Female Genitourinary Physiology

Question 1

Sex determination for the female reproductive system

Answer 1

Functional XX => functional ovaries

Ovaries produce O => Mullerian dev
-fallopian tube
-uterus
-upper 2/3d vagina

No DHT from T conversion => Wolffians lost
-lower 1/3d vagina
-external female genitalia

Question 2

Types of infertility

Investigations

Answer 2

Idiopathic
Anovulation - AIS
Tubal Factors

Assessing for ovarian reserve
-FSH, antral follicle count - affected by cycle
-AMH - unaffected by cycle

Assessing for other reasons
-FSH, LH, PRL, TSH
-rubella, HepBC, HIV immunity test
-cervical, chlamydia swab
-US pelvis

Question 3

PCOS
-risk factors
-presentation
-Ix
-Mx

Answer 3

Risk factors
-FHx
-obesity

Presentation
-hirsutism, acne
-irregular periods

Ix
-T => normal/high
-US => polycystic ovaries
Other investigations to rule out other causes of irregular periods and high T

Mx
-weight loss and managing CV risk
-can consider contraception
-letrozole for infertility

Question 4

POI
-risk factors
-presentation
-Ix
-Mx

Answer 4

Risk factors
-FHx of POI
-AI
-ovarian surgery

Presentation U40
-irregular, heavy periods
-menopausal symptoms
-infertility

Ix
-High FSH, low O

Mx
-HRT - combined continuous
-regular weight bearing exercise to protect joints and bones
-vaginal O/lubricants - vaginal dryness
-clonidine/gabapentin - hot flushes, night sweats
-antidepressants/CBT - depression

Question 5

Menopause
-presentation
-Ix
-Mx

Answer 5

Presentation
-irregular heavy periods
-mood swings, brain fog
-night sweats, disturbed sleep
-palpitations
-headaches, migraines
-muscle, joint pain
-vaginal atrophy, dryness, UTIs
-reduced libido

Ix
-FSH high
-clinical diagnosis

Mx
-HRT - combined continuous
-regular weight bearing exercise to protect joints and bones
-vaginal O/lubricants - vaginal dryness
-clonidine/gabapentin, reduce stress, dress well - hot flushes, night sweats
-antidepressants/CBT - depression

Question 6

Ways of taking HRT

Answer 6

Cyclical - O taken alone => O and P together
-menopausal symptoms but still have periods

Continuous - O and P
-for postmenopausal

Question 7

Pros and cons of HRT

Answer 7

Pros
-controls menopausal symptoms
-maintain bone strength
-reduces CVD risk

Cons
-slight increase in DVT and clot risk
-slight increased breast, endometrial cancer risk