Gynaecological endocrinology: GnRH agonist with add-back therapy: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Gynaecological endocrinology: GnRH agonist with add-back therapy

Sample item

A woman with endometriosis is given a GnRH agonist for 6 months. Which addition limits her hot flushes and bone loss without losing the benefit on the disease?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Low-dose oestrogen with a progestogen

GnRH agonists produce a hypo-oestrogenic state with vasomotor symptoms and bone loss. Add-back with a low-dose oestrogen and progestogen (or tibolone) stays below the threshold that stimulates endometriosis but protects bone.

Option by option

  • A. Cabergoline

    Cabergoline lowers prolactin and does not protect against oestrogen deficiency.

  • B. Danazol

    Danazol is another hypo-oestrogenic treatment and does not offset the side effects.

  • C. Low-dose oestrogen with a progestogen (correct)

    Correct. Low-dose add-back keeps oestradiol under the stimulating threshold while limiting symptoms.

  • D. Full-dose unopposed oestrogen

    Full-dose oestrogen would reactivate the endometriosis and defeat the treatment.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is C, Low-dose oestrogen with a progestogen. GnRH agonists produce a hypo-oestrogenic state with vasomotor symptoms and bone loss.

Why is "Cabergoline" not the answer?

Cabergoline lowers prolactin and does not protect against oestrogen deficiency.

Why is "Danazol" not the answer?

Danazol is another hypo-oestrogenic treatment and does not offset the side effects.

Why is "Full-dose unopposed oestrogen" not the answer?

Full-dose oestrogen would reactivate the endometriosis and defeat the treatment.

What concept does this question test?

It tests Gynaecological endocrinology: GnRH agonist with add-back therapy in OBG. Add-back with a low-dose oestrogen and progestogen (or tibolone) stays below the threshold that stimulates endometriosis but protects bone.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gynaecological endocrinology: GnRH agonist with add-back therapy?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.