{"id":8468,"date":"2025-11-12T00:01:38","date_gmt":"2025-11-12T08:01:38","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=8468"},"modified":"2025-10-09T14:18:40","modified_gmt":"2025-10-09T22:18:40","slug":"usmle-step-1-question-of-the-day-endometriosis-medication","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-endometriosis-medication","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Endometriosis medication"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-endometriosis-medication\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-endometriosis-medication\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-endometriosis-medication\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-endometriosis-medication\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-endometriosis-medication\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-endometriosis-medication\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em>Today\u2019s USMLE\u00ae Step 1 question of the day focuses on a 35-year-old woman presents to her primary care provider for evaluation of endometriosis. What medication side effects is this patient at risk of developing? Let\u2019s find out!<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 35-year-old woman presents to her primary care provider for evaluation of <strong>endometriosis<\/strong>. The patient was diagnosed nine months ago, and she has taken <strong>combined oral contraceptives <\/strong>and <strong>ibuprofen<\/strong>. The patient continues to experience significant pain with menstruation and sexual intercourse. <strong>Temperature is 37.6\u00b0C (99.7\u00b0F), blood pressure is 120\/75 mmHg, and pulse is 64\/min.<\/strong> Pelvic examination is notable for <strong>rectovaginal tenderness<\/strong> and <strong>nodularity of the uterosacral ligament<\/strong>. The patient is initiated on a new medication that binds directly to <strong>GnRH receptors<\/strong>. When this medication is administered continuously, it can lead to the <strong>downregulation<\/strong> of GnRH receptors. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Which of the following side effects is this patient at risk of developing after starting this new medication?<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Deep vein thrombosis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Endometrial malignancy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Pelvic inflammatory disease<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Reduced bone density<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Ovarian hyperstimulation syndrome<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis.org at the University College London, UK\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/DIp3u0oTLo4?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Reduced bone density<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Deep vein thrombosis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Patients taking estrogen-containing contraceptives are at risk for developing deep vein thrombosis (DVT). This patient was initiated on a GnRH analog (e.g. leuprolide). GnRH analogs can predispose patients to develop menopause-like symptoms like nausea, hot flashes, and osteoporosis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Endometrial malignancy<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Exogenous estrogen use and specific selective estrogen receptor modulators (e.g. tamoxifen) can increase the risk of developing endometrial cancer. These medications do not directly bind to GnRH receptors.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Pelvic inflammatory disease<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> This patient was most likely started on a GnRH agonist to treat endometriosis. However, GnRH agonists are not known to increase the risk of developing pelvic inflammatory disease. GnRH agonists can cause menopause-like and andropause-like symptoms, including hot flashes, osteoporosis, reduced libido, impotence, and gynecomastia (in men). Furthermore, patients may experience nausea, lightheadedness, and injection site irritation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Ovarian hyperstimulation syndrome<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Clomiphene acts as an estrogen receptor antagonist in the hypothalamus, reducing estrogenic negative feedback inhibition. These changes ultimately result in increased LH and FSH secretion from the pituitary gland. Clomiphene can lead to ovarian hyperstimulation syndrome, manifest with abdominal distention\/pain, rapid weight gain, dyspnea, and respiratory distress. GnRH agonists (e.g. leuprolide) are not associated with ovarian hyperstimulation syndrome.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presented with <strong>endometriosis <\/strong>and was started on a <strong>GnRH agonist<\/strong>, which can cause <strong>reduced bone density <\/strong>and <strong>osteoporosis<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">GnRH agonists (e.g., <strong>leuprolide, nafarelin, triptorelin<\/strong>) bind to GnRH receptors in the <strong><a href=\"https:\/\/www.osmosis.org\/learn\/Pituitary_gland_histology\">pituitary gland<\/a><\/strong>. These medications can be given in either a pulsatile or continuous fashion. When administered in a <strong>pulsatile pattern<\/strong>, they mimic the physiological secretion of GnRH from the hypothalamus. <strong>GnRH agonists bind and activate GnRH receptors,<\/strong> thereby <strong>increasing <\/strong>the downstream <strong>synthesis of LH, FSH, <\/strong>and <strong>sex hormones.<\/strong> This method of administration was historically used to treat <strong>infertility <\/strong>but is <strong>rarely used nowadays<\/strong> due to the availability of <strong>better alternatives.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In contrast, continuous administration of GnRH agonists caused an initial, transient stimulation of GnRH receptors and <strong>increased sex hormone synthesis.<\/strong> Over time this results in a downregulation in the number of GnRH receptors, and the body <strong>becomes less sensitive<\/strong> to the hormone. These changes decrease the downstream synthesis of LH, FSH, and sex hormones. Continuous administration can treat endometriosis,<strong> uterine fibroids, prostate cancer, <\/strong>and <strong>precocious puberty.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When given continuously, the medication can cause menopause-like and andropause-like side effects. These symptoms include <strong>hot flashes, reduced bone density, decreased libido,<\/strong> as well as <strong>impotence <\/strong>and <strong>gynecomastia in men. <\/strong>Furthermore, patients may experience <strong>nausea\/vomiting, lightheadedness, <\/strong>and <strong>injection site irritation.<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">GnRH agonists can be given in a pulsatile pattern to treat infertility or a continuous pattern to treat conditions such as <strong>endometriosis, uterine fibroids, <\/strong>and <strong>prostate cancer.<\/strong> If given continuously, GnRH agonists can cause <strong>menopause-like and andropause-like side effects<\/strong>, including hot flashes, reduced bone density, and decreased libido.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch this Osmosis video:<\/strong> <strong><a href=\"https:\/\/www.osmosis.org\/learn\/Endometriosis:_Clinical_sciences\">Endometriosis: Clinical sciences<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Swayzer, D.V., Gerriets, V. (2020) \u201cLeuprolide\u201d. StatPearls [Internet]. Web Address: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK551662\/\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK551662\/<\/a>.<\/li>\n\n\n\n<li>Wilson, A.C., Meethal, S.V., BOwen, R.L., Atwood, C.S. (2007) Leuprolide acetate: A drug of diverse clinical applications. Expert Opinion on Investigational Drugs. 16(11), 1851-1863. Doi: 10.1517\/13543784.16.11.1851.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/01\/Blog_Display_Ads_GENERAL3_2023.png?w=700\" alt=\"\" class=\"wp-image-5048\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/01\/Blog_Display_Ads_GENERAL3_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/01\/Blog_Display_Ads_GENERAL3_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis from Elsevier today! Access your&nbsp;<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/em>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A 35-year-old woman with endometriosis starts a GnRH agonist. What side effects should clinicians monitor for during continuous therapy?<\/p>\n","protected":false},"author":204,"featured_media":8471,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1369,44],"tags":[1803,323,1804,1807,1805,1806,1801,1302,1802,664],"class_list":["post-8468","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-bone-density","tag-endometriosis","tag-gnrh-agonist","tag-gynecology","tag-hormone-therapy","tag-leuprolide","tag-menopause-symptoms","tag-osteoporosis","tag-pelvic-pain","tag-usmle-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day:\u00a0Endometriosis medication - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-endometriosis-medication\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day:\u00a0Endometriosis medication - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"A 35-year-old woman with endometriosis starts a GnRH agonist. 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