Dr Clark Gynae Flashcards
what id endometriosis?
ectopic endometrial tissue outside the uterus. commonly in pelvic peritoneum
Causes of endometriosis?
retrograde menstration
what are the pathology od endometriosis?
deposit thickens with hormonal cycle
pain worse pre-menstrual and during period
cause scarring and adhesions
forzen pelvics
chocolate cysts
sympoms of endometriosis?
dysmenorrhoea
dysoareunia
pelvic pain
subfertility
management of endometriosis?
analgesia
prevent hormonal stimulation of ectrpic endometrium
remove endometriosis (lazer, excision)
what are the hotmomal preventions used to treat endometriosis?
COC pill
progesterone only
mirena coil
GnRH agalgogues
Oophorectomy
the effect of prolactin on ouvluation?
prolactin inhibits ovulation
causes of amenorrhoea?
pregnancy
prolactinoma
PCOS
premature ovarian failure
investigations used in amenorrhoea?
pregnanacy test
prolactinoma
LH/FSH;
riaised–> ovarian failure
reduced–>hypothalamic/pituary problem
increased–> PCOS
testerone–> rule our androgen secreting tumour
US
what is subfertility?
failure to conceive after 12 months of regular unprotected intercourse
what is primary subfertility?
someone who has never conceived.
as oppose to secondary where someone has previously conceived
causes of subfertility?
anovulation - 30%
male factor- 25 %
tubal-20 %
25% couple have unexplained subfertility t/f?
t
what is anovulation?
failure of ovulation due to a problem in the hypothalamo-pituary-ovarian (HPO) axis
what problems of the hypothalamic can lead to anovulation?
stress
anorexia
weight loss
what problems of the pitutary can lead to anovulation?
prolactinone pituitary necrosis (sheehan's)
what problems of the ovaries can lead to anovulation?
PCOS
Ovarian failure/tumour
what problems of the tubal can lead to anovulation?
PID (chlamydia)
endometriosis
surgical adhesions
what are the male factors in subfertility?
absent spermatozoa-azoospermia
few spermatozoa-oligospermia
excessive number of abnormal sperm- tetratozoospermia
large number of immotile sperm-asthenozoospermia
investigations into subfertility in female?
laparoscopy and dye
hysterosalpingogram
what sort of assessments to do in HPO axis to assess subfertility?
prolactin
FSH/LH–> low in hypothalamopituitary failure, raised in primary ovarian failure (ovaries don’t work)
oesterogen
testerone
progesterone
The surge triggers the process of ovulation. On the surge day, LH levels should be greater than 20 mIU/ml. Levels of FSH and LH are found to be abnormal in PCOS (ovarian cyst). LH levels higher than FSH levels indicate that the woman has ovarian cyst or polycystic ovarian syndrome (PCOS). Low FSH levels and low LH levels in women indicate secondary ovarian failure due to a pituitary or hypothalamic problem while low FSH serum levels are associated with increased risk of ovarian cancer. High LH levels and high FSH levels are consistent with primary ovarian failure (ovaries themselves fail to work).
treatment for subfertility?
*********lifestyle:****** weight loss(if overweight)
smoking cessation/reduce caffine intake/ reduce alchole intake
intercourse aim for 2-3 times a week
treatment for anovulation?
clomifene
gonoadotropines (FHS/LH)
GnRH
treatment for premature ovarian failure?
egg donation or IVF
treatment for tubal damage?
tubal surgery or IVF
treatment for male factor in subfertility?
assisted reproduction
intrauterine insemination
intracytoplasmic sperm injection
