Disorders of ovulation and disturbances of the menstrual cycle

Question 1

menstrual cycle split into

Answer 1

ovarian cycle - development of follicle and ovulation

uterine cycle

Question 2

2 weeks leading up to ovulation is Called

Answer 2

follicular phase - menstrual and rpoliferative phase

Question 3

follicular phase starts on first day of menstruation
GnRH secreted to cause pituitary to release FSH or LH
afte rpibertu GnRH is released in pulses sometimes more sometimes less
follicles have what cells

Answer 3

theca cells

granulose cells on primary oocyte

Question 4

theca cells bind to LH in first 10 days and release

Answer 4

androstenedione

grnaulsoe cells do same converting armomatsase

this converted androstenedione converts into oestrogen by this which increase follicle growth - causing less FSH to be produced via negative feedback so only one follicle with develop

dominant follicule releases oestrogen more - now becomes positive feedback so more FSH and LH released - this happens a couple days before ovulation and rupture of follicle

Question 5

proliferative phase - oestrogen levels rise causing

Answer 5

thickening of endometrium
growth of endometrial glands
emergence of spiral arteries
cervical mucus more hospital too

Question 6

following ovulation remembrance of follicle becomes

Answer 6

corpus luteum

low lH causes grnaulosa cells secrete P450 to make pregnelone which makes more progesterone so more of this is made during this phase , oestrogen decreases
inhibit as well

Question 7

progesterone spiral arteries grow longer and uterine glands secrete more mucus
after 15 days window for fertilisation loses
CL degenerates to corpus albicans docent make hormones.

cervicla mucus thickens - progesterone

corpus albican

Answer 7

all hormones decline

Question 8

Lh receptors on

Answer 8

theca cells

cholesterol to progesterone to androgens then need aromatase to make oestrogen wihcih comes from the granulosa cells

Question 9

FSH receptors on granulosa cells

Answer 9

true

Question 10

ovulation breaks the basement membrane so grnaulsoa cells can take in cholesterol to make progesterone but they can’t turn that into androgens but make progesterone which goes into the blood but less oestrogen made

Answer 10

grnaulosa cells responsible for making oestrogen in proliferative phase

Question 11

what is ovarian steroidogenesis

Answer 11

Ovarian steroidogenesis is the process through which ovarian cells produce hormones for the maintenance of reproductive tissues, regulation of ovarian function and ovulation, and establishment of pregnancy

Question 12

hirsutism

Answer 12

excess hair growth in adorn dependent areas in women for example face, chest, abdomen, lower back and upper arms and thighs

Question 13

virilization

Answer 13

deep voice, reduced breast size, increased muscle bulk and clitorial hypertrophy

Question 14

commonest causes of secondary amenorrhea

Answer 14

ovaries - PCOS, POF/POI
uterus - adhesions
hypothalamus and pituitary - functional hyperprolactinaemia
sheehans syndrome
cushions
other is hyperthyroid , congenital adrenal hyperplasia and ovarian tumours

Question 15

how do you diagnose PCOS

Answer 15

Rotterdam criteria
2 out of 3

oligomenorrhoea or amenorrhea
hyperandrogism - are clinical effects of that
cystic ovaries on USS - at least 20 - string or pearl on US

Question 16

24yr women. 5 COCp stopped to have children still not pregnant. Cycles long and variable. Overweight, waxes her chin and has acne what is going on

she has oligomenorrhoea how many periods has she had in last month

preg negative and elevated free androgen index and high LH with normal FSH what additional result would you like to see

TSH and prolactin normal - does she have PCOS by Rotterdam criteria

Answer 16

6

TSH and prolactin ( can disturb these levels)
LH - increase theca cells

yes

Question 17

PCOS tends to emerge after puberty and the young you are more likely , likely to have androgen problem and leading cause of infertility. what are the treatments

Answer 17

weight loss, lifestyle
contraceptive pill

clomifenen
metformin

Question 18

Case 2
17yr , period at 13 and been erratic since
icnrease body hair on face abdomen and chest. Acne , BMI 27 Breast tanner 4 and pubic tanner 5
increased deltoids and hirsutism

(pregame test biochemistry) what Ix first

FSh and LH and oesotrgne normal , testosterone is way above limit
17alpha hydroxylase is high - ( if this docent work then you get more aldosterone and cortisol made) - steroid formation - what test now needs to be done

which enzyme is the girl low in to cause this

this is non-classical congenital adrenal hyperplasia

Answer 18

biochemistry

ACTH stimualtion test (short synacthen test)

21-hydroxylase - therefore less aldosterone and cortisol not made so more testosterone

Question 19

COH is autosomal recessive - oligomenorrhoea, fertility problems, hyperandrogegism , enzyme deficiency causes excess of androgens and deficit of corticoids and more easily recognised in females due to abnormal hair. signs start during puberty

treamtent

Answer 19

steroids - as they are deficient

classical - is mild version and result in absent corticoids and early onset leading to adrenal crisis.

Question 20

case 3 - 29yr woman , periods stoped 5 months , very slim , no signs of hyperandrogneism

FSH LH and oestrogen low to normal what additional test do you want

what is shown

Answer 20

TSH, prolactin and coeliac screen

osteopenia

Question 21

case 4- inability to conceive for about 1.5years
very tired and constipated
low BP

blood test results - hb is normal and ferritin , blood glucose normal , normal coeliac screen and normal EBV screen
creatinine normal
TSH is high and freeT4 is low she has milky discharge from the nipples over the past few months. what do you want to check

Answer 21

prolactin levels and thyroid peroxidase levels high too - diagnosed as Hashimotos thyroidisitis and treat with L-thyroixin

hypothyroidism adn hyperprolactinoma

TRH secretion is increased by hypothalamus due to feedback mechanism in hypothyroidism, this increased TRH affects prolactin and TSH levels by increasing their secretion from the thyroid gland

Question 22

primary amenorrhea

Answer 22

no menarche by 15 years old

Question 23

secondary amenorrhea

Answer 23

absence of menses for over 3 months of woman previously having them

Question 24

oligomenorrhoea

Answer 24

ireggualr menses fewer than 6-8 periods a year

Question 25

commonest cause of secondary amenorrhea

Answer 25

PCOS 
POI
adnehsion 
hyperporlactinaemia 
sheehans syndromen 
cushions 
congenial adernal hyperplasia

Question 26

roterdarm criteria need 2 out of 3 for PCOS

Answer 26

oligo or amenorrhea
hyperadnrogensism - clinical or biochemistry
cystic ovaries in USS

Question 27

in addition to LH and FSH what tests shield you check

Answer 27

TFT and prolactin

Question 28

human steriodegnenesis showing the reactions

what does a deficiency in 21-hydroxylase cause

Answer 28

less aldosterone and cortisol made but more oestorne and testosterone

leading to irregular menstruation, decreased fertility, baldness, hirustims