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Block I: Reproduction & Sexuality > Clinical: PCOS and Oligomenorrhea > Flashcards

Clinical: PCOS and Oligomenorrhea Flashcards

1
Q

Treatment for PCOS anovulation

A

Clomiphene (effective ovulation induction agent in 70-80%)

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2
Q

Describe how clomiphene works

A

Anti-estrogen = increase in endogenous FSH –> induces follicular growth and then ovulation

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3
Q

2 adverse effects of clomiphene

A
  • Ovarian cancer risk
  • Risk of multiple pregnancy
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4
Q

3 reasons why Clomiphene-resistant PCOS may occur

A
  • Obesity
  • High insulin resistance
  • High free androgen index
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5
Q

Accepted first-line treatment for clomiphene-resistant PCOS

A

Gonadotropins (injected FSH)

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6
Q

2 risks of injected FSH

A
  • OHSS
  • Multiple pregnancy
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7
Q

3 findings of severe OHSS

A
  • Ascites
  • Pleural effusion
  • Tromboses
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8
Q

2 types of surgical treatments of CC-resistant PCOS

A
  • Wedge resection
  • Laparoscopic techniques
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9
Q

4 laparoscopic techniques to treat CC-resistant PCOS

A
  • Biopsy
  • Cauterization
  • Electrocoagulation
  • Laser
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10
Q

4 problems with surgical treatment for CC-resistant PCOS

A
  • Risks of anaesthesia and laparoscopy
  • Periadnexal adhesion formation
  • Ovarian failure/atrophy
  • Anti-ovarian antibodies
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11
Q

2 insulin sensitizing agents

A
  • Metformin
  • Troglitazone
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12
Q

Describe the function of metformin

A

Dereases peripheral insulin resistance and lowers serum glucose and therefore serum insulin

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13
Q

2 adrenal steroids to treat CC-resistant PCOS

A
  • Cortisone
  • Dexamethasone
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14
Q

5 causes of anovulation

A
  • Pituitary and hypothalamic
  • Weight and exercise-related
  • Systemic
  • Hyperprolactinemia
  • Polycystic ovary syndrome
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15
Q

5 causes of primary amenorrhea

A
  • Primary POF
  • Hypo-hypogonadism
  • PCOS
  • Hyperprolactinemia
  • Weight-related
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16
Q

6 causes of secondary amenorrhea

A
  • PCOS
  • POF
  • Hyperprolactinemia
  • Weight-related
  • Hypo-hypogonadism
  • Exercise-induced
17
Q

4 causes of anovulatory infertility

A
  • PCOS
  • Ovarian failure/POF
  • Hypogonadism
  • Hyperprolactinema
18
Q

Define hypogonadotropic hypogonadism (HH)

A

Generic term to describe various congenital and acquired defects in HPO axis leading to hypo-secretion of FSH and LH from the anterior pituitary

19
Q

Typical values of FSH and LH in hypogonadotropihic hypogonadism

A

FSH < 3 IU/L and LH <1 IU/L

20
Q

6 hypothalamic causes of HH

A
  • Weight loss
  • Intense exercise
  • Genetic (i.e. Kallmann’s)
  • Chronic illness
  • Tumos
  • Irradiation
21
Q

8 pituitary causes of HH

A
  • Hypopituitarism
  • Sheenhan’s
  • Tumors
  • Cranial irradiation
  • Surgery
  • Head injury
  • TB
  • Sarcoidosis
22
Q

Describe why ovulation usually returns with weight/fat gain (in a previously low BMI individual)

A

Increased leptin and decreased NPY activity – and resumption of pulsatile GnRH secretion

23
Q

5 physiological causes of hyperprolactinemia

A
  • Pregnancy
  • Lactation
  • Non-REM sleep
  • Stress
  • Nipple stimulation
24
Q

6 pharmacological causes of hyperprolactinemia

A
  • Dopamine receptor antagonists (i.e. phenothiazine, haloperidol)
  • Dopamine depletors (i.e. methyldopa)
  • Cocaine
  • Verapamil
  • Opiates
  • Clomipramine
25
Q

3 pathological causes of hyperprolactinemia

A
  • Stalk effect
  • Prolactinomas
  • Other pituitary tumors (i.e. increased PRL in 30% acromegaly cases)
26
Q

Example of stalk effect

A

Tumor compressing/damaging stalk, stopping dopamine to anterior pituitary

27
Q

2 treatments for hyperprolactinoma

A
  • Dopamine agonists (i.e. bromocriptine, carbegoline)
  • Transspenoidal hypophysecomy/pituitary radiotherapy
28
Q

Dopamine agonist to treat hyperprolactinoma that is better tolerated

A

Carbegoline (bromocriptine can cause headache, naudea, and postural hypotension)

29
Q

3 treatments for ovarian failure

A
  • Oocyte donation
  • HRT
  • Oral contraceptive pill
30
Q

Physical elements to monitor in ovulation induction

A
  • Change in basal body temp
  • Change in cervical mucus
31
Q

3 endocrinological elements to monitor in ovulation induction

A
  • Mid-luteal progesterone (>30 nmol/L)
  • Urinary analysis of LH
  • Estradiol blood levels
32
Q

Size of follicular maturity

A

18 - 23 mm

Block I: Reproduction & Sexuality (23 decks)

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