Endocrine Control Female Reproduction 6 Flashcards
Differentiate the endocrine causes of female reproductive dysfunction.
1
Q
What are the major categories of endocrine disorders of the HPG axis?
A
- Disruption of GnRH secretion
- Damage of the pituitary gonadotropes
- Damage to the ovary
- Androgen excess
2
Q
What is the most common cause of androgen excess?
A
-
Polycystic ovary syndrome (PCOS)
- one of the most common endocrine disorders
- affects 5-10% of reproductive-age women worldwide
- originally described as a reproductive disorder
- now recognized as a major metabolic disorder
3
Q
What are the types of menstrual dysfunction?
A
-
“Physiologic”
- pregnancy
- lactation
- menopause
-
Primary amenorrhea
- no menarche by age 15-16 years
- evaluation is appropriate if there are no secondary sex characteristics by age 13
-
Secondary amenorrhea
- arbitrarily defined as no menses for 6 months
- the longer the time period, the lower the rate of undiagnosed pregnancy
-
Oligomenorrhea
- menses every 36 days to 6 months
-
Anovulation
- diagnosed by appropriately-timed serum P level and/or urinary LH measurments
- body temperature increased by ~0.5 degrees F secondary to P
- lack of basal body temperature increase is indicative of anovulation
- amenorrhea and anovulation usually though not necessarily synonymous
- can have cyclic anovulatory menses and, conversely, ovulation without menses
4
Q
What are the principles of evaluation of endocrine disorders of reproduction?
A
- FSH is the most sensitive parameter of ovarian follicular reserve
-
Progestin challenge to assess estrogen secretion
- if there has been stimulation of endometrial growth by estrogen, administration of progestin will usually result in menses
- indirect assessment of residual estrogen production in women with amenorrhea