16,17,18 Infertility, virilization, menopause Flashcards
Infertility
-definition
1 year regular sex, no conception
Perimenopause and postmenopause: How to ts the following:
- menstrual irregularities
- Vaginal atrophy
- Hot flashes
- Osteoporosis ppx
- osteoporosis screening
- osteoporosis tx
- give it time
- estrogen cream
- venlafaxine (SNRI)
- Vit D3 + Calcium
- DEXA bone scan @65
- bisphosphonates
Infertility caused by physical, anatomic issue.
Examples (3)
- Fibroids
- tubal Stricture/ PID inflamm.
- Uterus developmental issue (eg bicornate uterus)
Premature ovarian failure:
How to confirm diagnosis of menopause
elevated FSH
(only do test to confirm premature ovarian failure)
Infertility
- male reasons (2)
- how to dx, tx
- ED–can do nightime tumescence test, determine organic vs psych. Tx with viagra/counseling
- bad sperm (amount, motility)
–semen analysis. Tx with ICSI (intra cytoplasmic sperm injection)–in vitro injection of sperm into egg
Hirsutism/Virilization:
Diff dx for each (3 each)
Hirsutism: PCOS, CAH, Familial
Virilization: Sertoli-leydig tumor, adrenal tumor, CAH
Hirsutism vs Virilization
sx, and difference?
Virilization is “Hirsute +”
Hirsutism: fat, hairy in male distribution
Virilization: hirsutism, + amenorrhea, clitoromegaly, more muscle mass, deep voice
Hirsutism is increase in androgens (not tumor, so bilateral ovarian/adrenal issue), Viriilization is super increase in androgens (tumor, so unilateral ovarian/adrenal issue)
menopause vs perimenopause
- definitions, normal length of time
- average age
- when is youngest menopause can be and still be normal?
menopause: the time 1 year after cessation of periods.
perimenopause: the period of time from onset of irregular periods to end of 1 yr w/o periods (start of menopause). Can last 4-8 years
- average age 51
- normal: early as 40. <40 is Premature ovarian failure
Hirsutism/Virilization:
where are sources of androgen? (2) and how to test?
- Ovaries, make T.
Do U/S to look for tumor.
- Adrenals, make DHEA.
Do 17-OH-Pro test, or CT to find tumor.
Infertility caused by anovulation
- how to dx (3)
- how to tx
- Basal temp: 1 degree rise is sign of ovulation
- endometrial bx (between day 14-28). Is it secretory uterus?
- Progesterone level (on day 22 ). Should be elevated.
Tx: Clomiphene (SERM–estrogen receptor blocker in hypothalamus)
CAH
- dx
- tx
dx: high 17-OH-Pro
tx: replace missing hormones:
- Cortisol
- Fludrocortisol for Aldosterone, if needed
PCOS:
dx:
tx (4): and why
Dx: LH/FSH >3:1
1000s of atretic follicles make E but do not make P. E is converted to T
Tx: 1. OCP (shut down HPO axis, reducing follicle production of E)
- Spironolactone (block androgen receptors)
- Metformin (control DM but also reduce androgen effect)
- Clomiphene: induce ovulation
Infertility
-female causes (4) and diagnostic algorithm/tests
First, r/o male problems (ED, hypospermia)
- Is mucus hospitable to sperm? Smush test, microscopy. If not, hostile mucus.
- Can pt ovulate? Do ovulation tests. If not, anovulation
- Uterus physical issue? Do imaging. If yes, abnormal anatomy.
- If not above, do diagnostic scope to look for endometriosis.
If nothing, unexplained.
Couple wants to conceive: What is window of conception?
5 days prior to ovulation, to day of ovulation. Daily sex recommended during this time. reduced sperm of daily sex is outweighed by daily attempts.
infertility caused by hostile uterine mucus.
How to dx (2)
how to tx?
dx:
- smush test (>6cm stretch for hospitable),
- Microscopy: Fern sign or sperm(+fern sign means hospitable)
Tx: Estrogen (softens mucus). Or, do ICSI
