6. To be or not to be fertile

Question 1

Oligomenorrhea

Answer 1

Cycles longer than 3 months

Question 2

Menstrual cycle

Answer 2

Fertile period: 14 days before next cycle
Conception risk highest 2-3 days before ovulation

Question 3

Early pill

Answer 3

Only estrogen release
Stimulate uterine proliferation
Inhibitory effect on proliferation of other follicles

Question 4

Present pills

Answer 4

Progesterone like agents added, little estrogen
Pregnancy hormone: stimulate proliferation
Inhibit GnFH release, hence stop normal hormonal production
Inhibit follicle proliferation

Question 5

Male hormone contraceptive

Answer 5

Initially testosterone and combinations thereof to diminish spermatogenesis
Inhibit HPG axis –> delay in onset due to generation/survival of sperm
Poor bioavailability: injections, implants, hepatic toxicity, slow recovery

Question 6

Abortion pills

Answer 6

Morning after (progesterone), prevents ovulation and implantation
Abortion: soften cervix, progesterone antagonist + prostaglandin: uterine contraction

Question 7

Menopause

Answer 7

FSH elevation
Temporary: GnRH
Associated with osteoporosis, diabetes, cardiovascular disease
Birth control pill may help in cases of perimenopausal symptoms

Question 8

Primary ammenorrhea

Answer 8

Failure of spontaneous menses to occur before 16
Ovary, hypothalamus, secondary sexual characteristics?, stress

Question 9

Causes primary amenorrhea

Answer 9

Ovary not stimulated: hypogonadotropic amenorrhea, pituitary deficiency, cerebral tumor, congenital CNS defect, constitutional growth delay, weight loss
Ovary cannot respond: hypergonadotropic amenorrhea (no inhibin -> increase in FSH), ovarian failure (intense physical training, chromosomal insufficiency)
Gonadal dysgenesis or hormone replacement

Question 10

Obstruction to outflow of menses (primary amenorrhea)

Answer 10

Genital tract obstruction
Outflow obstruction
Obstructed hymen
Late discovery may lead to imperforate hymen (cryoptomenorrhea)

Question 11

Secondary amenorrhea

Answer 11

Absence of menstruation for 6 months in previously menstruating woman
Hypothalamus PCOS
Physiological: pregnancy, lactation, menopause
Pathological: anovulation, Ascherman’s syndrome (adhesions, obstruct uterus)

Question 12

Causes secondary amenorrhea

Answer 12

Hyperprolactinaemia: tranquilizers, antipsychotics (dopamine agents treatment)
Polycystic ovarian syndrome (PCOS): multiple small follicles on ovarian epithelium forming into cysts
High androgen, hypersecretion LF,
Genetic aetiology