USMLE (United States Medical Licensing Examination) Step 1 Practice Exam

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Which hormonal change is diagnostic for menopause?

Increased estrogen
Increased FSH
Decreased LH surge
Decreased GnRH

The correct answer is: Increased FSH

The hormonal change that is diagnostic for menopause is an increase in follicle-stimulating hormone (FSH). During menopause, the ovaries significantly decrease their production of estrogen due to the depletion of ovarian follicles. This decline in estrogen levels leads to decreased negative feedback on the hypothalamus and pituitary gland. As a result, the pituitary gland increases the secretion of FSH in an attempt to stimulate the ovaries. Since the ovaries are no longer responsive to FSH due to their reduced follicular reserve, the levels of FSH remain elevated. Therefore, measuring high levels of FSH in conjunction with decreased estrogen is characteristic of menopause and is often used as a diagnostic criterion. The other hormonal changes associated with menopause do not serve as definitive diagnostic markers. For instance, while LH levels may also change, the increase in FSH is more clinically relevant for diagnosis. Likewise, GnRH levels do not directly provide diagnostic clarity in the context of menopause.