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The Mature Woman

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Menopause may be identified by which of the following?

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a. The point in time 1 year after cessation of menses

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b. The time when menstruation permanently stops due to loss of ovarian function

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c. The state associated with physical symptoms and with metabolic and structural changes related to declining estrogen levels

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d. All of the above

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Regarding the findings from the large observational Nurses’ Health Study (Stampfer, 1985), all of the following are correct EXCEPT:

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a. It identified a significant reduction in heart disease among postmenopausal hormone users.

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b. It suggested at least a doubling of cerebrovascular disease among postmenopausal hormone users.

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c. Its findings likely were confounded by timing of the initiation of postmenopausal hormone therapy.

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d. It was likely biased by including participants that were not representative of the U.S. postmenopausal population.

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The Writing Group for the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial (1995) reported which of the following regarding women receiving placebo compared with those receiving hormones?

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a. Fibrinogen levels were increased.

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b. Cardiac morbidity declined by 50 percent.

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c. Low-density lipid levels declined.

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d. High-density lipid levels increased.

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Which of the following is correct regarding the Heart and Estrogen/Progestin Replacement Study (HERS) and HERS II.

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a. They included healthy women without preexisting heart disease.

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b. They showed that estrogen was a useful medication for secondary prevention of cardiac disease progression.

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c. They showed (at 1 year) an increased rate of myocardial infarction in women who received conjugated equine estrogen and continuous medroxyprogesterone acetate.

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d. They showed (at 4 years) a sustained increased risk of myocardial infarction in women receiving combined hormone therapy.

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A 56-year-old woman has been amenorrheic for 4 years and asks whether hormone therapy will lead to heart attack. You explain that results from the Women’s Health Initiative (WHI) suggest ...

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