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203 Theme 2 > Disorders of ovulation > Flashcards

Disorders of ovulation Flashcards

1
Q

Causes of Ovulation problems

A

3 places

hypothalamus
pituitary
ovaries (PCOS)

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2
Q

Problems in the hypothalamus that causes ovulation problems

A

Kiss1 gene deficiency- rare
GnRH gene deficiency - rare
weight loss/stress related/excessive exercise
anorexia/bulimia

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3
Q

Problems in the pituitary that causes ovulation problems

A 
pituitary tumours (prolactinoma/other tumours)
post pituitary surgery /radiotherapy
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4
Q

Problems in the ovaries that causes ovulation problems

A

Premature ovarian insufficiency
Developmental or genetic causes eg Turner’s syndrome
Autoimmune damage and destruction of ovaries
Cytotoxic and radiotherapy
Surgery

Polycystic Ovarian Syndrome: commonest cause

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5
Q

Oligomenorrhoea

A

irregular periods

usually occurring more than 6 weeks apart

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6
Q

Polymenorrhoea

A

periods occurring less than 3 weeks apart

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7
Q

Amenorrhoea

A

lack of a period for more than 6 months

Primary Amenorrhoea - never had a period (never went through menarche)
Secondary Amenorrhoea -has menstruated before

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8
Q

HIRSUTISM

A

Excess body hair in a male distribution

Androgen-dependent

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9
Q

PCOS

USS appearance

A

> /= 10 subcapsular follicules 2-8 mm in diameter,
arranged around a thickened ovarian stroma
not all women with PCOS will have USS appearance

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10
Q

Hormonal abnormalities in PCOS

A

Raised baseline LH and normal FSH levels. Ratio LH:FSH 3:1
Raised androgens and free testosterone
Reduced Sex Hormone Binding Globin (SHBG)
Oestrogen usually low but can be normal

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11
Q

Hormone Binding Globulin

A
  • Produced by the liver
  • Binds testosterone and oestradiol
  • If testosterone bound - not converted to active component dihydrotestosterone ie not “free”
  • SHBG increased by oestrogens
  • SHBG decreased by testosterone thus releasing more free testosterone
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12
Q

Reproductive Effects of PCOS

A
  • PCOS is maybe associated with varying degrees of infertility
  • 15% of all causes of infertility is lack of ovulation
  • 80% of lack of ovulation due to PCOS
  • Associated with increased miscarriages
  • Increased risk of Gestational Diabetes
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13
Q

PCOS and Endometrial Cancer

A

Increased endometrial hyperplasia and cancer
Lack of progesterone on the endometrium
Endometrial cancer associated with type 2 diabetes & obesity

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14
Q

First line treatment

A

COOC

increases SHBG and thus decreases free testosterone
decreases FSH & LH and therefore ovarian stimulation
regulates cycle & decreases endometrial hyperplasia
BUT may cause weight gain, venous thrombosis, adverse effects on metabolic risk factors

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15
Q

Other treatments of PCOS

Spironolactone (oral tablet)

A

anti mineralocorticoid and anti androgen properties

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16
Q

Other treatments of PCOS

Cyproterone Acetate (oral tablet)

A

inhibits binding of testosterone & 5 alpha dihydrotestosterone to androgen receptors

17
Q

FIRST LINE to increase ovulation in PCOS

A

clomifene AND cooc

safe in pregnancy
increases frequency of ovulation

18
Q

Targeting insulin resistance in PCOS

SECOND LINE

19
Q

PRIMARY OVARIAN INSUFFICIENCY

-presentation

A 
Primary or secondary amenorrhoea
Secondary amenorrhoea may be associated with hot flushes & sweats
Other terms used:
Premature ovarian failure
Premature menopause
20
Q

PRIMARY OVARIAN INSUFFICIENCY

-Aetiology

A

Autoimmunity

  • May be associated with other autoimmune endocrine conditions
  • X chromosomal abnormalities
  • Turner syndrome
  • Fragile X associated
  • Genetic predisposition
  • Premature menopause
  • Iatrogenic
  • Surgery, radiotherapy or chemotherapy
21
Q

REMATURE OVARIAN FAILURE

A

before the age of 40

22
Q

TURNER SYNDROME

-presentation

A

X linked

  • May be diagnosed in the neonate
  • May present with short stature in childhood
  • May present with primary / secondary amenorrhoea
23
Q

TURNER SYNDROME

-associated problems

A 
Short stature 
Consider GH treatment
CV system
Coarctation of aorta
Bicuspid aortic valve
Aortic dissection
Hypertension (adults)
Renal
Congenital abnormalities
Metabolic syndrome
Hypothyroidism
Ears / hearing problems
Osteoporosis (lack HRT)
24
Q

CONGENITAL ADRENAL HYPERPLASIA (CAH)

A
  • autosomal recessive
  • different mutation on 2 alleles
  • 95% CAH cases caused by 21-hydroxylase deficiency (earlier presentation)
25
Q

21-hydroxylase deficiency

A

Defect in cortisol biosynthesis  raised CRH / ACTH (lack of negative feedback)  drives excess adrenal androgen production

26
Q

2 stimulators of GnRH.

What are they stimulated by?

A

Kisspeptin
KNDy neurones

They are stimulated by high oestrogen and they drive LH production through stimulation of GnRH

27
Q

A rise in oestrogen …. FSH?

increases/supresses

203 Theme 2 (22 decks)

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