Disorder of Female Reproductive Tract Flashcards by Daniëll de Bruyn

What is the function of FSH

Act on granulosa cells to stimulate growth of follicles

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What is the function of LH

Act on theca cells that turns follicle into corpus luteum by triggering ovulation

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What does granulosa cells secretion for negative feedback & where does it act

Inhibin on pituitary

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What does theca cells secretion for negative feedback & where does it act

Progesterone on the pituitary & hypothalamus

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What is the appearance of the HPG axis during pre-puberty

Highly sensitive to - feedback by gonadal steroids & low levels of gonadal steroids & gonadotropins

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What is the appearance of the HPG axis during puberty

Increased GnRH pulsatility & ovarian estradiol secretion

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What is the function of estradiol

Linear growth & breast development called thelarche

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What is adenarche

Onset of adrenal androgen secretion that stimulate axillary & pubic hair growth

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What is menarche

Initiation of menses 2-3 years after onset of puberty

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What is menopause

Permanent cessation of menstruation from physiological loss of ovarian function due to follicle number decreased & menopause few or none left

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After what periods is it classified as menopause

12 consecutive months of amenorrhea

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What occur during peri-menopause

FSH rises 1-2 year before menopause trying to stimulate follicles growth
LH & estrogen remain unchanged

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What occur during post-menopause

FSH & LH increase significantly
Estrogen decrease increasing risk of coronary heart disease & osteoporosis

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What is the 2 cycles happening at the same time

Ovaries cycle with follicular & luteal
Endometrium with proliferation & secretion

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When does the follicular phase occur

10-16 days (change)

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What is the main hormone during follicular phase for the endometrium

Estrogen

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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

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What occur during mid cycle of menstrual cycle

Estrogen negative feedback switch to positive feedback & increase gonadotropin sensitivity to GnRH

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What 3 things are the LH surge responsible for during mid cycle

Completion of meiosis I
Forceful follicular wall rupture
Ovulation

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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

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When does the luteal phase occur

14 days exactly

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What is the main hormone during luteal phase

Progesterone & highest at day 21

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What happens during luteal phase

Corpus luteum formation
Continue prepare of uterus for implantation by increase blood supply & glands secretion

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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)