Axis Clinical Sessions Flashcards
Irregular menstrual cycles are usually due to irregular _____
Ovulation
Dopamine has a negative feedback on the anterior pituitary to inhibit ____ secretion
Prolactin
Which drugs might cause elevated prolactin levels in a patient?
Psychotropic drugs e.g. haloperidol, stelazine
Which drugs are used to treat a prolactinoma?
Bromocriptine or cabergoline (dopamine agonists)
Treatment of prolactinoma
Bromocriptine or cabergoline should be introduced slowly, starting with a ___mg tablet per day
1.25
How do you manage hypothalamic amenorrhoea?
- Counselling
- Hormone therapy
- Regular follow up
- Review when considering starting a family
To assess ovulation you would measure progestagin on day ___ of the 28 day cycle
21
To assess ovulation you would measure FSH/oestradiol on day ___ of the 28 day cycle
3 (2-4)
What is a hysteroalpingogram?
An x-ray where you can see the outline of the uterine cavity and tubes
What is the definition of Premature Ovarian Insufficiency (POI) ?
Ovarian insufficiency leading to amenorrhea in women before age 40
What is the triad of symptoms seen in Polycystic Ovarian Syndrome (PCOS)?
- Amenorrhoea
- Obseity
- Hirstuism
(And enlarged ovaries)
Gold standard diagonsis of PCOS is:
____-ovulation
Clinical and/or biochemical evidence of ______
Polycystic ovaries on ultrasound (>= ___ small peripheral follicles on each ovary)
- Oligo-ovulation and/or anovulation
- Clinical and/or biochemical evidence of hyperandrogenism
- Polycystic ovaries on ultrasound (>= 12 small peripheral follicles on each ovary)
What is the hormonal abnormality that causes the symptoms of PCOS?
Imbalance between LH and FSH leading to follicular arrest
Obesity increases peripheral conversion of androgens to oestrogens, increasing the negative feedback on ____ increasing the ____ ratio
FSH
LH:FSH ratio
Hyperinsulinemia increases ___ pulses and favours ___ over ____
GnRH
FSH over LH
What are some clinical features of PCOS?
- Hair loss on the scalp
- Hirstuism
- Acne
- Acanthosis nigracans
- Obesity
- Male pattern hair growth
A polycystic ovary has ___ volume and ___ number of ovarian follicles
Increased
Increased
What is the most common cause of anovulation?
Polycystic Ovarian Syndrome (PCOS)
Which demographic with PCOS is more predisposed to metabolic sequelae?
Maori and Pacific women
What is the mechanism of clomiphene citrate?
Anti-oestrogen -> increased FSH -> normal follicular maturation -> ovulation
Women with PCOS starting on clomiphene citrate should take one tablet for __ days of each cycle (start day 2 or day 5), usually start at __mg
5
25
Women with PCOS starting on metformin should take ___ tablets daily starting at __mg
1-3
250
What is the mechanism of surgery for PCOS?
- Removal of androgen producing tissue
- LH and androgen levels fall following procedure
What could be a consequence of anovulation?
Excessive proliferation of the endometrium -> endometrial thickening and hyperplasia (endometrial cancer)
Why is endometrial biopsy important with an extended period of anovulation?
- Exclude endometrial hyperplasia
Under __ % of atypical hyperplasia will progress to cancer and up to __% of atypical hyperplasia has co-existent cancer
25
50
How do you manage anovulation?
- Induce a withdrawal bleed every 4-6 weeks (progestogen tablets)
OR
- Prevent endometrial proliferation (hormonal treatments e.g. COCP, POP, Depo Provera, Mirena, IUS, Jadelle)
What is the mechanism of mirena?
- Releases a small amount of LNG to endometrium
- Keeps endometrium thin, prevents proliferation and hyperplasia
Women with PCOS are at increased risk of developing ______
Metabolism syndrome
What other co morbidities is it important to screen women with PCOS for?
- Impaired glucose tolerance/diabetes
- Hypercholesterolemia
- CVD
- Hypertension
How do you manage premature ovarian insufficiency?
- Counselling and psychological support
- Refer fertility specialist
- Menopausal hormonal therapy (if not wanting infertility)
