Australian Family Physician
Australian Family Physician


Volume 46, Issue 6, June 2017

Clinical Challenge

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Case 1

>Mary, 51 years of age, presents to your office seeking advice regarding contraception. Her periods have been increasingly heavy and irregular over the past couple of years. She is sexually active and uses condoms. She has been told that it is very unlikely that she will conceive at this age but would like to discuss this further.

Question 1

Which one of the following is not a key determinant of contraceptive choice for Mary?

  1. Accessibility
  2. Packaging
  3. Affordability
  4. Side effects

Question 2

Which one of the following contraceptive methods is recommended for use in Mary’s age group?

  1. Combined oral contraception
  2. Vaginal ring
  3. Depot medroxyprogesterone acetate (DMPA)
  4. Levonorgestrel intrauterine device (LNG-IUD)

Question 3

Mary is keen to have an LNG-IUD inserted today. Which one of the following does not preclude insertion of an IUD at the initial consultation?

  1. Heavy menstrual bleeding
  2. Postcoital bleeding
  3. Obesity
  4. Breast cancer when aged 30 years

Question 4

The LNG-IUD is no longer required for women aged 50 years and older if:

  1. they have been amenorrhoeic for ≥12 months
  2. their follicle-stimulating hormone (FSH) level is ≥30 IU/L
  3. they are aged ≥60 years
  4. they have increasing acne.

Case 2

Lucinda, 35 years of age, presents with a 10-month history of amenorrhea. She has no significant past medical history and has not been sexually active for the past two years. Menarche occurred at age 14 years and she has only used barrier methods of contraception in the past. You are concerned about the possibility of premature ovarian insufficiency (POI).

Question 5

Which one of the following is not a symptom of menopause?

  1. Insomnia
  2. Hot flushes
  3. Dyspareunia
  4. Dry facial skin

Question 6

Which one of the following is not a known cause of spontaneous POI?

  1. Fertility medications
  2. Addison’s disease
  3. Mumps infection
  4. Turner syndrome

Question 7

Which one of the statements regarding causes of POI is most correct?

  1. Genetic causes are the most common.
  2. Idiopathic causes account for 10% of cases.
  3. Associated autoimmune conditions include coeliac disease.
  4. All of the above are correct.

Question 8

To assess for POI, you perform a serum FSH assay, which shows a result in the menopausal range (>40 IU). How many times does this test need to be repeated to confirm menopause?

  1. Once
  2. Twice
  3. Three times
  4. Four times

Question 9

Lucinda is worried about osteoporosis as her mother had this condition. Which one of the following is the usual first‑line treatment to maintain bone health in this situation?

  1. Biphophonates
  2. Hormone replacement therapy
  3. Combined oral contraceptive pill
  4. LNG-IUD

Case 3

Anne, 52 years of age, presents to your office with concerns about recent weight gain. She states that she has put on about 15 kg over the past five years and has not had a period for the past two years. She says she is being careful about her diet and is trying to stay active; however, she has continued to gain weight and is feeling down and frustrated by her lack of success in losing weight.

Question 10

Which one of the following is the principal cause of postmenopausal weight gain, as demonstrated in a study by Lovejoy et al?

  1. Increased appetite
  2. Decreased spontaneous activity
  3. Changed metabolism
  4. Predilection for high fat food

Question 11

The fat layer that increases after menopause is predominantly of which one of the following types?

  1. Visceral adipose tissue (VAT)
  2. Subcutaneous adipose tissue (SAT)
  3. Fat around the neck
  4. Fat around the hips and thighs

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