anovulation and hormonal irregularities

Question 1

what can the main causes of anovulation be divided into ?

Answer 1

physiological causes

pathological causes

Question 2

what is the definition of an-ovulation ?

Answer 2

not a disease but rather a sign that indicates the failure to achieve the normal cyclic ovulation

Question 3

what are the types of an-ovulation ?

Answer 3

sporadic

chronic

Question 4

what are the physiological causes of an-ovulation ?

Answer 4

before puberty
menopause
pregnancy
lactation

Question 5

what are the pathological causes of an-ovulation ?

Answer 5

hypothalamic causes 
pituitary causes 
ovarian causes 
endocrinal causes 
drug induced

Question 6

what are the hypothalamic causes of an-ovulation?

Answer 6

emotional stress
excessive stressful exercise
marked weight gain or loss
kallman’s syndrome

Question 7

what is kallmannn’s syndrome ?

Answer 7

form of hypogonadotropic hypogonadism, a condition characterized by delayed or absent puberty and an impaired sense of smell
congenital deficiency of GnRh receptors

Question 8

what are the pituitary causes of an-ovulation?

Answer 8

pituitary adenomas
empty sella syndrome ( hyperprolactinemia)
pituitary insufficiency

Question 9

what is sheehan’s syndrome ?

Answer 9

when a mother loses a lot of blood after delivery , hypoxic damage occurs in the pituitary and causes pituitary insufficiency

Question 10

what are the ovarian causes of an-ovulation ?

Answer 10

polycystic ovarian syndrome
premature ovarian failure
bilateral surgical removal or destruction by irradiation

Question 11

what are the endocrinal causes of an-ovulation ?

Answer 11

thyroid causes ( hypothyroidism)
adrenal disorders ( cushing disease)

Question 12

what are the drug induced causes of an-ovulation?

Answer 12

OCPs 
progestins therapy 
Progestin drugs ( Danzol )
GnRh Agonists 
drug induced hyperprolactinemia 
antihypertensive drugs

Question 13

which drugs induce hyperprolactinemia ?

Answer 13

psychotropic agents
anti-emetics
anything that is a dopamine blocker

Question 14

which anti-hypertensive drug can cause an-ovulation?

Answer 14

alpha methyl dopa

Question 15

what are the methods for detection of ovulation?

Answer 15

basal body temperature 
Urinary LH kit 
Ultrasound folliculometry
Mid Luteal Serum Progesterone 
Premenstrual endometrial biopsy

Question 16

how is a mid luteal serum progesterone level test done?

Answer 16

blood sample is taken mid luteal phase according top the patients cycle to measure progesterone levels
less than 5 means an-ovulation
more than 10 means ovulation
between 5-10 luteal phase defect

Question 17

what do the different results of premenstrual endometrial biopsies indicate ?

Answer 17

proliferative endometrium: an-ovulation
secretory endometrium: ovulation
poor secretory changes: luteal phase defect

Question 18

what is the pathology in the luteal phase defect ?

Answer 18

inadequate secretion of progesterone from the corpus leuteum
leading to inadequate secretory changes of the endometrium

Question 19

how does the luteal phase defect present ?

Answer 19

manifests by spotting during the second half of the menstrual cycle
infertility
recurrent pregnancy loss

Question 20

what is the criteria for the diagnosis of PCOS ?

Answer 20

menstrual irregularities
evidence of hyperandrogegism
ultrasound cystic changes of the ovary

Question 21

what labs results are required fore the diagnosis of PCOS ?

Answer 21

increased triad of :
LH
Insulin
Androgen

Question 22

which enzyme is inhibited inn PCOS ?

Answer 22

aromatase enzyme

aromatase converts androgens into oestrogen

Question 23

what is the effect of high levels of androgens ?

Answer 23

1. the high level of androgens is stimulated by the high levels of LH
2. an increase in androgens stimulates the secretion of estrone
3. this causes endometrial hyperplasia due to the unopposed effect of oestrogen
4. increases the risk of endometrial carcinomas

Question 24

what is the diagnostic appearance of PCO on ultrasound ?

Answer 24

pearl necklace appearance , no dominant follicle present

Question 25

with laparoscopy what is the diagnostic image of PCO?

Answer 25

oyster shell ovary

Question 26

what is the long term risk of PCOS ?

Answer 26

risk for type 2 DM hyperlipidemia higher risk of endometrial hyperplasia

Question 27

what is the management for PCOS ?

Answer 27

life style modification hormonal therapy ( OCPs, cyclic gestagens) insulin sensitizing drugs : Metformin Induction of ovulation ( if fertilization is the main concern )

Question 28

what are the causes of hyperprolactinemia ?

Answer 28

``` pregnancy and lactation severe stress hypothyroidism pituitary adenoma hypothalamic tumors antipsychotics - TCA ```

Question 29

what is the management for hyperprolactinemia ?

Answer 29

stop the causative drug treat underlying cause use cabergoline ( dopaminergic drug) bromo-ergo-cryptin ( inhibits pituitary prolactin ) surgical removal in cases of pituitary adenoma

Question 30

what is primary ovarian failure ?

Answer 30

early exhaustion of ovarian primordial follicles before the age of 40 years , causing premature menopause

Question 31

what are the causes of premature ovarian failure ?

Answer 31

autoimmune ovarian destruction Mosaic turner Mumps radiation or chemotherapy