Endocrine Regulation of Female Infertility

Question 1

In primary amenorrhoea the patient will never have had a period. T/F?

Answer 1

True

Question 2

What are the possible causes of primary amenorrhoea?

Answer 2

Genitourinary abnormalities e.g. congenital absence of the uterus, cervix or vagina due to Rokitansky syndrome or androgen insensitivity syndrome
Chromosomal abnormalities (turner’s)
Secondary hypogonadism - Kallmann syndrome, pituitary disease, hypothalamic amenorrhoea

Question 3

How is secondary amenorrhoea defined?

Answer 3

No periods for 6 months

Question 4

Give examples of causes of secondary amenorrhoea?

Answer 4

Uterine - washerman’s syndrome
Ovarian - PCOS, prematur ovarian failure
Pituitary - prolactinoma, pituitary tumour
Hypothalamic - weight loss, stress, drugs (e.g. opiates)

Question 5

What are the physiological causes of amenorrhoea?

Answer 5

Pregnancy

Lactation

Question 6

What are the iatrogenic causes of amenorrhoea?

Answer 6

Oral contraceptive pill

Other hormonal contraceptives

Question 7

What are the endocrine causes of amenorrhoea?

Answer 7

Thyroid dysfunction

Hyperandrogenism (Cushing’s. syndrome, congenital adrenal hyperplasia, adrenal/ovarian tumour)

Question 8

Define hirsutism

Answer 8

Excess hair growth in a male pattern due to increased androgens and increased skin sensitivity to androgens

Question 9

What are the possible causes of hirsutism?

Answer 9

PCOS
androgen secreting ovarian/adrenal tumour
Congenital adrenal hypertrophy
Idiopathic

Question 10

What are the symptoms of polycystic ovarian syndrome?

Answer 10

Amenorrhoea / oligomenorrhoea / irregular cycles
Hirsutism
Acne
Alopecia

Question 11

At what stage of development does polycystic ovarian syndrome typically present?

Answer 11

During adolescence

Question 12

What is the most common cause of anovulatory infertility?

Answer 12

Polycystic ovarian syndrome

Question 13

What are the typical endocrine/biochemical features of polycystic ovarian syndrome?

Answer 13

Raised testosterone and LH

Low constant levels of FSH

Question 14

What metabolic condition is polycystic ovarian syndrome associated with?

Answer 14

T2DM

Question 15

Describe the pathogenesis of polycystic ovarian syndrome?

Answer 15

Increased LH concentration and increased LH receptors leading to support of ovarian theca cells to increase production of ovarian androgens.
Low constant levels of FSH result in continuous stimulation of the follicles without ovulation and decreased conversion of androgens to oestrogen in the granulosa cells.

Question 16

In particular, which ovarian androgen, increases in polycystic ovarian syndrome?

Answer 16

Androstenedione

Question 17

There is reduced insulin sensitivity in women with polycystic ovarian syndrome. How does this act to propagate the pathogenesis of the condition?

Answer 17

Insulin resistance leads to hyperinsulinaemia and insulin then stimulates the theca cells of the ovaries and reduces hepatic production fo SHBG

Question 18

Overweight or obese women with polycystic ovarian syndrome are more symptomatic. T/F?

Answer 18

True

Question 19

How is polycystic ovarian syndrome investigated?

Answer 19

Blood tests to determine levels of testosterone, androstenedione, DHEAs, SHBG, FSH and LH.
Blood tests for features of T2DM and abnormal lipids

Question 20

How is PCOS treated?

Answer 20

Encouraging weight loss
Insulin sensitising agents (metformin)
COCP to suppress ovarian andrigens
Corticosterois to suppress adrenal androgens
Spironolactone / cyproterone acetate to antagonise androgen receptors
Finasteride to inhibit 5 alpha reductase
Elfornithine to act as a topical inhibitor

Question 21

What is the rationale behind using metformin to treat PCOS?

Answer 21

Improves insulin sensitivity
Decreases LH levels
Increases. SHBG

Question 22

Metformin is effective in treating infertility in PCOS. T/F?

Answer 22

False