Women’s hormones and mental illness

Question 1

Which of the following is the term used to describe the initiation of the 1st menstrual cycle?

1 - menopause
2 - perimenarche
3 - menarche
4 - perimenopause

Answer 1

3 - menarche
- occurs during puberty

Question 2

Which of the following is the term used to describe when the menstrual cycle stops occurring in a woman?

1 - menopause
2 - perimenarche
3 - menarche
4 - perimenopause

Answer 2

1 - menopause

Question 3

Menopause is a physiological phase that is defined how long following amenorrhea?

1 - 1 month
2 - 6 months
3 - 12 months
4 - 24 months

Answer 3

3 - 12 months
- most symptoms occur in this 12 month period

Question 4

Which 2 hormones rise and fall during the menstrual cycle?

1 - growth hormone
2 - prolactin
3 - progesterone
4 - estradiol

Answer 4

3 - progesterone
4 - estradiol

Question 5

Progesterone and estradiol levels fluctuate during the menstrual cycle and can affect the CNS. What type of receptor do progesterone and estradiol bind with in the CNS?

1 - GPCR
2 - steroid receptors
3 - enzyme induced receptors
4 - tyrosine kinase receptors

Answer 5

2 - steroid receptors
- can affect levels of GABA, glutamate, dopamine and serotonin
- metabolites of sex hormones regulate mood, behaviour, and cognitive abilities

Question 6

Is estrogen associated with depression?

Answer 6

• yes

Question 7

Premenstrual syndrome (PMS) is characterised by repetitive, cyclical, physical, and behavioural symptoms occurring in the luteal phase of the normal menstrual cycle. PMS can cause symptoms in the figure. To be diagnosed with PMS, which 2 of the following are required?

1 - cannot be an exacerbation of another mental health disorder
2 - patient must be >21 y/o
3 - patient must have been experiencing PMS for >12 months
4 - PMS symptoms must affect patients ADLs

Answer 7

1 - cannot be an exacerbation of another mental health disorder
4 - PMS symptoms must affect patients ADLs

Question 8

Are symptoms including physical changes , breast tenderness and minor changes in mood occurring in the luteal phase including in the diagnosis of premenstrual syndrome (PMS)?

Answer 8

• no
• not considered a disorder
• 80% of women experience these symptoms though
• these symptoms are also less likely to impact ADLs

Question 9

Premenstrual dysphoric disorder (PMDD) is a more severe variant of premenstrual syndrome (PMS). Although there are a number of symptoms experienced, which is more common?

1 - energy levels
2 - psychosis
3 - mood symptoms
4 - all of the above

Answer 9

4 - all of the above

Question 10

Premenstrual dysphoric disorder (PMDD) is a more severe variant of premenstrual syndrome (PMS). Mood symptoms dominate in PMDD, but which of the following do patients with PMDD typically have at least one of?

1 - anger
2 - irritability
3 - internal tension occurs during the second half of the menstrual cycle
4 - all of the above

Answer 10

4 - all of the above
- need minimum of 1 for diagnosis, but patients can have lots
- PMDD present with the same symptoms as PMS

Question 11

Are patients with premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS) more at risk of depression?

Answer 11

• yes

Question 12

Which of the following is NOT a risk factor for premenstrual dysphoric disorder (PMDD), a more severe variant of premenstrual syndrome (PMS)?

1 - age (20-30)
2 - ethnicity
3 - smoking
4 - comorbid psychiatric disorders
5 - genetics
6 - psychosocial stress
7 - obesity

Answer 12

2 - ethnicity

Question 13

Which of the following is NOT a diagnostic tool used to diagnose premenstrual dysphoric disorder (PMDD) or premenstrual syndrome (PMS)?

1 - menstrual history and diary of symptoms
2 - record and of severity of problems (3 months)
3 - symptom free for at least one week per cycle
4 - symptoms mostly occur in luteal phase or cyclical
5 - TSH and FBC
6 - depression screening
7 - estradiol and progesterone levels

Answer 13

7 - estradiol and progesterone levels
- not used in diagnosis

• TSH rules out thyroid issues
• FBC rules out anaemia

Question 14

In a patient with MILD premenstrual syndrome (PMS), which of the following is NOT a typical treatment option?

1 - Lifestyle changes
2 - Exercise
3 - Reduce alcohol
4 - Diet
5 - SSRIS –e.g Fluoxetine
6 - CBT

Answer 14

5 - SSRIS –e.g Fluoxetine

Question 15

In a patient with MODERATE premenstrual syndrome (PMS), which of the following is NOT a typical treatment option?

1 -SSRIS –e.g Fluoxetine either continuous or luteal phase
2 - Combined oral contraceptive pill
3 - HRT
4 - CBT

Answer 15

3 - HRT

• Fluoxetine or sertraline is most commonly used
• Combined oral contraceptive pill can stop periods and therefore stop patients symptoms

Question 16

In a patient with MODERATE premenstrual syndrome (PMS) or the more severe form premenstrual dysphoric disorder (PMDD), which of the following is NOT a typical treatment option?

1 -SSRIS –e.g Fluoxetine either continuous or luteal phase
2 - Combined oral contraceptive pill
3 - HRT
4 - CBT
5 - GnRH agonist to suppress ovulation
6 - Surgical treatment (oophorectomy)

Answer 16

3 - HRT

• Fluoxetine or sertraline is most commonly used

Question 17

When treating premenstrual dysphoric disorder (PMDD) we can prescribe medications. Which of the following is commonly used?

1 - SSRIs
2 - Atypical antipsychotics
3 - Tetracyclics
4 - Anti-epileptics

Answer 17

1 - SSRIs
- increase serotonin levels rapidly

Question 18

What is the average age of menopause in the UK?

1 - 35-45
2 - 40-50
3 - 51-52
4 - >65

Answer 18

3 - 51-52
- older than in other countries
- no blood test used for diagnosis in patients >45 y/o

Question 19

What are the most common symptoms of menopause?

1 - hot flushes
2 - mood changes
3 - brain fog
4 - vaginal symptoms
5 - bloating
6 - joint pains
7 - all of the above

Answer 19

7 - all of the above

Question 20

A lot of women can manage symptoms associated with menopause, but HRT is becoming a more common treatment.

Question 21

A lot of women can manage symptoms associated with menopause, but HRT is becoming a more common treatment. Which 2 hormones are typically included in HRT?

1 - oxytocin
2 - progesterone
3 - estradiol
4 - prolactin

Answer 21

2 - progesterone
3 - estradiol

• without progesterone patients have an increased risk of endometrial cancer

Question 22

Which of the following are typical risks associated with HRT?

1 - cancer
2 - heart disease/CVD
3 - thrombosis
4 - all of the above

Answer 22

4 - all of the above

Question 23

Does HRT have any impact upon dementia?

Answer 23

• yes
• can improve memory in carriers of the APOE Alzheimers gene