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RDS Test 1 > B8.008 Prework 1: Female Infertility: Secondary Amenorrhea > Flashcards

B8.008 Prework 1: Female Infertility: Secondary Amenorrhea Flashcards

1
Q

what is infertility

A

unprotected intercourse for 12 mo if a female is < 35 or 6 mo if a female is > 35

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2
Q

broad categories of female infertility

A

tubal
uterine
ovarian
unexplained (20%)

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3
Q

tubal causes of infertility

A

blockage: prior ligation, scarring, prior infection
hydrosalpinx
endometriosis

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4
Q

uterine causes of infertility

A

submucosal fibroids

intrauterine scarring: prior procedures, scarring

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5
Q

ovarian causes of infertility

A

anovulation

low ovarian reserve

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6
Q

prevalence of infertility

A

12%

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7
Q

what is amenorrhea

A

absence of menses

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8
Q

primary amenorrhea

A

no menarche by age 15

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9
Q

secondary amenorrhea

A

absence of menses for > 3 mo in females with prior regular cycles
absence of menses for > 6 mo in females with prior irregular cycles

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10
Q

anatomic locations of amenorrhea etiologies

A

hypothalamus (35%)
pituitary (17%)
ovary (40%, most common)
uterus (7%)

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11
Q

hypothalamic causes of amenorrhea

A

suppression due to systemic illness, radiation, low energy states

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12
Q

pituitary causes of amenorrhea

A 
any hormone secreting tumor
hyperprolactinemia (13%)
empty sella syndrome (1.5%)
sheehan syndrome (1.5%)
cushing's syndrome (1%)
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13
Q

empty sella syndrome

A

rare

enlargement of sella tunica in pituitary

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14
Q

sheehan syndrome

A

pituitary infarct, usually due to post partum hemorrhage

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15
Q

ovarian causes of amenorrhea

A

PCOS (30%)

primary ovarian insufficiency (10%)

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16
Q

general “cause” of secondary amenorrhea

A

inappropriate hormone signaling in HPA

prohibits cyclic oocyte release

17
Q

follicular phase HPA

A

hypothalamus secretes GnRH
anterior pituitary stimulated to secrete FSH and LH
ovary is stimulated to release estradiol due to production by rapidly maturing oocytes
estradiol has an inhibitory effect at the level of the hypothalamus and the anterior pituitary

18
Q

midcycle HPA

A

hypothalamus secretes GnRH
anterior pituitary stimulated to secrete FSH and LH
LH surge
ovary is stimulated to release estradiol
estradiol has stimulatory effect at level of hypothalamus and the anterior pituitary

19
Q

luteal phase HPA

A

hypothalamus secretes GnRH
anterior pituitary stimulated to secrete FSH and LH
ovary contains corpus luteum (remnant of follicle) which secretes progesterone from glandular endometrium
progesterone has inhibitory effect at the level of the hypothalamus and anterior pituitary

20
Q

GnRH pulsatility for LH release

A

increasing amplitude, high frequency

21
Q

GnRH pulsatility for FSH release

A

decreased amplitude, low frequency

22
Q

effect of estrogen on GnRH

A

increases pulse frequency

23
Q

effect of progesterone on GnRH

A

decreases pulse frequency

24
Q

WHO 1 amenorrhea

A

hypothalamic

decreased FSH, LH, E2

25
Q

WHO 2 amenorrhea

A

PCOS
normal levels
can have increased LH and T (but not necessary for diagnosis)

26
Q

WHO 3 amenorrhea

A

ovarian failure
increased FSH, LH
decreased E2

27
Q

what needs to be excluded in hypothalamic amenorrhea

A 
craniopharyngioma
radiation of sellar tumor
infiltrative disease
systemic illness
do an MRI to rule out tumor
28
Q

risk factors for hypothalamic amenorrhea

A

excess exercise
stress
nutritional deficiency (hypoleptinemia)
low energy states

29
Q

rotterdam criteria for PCOS

A

need 2/3:

  1. PCO
    - >12 antral follicles on US
  2. hyperandrogenism
  3. irregular menstrual cycles
30
Q

signs of hyperandrogenism

A

hirsutism
acne
elevated T

31
Q

irregular menstrual cycles

A

< 21 days

> 35 days

32
Q

why does PCOS lead to infertility

A

increased ratio of LH:FSH induces thecal proliferation

follicles continue to grow but done mature and rupture, thus ovulation does not occur

33
Q

characteristics of primary ovarian insufficiency (POI)

A

< 40 years of age

FSH > 30 on 2 occasions

34
Q

etiology of POI

A 
iatrogenic (radiation, chemo)
immunologic
chromosomal
-turners
-galactosemia
-fragile x
-perrault
35
Q

treatment for WHO 1 amenorrhea

A

decrease stress
increase energy intake
gonadotropins

36
Q

treatment for WHO 2 amenorrhea

A

decrease energy intake
letrozole (aromatase inhibitor)
clomid, gonadotropins, ovarian drilling (last resorts)

37
Q

mechanism of action of letrozole

A

inhibits aromatase in ovaries and peripheral tissues, reducing estrogen levels
estrogen reduction stimulates HPA to produce more FSH
FSH mediated follicle stimulation, which causes estrogen to rise
once estrogen begins to rise again, FSH is suppressed leaving a single dominant follicle

38
Q

treatment for WHO 3 amenorrhea

A

donor oocytes

RDS Test 1 (22 decks)

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