Disorder of Female Reproductive Tract Flashcards
What is the function of FSH
Act on granulosa cells to stimulate growth of follicles
What is the function of LH
Act on theca cells that turns follicle into corpus luteum by triggering ovulation
What does granulosa cells secretion for negative feedback & where does it act
Inhibin on pituitary
What does theca cells secretion for negative feedback & where does it act
Progesterone on the pituitary & hypothalamus
What is the appearance of the HPG axis during pre-puberty
Highly sensitive to - feedback by gonadal steroids & low levels of gonadal steroids & gonadotropins
What is the appearance of the HPG axis during puberty
Increased GnRH pulsatility & ovarian estradiol secretion
What is the function of estradiol
Linear growth & breast development called thelarche
What is adenarche
Onset of adrenal androgen secretion that stimulate axillary & pubic hair growth
What is menarche
Initiation of menses 2-3 years after onset of puberty
What is menopause
Permanent cessation of menstruation from physiological loss of ovarian function due to follicle number decreased & menopause few or none left
After what periods is it classified as menopause
12 consecutive months of amenorrhea
What occur during peri-menopause
FSH rises 1-2 year before menopause trying to stimulate follicles growth
LH & estrogen remain unchanged
What occur during post-menopause
FSH & LH increase significantly
Estrogen decrease increasing risk of coronary heart disease & osteoporosis
What is the 2 cycles happening at the same time
Ovaries cycle with follicular & luteal
Endometrium with proliferation & secretion
When does the follicular phase occur
10-16 days (change)
What is the main hormone during follicular phase for the endometrium
Estrogen
What is the HPO axis during follicular phase
GnRH
LH stimulate FSH release & theca cell releasing androgens & aromatase convert to estrogen
FSH act on granulosa cells to release inhibin & estrogen for negative feedback
What occur during mid cycle of menstrual cycle
Estrogen negative feedback switch to positive feedback & increase gonadotropin sensitivity to GnRH
What 3 things are the LH surge responsible for during mid cycle
Completion of meiosis I
Forceful follicular wall rupture
Ovulation
What is the HPO axis during mid cycle
GnRH
LH stimulate granulosa cells to release progesterone & theca cell releasing androgens & aromatase convert to estrogen with + feedback on pituitary & hypothalamus
When does the luteal phase occur
14 days exactly
What is the main hormone during luteal phase
Progesterone & highest at day 21
What happens during luteal phase
Corpus luteum formation
Continue prepare of uterus for implantation by increase blood supply & glands secretion
What is the HPO axis during luteal phase
GnRH
LH acting on the corpus luteum to secrete inhibin for negative feedback, increased progesterone secretion & estrogen secretion
All promoting uterus growth
What is the principle ovarian hormone
Oestradiol
What is another form of estrogen in small amount
Estrone formed by androstenedione conversion in ovaries
What is 2 other sources other than the ovaries that secrete estrogen
Corpus luteum
Placenta
What is the concentration of estrogen throughout lifespan
Low before puberty
Cyclical changes
Low concentration during menopause
Is estrogen mostly bound or free
Mostly bound to SHBG or albumin
2-3% free & biologically active
What is the 5 functions of estrogen
Stimulate muscle & bone growth
Maintain secondary sex characteristics
Affects CNS by increasing sex drive
Initiate repair & growth of endometrium
Stimulate synthesis of SHBG
What are the 3 sources of progesterone
Intermediate in steroid biosynthesis
Corpus luteum
Placenta
What is the cyclical changes of progesterone
Rise in send half of menstrual cycle & fall if no conception
Is progesterone mostly bound or transported
1-2% free
Extensively bound to albumin & transcortin
What is the 5 functions of progesterone
Promote secretion & prepare endometrium for implantation
Maintain early pregnancy
Pyrogenic at ovulation
Thickening of cervical mucous
Decrease contractions
What is the source of androgens
Ovaries produce even after menopause
To what is androgen bound to
SHBG that has higher affinity for testosterone than esotrgen
What 3 things occurs with excess androgens
Hirsutism
Loss of female characteristics
Masculinization or virilisation
What is the 2 functions of androgens in females
Muscle growth
Pubic & axillary hair growth
What 4 things increases SHBG
Oestrogen (stimulate synthesis)
Hyperthyroidism (stimulate synthesis)
Liver cirrhosis (increase estrogen)
Anorexia
What decreases SHBG
Androgen (inhibit synthesis)
Hypothyroidism (inhibit synthesis)
Glucocorticoid (increase insulin resistance)
Obesity
What is early puberty called
Precocious
What is early menopause called
Primary ovarian insufficiency
What is secondary puberty called
Delayed puberty
What is amenorrhea
Absence of menstruation for 3 months
What is oligomenorrhea
Infrequent or irregular menstrual bleeding or long menstrual cycles of 35-40 days
What is the 2 types of amenorrhea
Primary: failure to reach menarche by 15 w/ normal growth & secondary sex characteristics
Secondary: cessation of regular menses for more than 3 months or irregular menses for 6 months
What is the 2 types of primary amenorrhea causes
1. Ovarian disorders:
Gonadal dysgenesis (Turner syndrome)
Premature ovarian failure (idiopathic, autoimmune, viral, chemotherapy or radiation)
2. Outflow tract/uterus disorders:
Müllerian duct anomalies
Androgen insensitivity syndrome
Asherman’s syndrome
What is the effect of primary amenorrhea causes
Decrease estrogen but increased FSH & LH
What is the effect of secondary amenorrhea causes
Decrease estrogen, LH & FSH
What is the 2 types of secondary amenorrhea causes
1. Hypothalamic disorders:
Kallmann’s syndrome
Hypothalamic infiltration
Weight loss, stress or exercise
2. Pituitary disorders:
Prolactin secreting tumour
Granulomatous infiltration
Sheehan’s syndrome
What is PCOS
Excess androgen production & LH prevent LH surge that allows for ovulation & remain as a cyst
What is 5 features of PCOS
Menstrual irregularities & infertility
Hyperandrogenism feature like hirsutism, acne & male pattern balding
Central obesity
Insulin resistance
Multiple ovarian follicles due to failure of development of dominant follicle
How does the presence of androgen features occur
Excess androgen & insulin production suppress SHBG synthesis & more free testosterone
What is the biochemical pattern of PCOS
Oestradiol & FSH is normal
LH is high
What is used for biochemical testing of PCOS
Free androgen index = total testosterone / SHBG
What is hirsutism
Male pattern of hair growth
What is 5 causes of hirsutism
Ovarian (PCOS or tumor)
Adrenal (congenital adrenal hyperplasia or tumour)
Cushing syndrome
Idiopathic
Drugs
What is 4 concerning feature of hirsutism
Virilisation
Serum testosterone >5.2
Rapid onset
Palpable abdominal mass
What is 5 laboratory testing of hirsutism
SHBG
S-testosterone
DHEA-S (concerned about tumor)
17-OH progesterone (exclude late onset CAH)
Cortisol (Cushing)
