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Module 203 Theme 2 > disorders of ovulaton > Flashcards

disorders of ovulaton Flashcards

1
Q

What is Kisspeptin

A

A GnRH secretagogue, at the apex of the reproductive axis in the hypothalamus.

highly responsive to oestrogen

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2
Q

What are some tests to diagnose ovulation

A

Day 21 progesterone blood test
LH detection kits: urinary kits, over counter
Transvaginal pelvic ultrasound is done from day 10, alternate days to show the developing follicle size.

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3
Q

What is Amenorrhoea

A

Lack of period for more than 6 months
primary- never had a period (no menarche)
secondary- has menstruated before

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4
Q

What is oligomenorrhoea

A
  • irregular periods

- usually 6 weeks apart

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5
Q

What is polymenorrhoea

A

Periods occurring less than 3 weeks apart

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6
Q

What are hypothalamic causes of ovulation problems

A

GnRH deficiency (Kallmann’s syndrome)

‘Functional’ hypothalamic amenorrhoea

  • weight loss/ stress-related
  • anorexia nervosa/ bulimia
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7
Q

What are some pituitary causes of ovulation problems

A

lack of FSH and LH

  • pituitary tumours
  • post pituitary surgery/ radiotherapy
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8
Q

What are some ovarian causes of ovulation problems

A

Premature ovarian insufficiency

  • chromosomal e.g. turners syndrome
  • autoimmune
  • latrogenic ( post-surgery/ chemotherapy)

hyperandrogenism

  • POCS
  • congenital adrenal hyperplasia
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9
Q

What is Hirsutism

A

Androgen-dependant hirsutism is excess body hair in a male distribution

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10
Q

What are the commonest causes of hirsutism

A

PCOS or idiopathic

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11
Q

When should you worry about Hirsutism

A

Sudden onset of severe symptoms
Virilization: Frontal balding, deepening of voice, male-type muscle mass and clitoromegaly
-possible Cushing’s syndrome

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12
Q

What are the clinical features of PCOS

A

Hyperandrogenism
-hirsutism, acne

chronic oligomenorrhoea/ amenorrhoea

  • less than 9 or 9 periods per year
  • subfertility

obesity (but 25% of women with PCOS are “lean”)

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13
Q

What are the hormonal abnormalities in PCOS

A

Raised baseline LH and normal FSH levels, 3:1
raised androgens and free testosterone
reduced sex hormone-binding globulin (SHBG)
Oestrogen usually normal

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14
Q

What is SHBG

A

Sex Hormone Binding Globulin
produced by the liver
binds testosterone and oestradiol
SHBG increased by oestrogens and decreased by testosterone.

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15
Q

What are the reproductive effects of PCOS

A

15% of all causes of infertility is due to a lack of ovulation and 80% of lack of ovulation is due to PCOS

there is an increase in miscarriages and gestational diabetes

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16
Q

How do PCOS and endometrial cancer link

A

in PCOS Irregular periods and high oestrogen levels can lead to endometrial hyperplasia which is a risk factor for endometrial cancer (also type 2 diabetes and obesity)

17
Q

What lifestyle modifications are important for PCOS

A

Diet and exercise, and stop smoking. results in:

  • decreased insulin resistance
  • increased SHBG
  • decreased free testo
  • improved fertility and better metabolic syndrome factors
18
Q

What is another form of treatment for PCOS

A

Combined oral contraceptives

  • increases SHBG and thus decreases free testosterone
  • decreases LH and FSH, therefore ovarian stim regulates the cycle and decreases endometrial hyperplasia.

may cause weight gain, venous thrombosis, adverse effects on metabolic risk factors.

19
Q

What are some examples of anti-androgens and why are they used

A 
Cyproterone acetate (oral tablet)
spironolactone (anti-mineralocorticoid and anti-androgen properties)

They can be used with COCP’s if COCP has been insufficient but must be taken with secure contraception because they have a teratogenic effect.

20
Q

How does metformin work and why would it be used for PCOS

A

decreases insulin resistance, insulin levels and ovarian androgen production

may help with weight loss and diabetic prevention, used because it helps increase ovulation, (with clomifene) safe in pregnancy

less helpful for hirsutism and oligomenorrhoea

21
Q

How does primary ovarian insufficiency or premature menopause present

A

presents as primary or secondary amenorrhoea

22
Q

What is the aetiology for primary ovarian insufficiency

A

Autoimmunity: may be associated with other autoimmune endocrine conditions

X chromosomal abnormalities
e.g. Turners syndrome and fragile X syndrome

iatrogenic e.g. surgery, radio or chemo

23
Q

What are the investigations for primary ovarian insufficiency

A

Herstory/exam
look for an increase in LH/ FSH levels
consider pelvic USS
consider screening for autoimmune endocrine disease (ThyroidFT, glucose and cortisol)

24
Q

How is primary ovarian insufficiency managed

A

Psychological support
HRT (hormone replacement therapy)
Monitor bone density via DEXA scan
fertility- IVF with donor egg.

25
Q

What is turners syndrome and how does it present

A

Complete or partial X monosomy in some/ all cells

  • 50% of cases will have just 1 X chromosome
  • rest: partial absence of X

presentation: may be diagnosed in the neonate, may present with short stature in childhood
primary or secondary amenorrhoea.

26
Q

What are associated problems with turners syndrome

A
  • short stature, consider GH treatment
  • CV system, coarctation of the aorta, bicuspid aortic valve, hypertension (adults)
  • Renal (congenital abnormalities)
  • Metabolic syndrome
  • hypothyroidism
  • ears/ hearing problems
  • osteoporosis (lack of HRT)
27
Q

What are some features of congenital adrenal hyperplasia (CAH)

A
  • cortisol deficiency
  • may have aldosterone deficiency
  • androgen excess
  • depends on the degree of enzyme deficiency
28
Q

How does CAH present in childhood

A

salt wasting: hypovolaemia, shock

virilisation: ambiguous genitalia in girls and early virilisation in boys
- precocious puberty
- abnormal growth

29
Q

How does CAH present in adulthood

A
  • hirsutism
  • oligo/ amenorrhoea
  • acne
  • subfertility
  • similar to PCOS presentation
30
Q

What are some treatments for CAH

A

Gluco/ mineralocorticoid replacement (hydrocortisone and fludrocortisone
excess glucocorticoids may inhibit growth
surgical management for ambiguous genitalia

Module 203 Theme 2 (14 decks)

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