite of all that is said about more vaginal discomfort after menopause due to lack of estrogen, sexual desire is affected by many other circumstances. Irritation or anger at one's partner is probably the most common cause of decreased sexual desire at any age. As women get older, they or their spouse may be on medications that interfere with sexual desire. These factors are usually more common than the fear of vaginal discomfort as a cause of decreased sexual desire.































Correct

Beyond the physical changes caused by lack of estrogen, there is still a decreased level of sexual desire after the menopause that scientists cannot fully explain. This doesn't happen to all women but it happens enough that it affects many women, even if they are taking estrogen replacement and don't have the other life circumstances that are associated with decreased sexual desire such as:

• taking antidepressant, antihypertensive or pain medications
• having a partner who has decreased sexual desire or lack of sexual skills
• fear of intimacy
• previous sexual trauma
• religious beliefs containing sexual prohibitions

Sexual desire is often very much related to a partner's sexual desire. If a husband has decreased desire due to medications or illness, a wife's desire also decreases.

Question 3

Which one of the following is true about menopause and estrogens and their relation to cardiovascular disease?

1. estrogens cause blood clots
2. estrogens decrease heart disease by 50%
3. estrogens decrease good cholesterol blood levels
4. estrogens increase the incidence of hypertension
5. estrogens increase total cholesterol levels

In the premenopausal age range, estrogen containing oral contraceptives increase blood clots in the legs and to the lungs. These are much higher estrogen doses than are used after menopause. Postmenopausal estrogen replacement is NOT associated with blood clots.































Correct

Most studies have shown that taking estrogen replacement (ERT) after menopause reduces the new occurrence of heart disease by 50%. Since heart disease is so common, estrogen replacment increases the life span of women as compared to not taking any ERT. Even if there is a small increase in breast cancer from ERT after many years (and it is not certain that this is so), the decrease in death due to heart attacks far outweighs deaths due to any increased breast cancer.































Incorrect

Actually estrogen therapy increases good cholesterol or high density lipoprotein. It is thought that this effect accounts for about 25% of the decrease in heart disease due to estrogens. The cause of the other 75% of the decrease in heart disease is unknown but it is postulated to be by a direct effect of estrogen on the blood vessels.































Incorrect

The incidence of hypertension in women increases after menopause but estrogen replacement dosen't cause this. In fact estrogen replacement may slightly lower blood pressure. This is in contrast to the high doses of estrogens in oral contraceptives which may increase blood pressure in premenopausal women.































Incorrect

Estrogen replacement therapy (ERT) after the menopause tends to increase good cholesterol (high density lipoproteins) and lower bad cholesterol (low density lipoproteins). Instead of the net effect being no change, there is actually a lowering of total cholesterol. When a postmenopausal woman starts on ERT, the cholesterol is usually lowered by 15mg/dl, eg. 220 mg/dl to 205 mg/dl.

Question 4

Which one of the following is true about menopause and estrogens and their relation to non cardiovascular systems?

1. depression is more common after the menopause
2. estrogen replacement may lower the incidence of Alzheimer's disease
3. estrogen replacement can reverse the bone loss of osteoporosis
4. progestins added to estrogen replacement usually improves irritability symptoms
5. overweight women are more likely to develop osteoporosis

In spite of public "hearsay", depression is actually less frequent during the menopause compared to other life periods for a woman.































Correct

Yes, there are studies that suggest all senile dementias, including Alzheimer's disease, are decreased in menopausal women who take estrogens versus those who do not. There are also studies that suggest that in general, memory and concentration are also better in women taking estrogen replacement.































Incorrect

In general, bone loss is prevented by taking estrogen replacement but there isn't much, if any, more bone laid down. That is why many physicians advocate starting estrogen replacement immediately after menopause starts, in order to prevent the bone loss in the first place.

There is a suggestion by some studies that estrogen plus some of the other nonhormonal osteoporosis prevention medicines can actually result in more bone mass if they are both taken together. It remains to be seen if this combined therapy will have a net result on prevention of spontaneous fractures.































Incorrect

If there is any effect, progestins increase rather than decrease mood irritability when taking estrogen replacement.































Incorrect

Overweight women have greater bone mass similar to that of men because the bones have been under more weight stress and lay down more calcium accordingly. It is one of the few benefits of being overweight.

Question 5

According to the continuing education paper you have just read, which one of the following statements is most likely to be true?

1. addition of progestin to estrogen replacement therapy is likely to lower the incidence of breast cancer
2. if breast cancer develops while taking estrogens, it is likely to develop in the 1st five years of taking the medicine
3. estrogens increase the risk of breast cancer by 4 times (risk ratio 4.0 or more)
4. there is a higher incidence of breast cancer during and immediately after pregnancy, which is a very high estrogen situation
5. long term use of estrogen replacement therapy during the menopause may be associated with a small risk (risk ratio less than 2.0) of breast cancer

Several studies, but not all, have demonstrated that the addition of progestin to estrogen replacement does NOT lower the risk of breast cancer to that of estrogen use alone.































Incorrect

Most investigators agree that if there is any increase in breast cancer due to estrogen replacement therapy, it is likely to be with long term use of greater than 5-10 years.































Incorrect

Most of the studies that show an increase in the risk of breast cancer with estrogen replacement only show a small increase, not a large increase. Risk ratios of positive studies are usually under 2.0































Incorrect

Pregnancy is a very high estrogen state but it is not associated with an increase in breast cancer nor immediately after it.































Correct

There are enough studies that show a small, but real, increase in the incidence of breast cancer with the long term use of estrogen replacement after the menopause, especially after 5-10 years of use. It may be that this takes place only in women who are genetically susceptible but at the current time we are not sure.

We are sure that more women live longer because of the lower incidence of heart disease when taking estrogen replacement and that this decrease outweighs deaths due to an increase in breast cancer. Any women taking estrogen replacement should have an annual mammogram so that breast changes can be found early.

Completion of Quiz

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