Clinical: PCOS and Oligomenorrhea Flashcards
Treatment for PCOS anovulation
Clomiphene (effective ovulation induction agent in 70-80%)
Describe how clomiphene works
Anti-estrogen = increase in endogenous FSH –> induces follicular growth and then ovulation
2 adverse effects of clomiphene
- Ovarian cancer risk
- Risk of multiple pregnancy
3 reasons why Clomiphene-resistant PCOS may occur
- Obesity
- High insulin resistance
- High free androgen index
Accepted first-line treatment for clomiphene-resistant PCOS
Gonadotropins (injected FSH)
2 risks of injected FSH
- OHSS
- Multiple pregnancy
3 findings of severe OHSS
- Ascites
- Pleural effusion
- Tromboses
2 types of surgical treatments of CC-resistant PCOS
- Wedge resection
- Laparoscopic techniques
4 laparoscopic techniques to treat CC-resistant PCOS
- Biopsy
- Cauterization
- Electrocoagulation
- Laser
4 problems with surgical treatment for CC-resistant PCOS
- Risks of anaesthesia and laparoscopy
- Periadnexal adhesion formation
- Ovarian failure/atrophy
- Anti-ovarian antibodies
2 insulin sensitizing agents
- Metformin
- Troglitazone
Describe the function of metformin
Dereases peripheral insulin resistance and lowers serum glucose and therefore serum insulin
2 adrenal steroids to treat CC-resistant PCOS
- Cortisone
- Dexamethasone
5 causes of anovulation
- Pituitary and hypothalamic
- Weight and exercise-related
- Systemic
- Hyperprolactinemia
- Polycystic ovary syndrome
5 causes of primary amenorrhea
- Primary POF
- Hypo-hypogonadism
- PCOS
- Hyperprolactinemia
- Weight-related
6 causes of secondary amenorrhea
- PCOS
- POF
- Hyperprolactinemia
- Weight-related
- Hypo-hypogonadism
- Exercise-induced
4 causes of anovulatory infertility
- PCOS
- Ovarian failure/POF
- Hypogonadism
- Hyperprolactinema
Define hypogonadotropic hypogonadism (HH)
Generic term to describe various congenital and acquired defects in HPO axis leading to hypo-secretion of FSH and LH from the anterior pituitary
Typical values of FSH and LH in hypogonadotropihic hypogonadism
FSH < 3 IU/L and LH <1 IU/L
6 hypothalamic causes of HH
- Weight loss
- Intense exercise
- Genetic (i.e. Kallmann’s)
- Chronic illness
- Tumos
- Irradiation
8 pituitary causes of HH
- Hypopituitarism
- Sheenhan’s
- Tumors
- Cranial irradiation
- Surgery
- Head injury
- TB
- Sarcoidosis
Describe why ovulation usually returns with weight/fat gain (in a previously low BMI individual)
Increased leptin and decreased NPY activity – and resumption of pulsatile GnRH secretion
5 physiological causes of hyperprolactinemia
- Pregnancy
- Lactation
- Non-REM sleep
- Stress
- Nipple stimulation
6 pharmacological causes of hyperprolactinemia
- Dopamine receptor antagonists (i.e. phenothiazine, haloperidol)
- Dopamine depletors (i.e. methyldopa)
- Cocaine
- Verapamil
- Opiates
- Clomipramine
3 pathological causes of hyperprolactinemia
- Stalk effect
- Prolactinomas
- Other pituitary tumors (i.e. increased PRL in 30% acromegaly cases)
Example of stalk effect
Tumor compressing/damaging stalk, stopping dopamine to anterior pituitary
2 treatments for hyperprolactinoma
- Dopamine agonists (i.e. bromocriptine, carbegoline)
- Transspenoidal hypophysecomy/pituitary radiotherapy
Dopamine agonist to treat hyperprolactinoma that is better tolerated
Carbegoline (bromocriptine can cause headache, naudea, and postural hypotension)
3 treatments for ovarian failure
- Oocyte donation
- HRT
- Oral contraceptive pill
Physical elements to monitor in ovulation induction
- Change in basal body temp
- Change in cervical mucus
3 endocrinological elements to monitor in ovulation induction
- Mid-luteal progesterone (>30 nmol/L)
- Urinary analysis of LH
- Estradiol blood levels
Size of follicular maturity
18 - 23 mm
