female ovulatory disorders and infertility Flashcards
what signifies ovarian failure
high LH and FSH, low oestrogen, amenorrhea
what defines infertility
absence of pregnancy after trying for 12 months in a couple who have never conceived
what is primary vs secondary infertility
primary = never conceived, secondary = miscarried
what is the most common form of primary (hypergonadotrophic) hypogonadism
premature ovarian failure
what is premature ovarian failure
menopause before 40
what can cause premature ovarian failure
idiopathic, genetic (turners, fragile X), chemo, radio
what are symptoms of premature ovarian failure
hot flushes, night sweats, atrophic vaginitis, decreased periods, vaginal dryness, headaches
how do you diagnose premature ovarian failure
high FSH/ LH + low oestrogen, progesterone challenge test, USS for follicular growth
how do you treat premature ovarian failure
HRT and egg/ embryo donation
what is secondary hypogonadism
problem from pituitary/ hypothalamus
name some common secondary hypogonadism causes in woman
PCOS (most common), anorexia, overeating
what are symptoms of PCOS
obesity, hirsutism (androgens), acne (testosterone), oligomenorrhoea/ amenorrhea, diabetes
what hormone abnormalities are found in PCOS
high androgens, high LH< impaired glucose tolerance (T2DM)
how do you diagnose PCOS
need 2/3: chronic anovulation, polycystic ovaries on scans, hyperandrogegism (testosterone)
what treatment can be given to manage PCOS (6)
weight loss, stop smoking/ alcohol, folic acid, rubella vaccine, metformin (if needed)
what is given to induce ovulation in ovulation disorders
clomiphene citrate/ LH+FSH daily injections/ laparoscopic ovarian diathermy
what are risks associated with ovulation induction
hyperstimulation, multiple pregnancy (hyperemesis, hypertension, miscarriage, twin transfusion syndrome)
what is twin transfusion syndrome
unbalanced communications with twins and placenta: recipient twin has poyhydramnios and pressure on heart. donor twin doesn’t have enough blood for growth
how do you treat twin transfusion syndrome surgically
laser division of placenta, amnioreduction, septosomy
where is the problem with PCOS
pituitary
what are symptoms of hyperprolactinaemia
amenorrhea, galactorrhea, vaginal dryness, visual field disruption
how do you diagnose hyperprolactinaemia
normal FSH/ LH, low oestrogen, raised prolactin, MRI of head
how do you treat hyperprolactinaemia
dopamine agonist eg cabergoline (Stop in pregnancy)
what can cause hypogonadotrophic (secondary) hypogonadism that affects the hypothalamus
stress, anorexia, over-exercise, tumours, Kallman’s, drugs
what happens to hormone balance in secondary hypogonadism
low FSH LH and oestrogen
what can cause infertility in women (3)
ovulatory disorders (premature ovarian failure/ PCOS), tubal disease and
what is tubal disease
damaged/ blocked fallopian tubes
what infective causes can cause tubal disease (3)
pelvic inflam (chlamydia, gonorrhoea)/ transperitoneal spread (appendicitis)/ after procedures (coil)
what non-infective causes can cause tubal disease
endometriosis, surgical sterilisation, polyps, congenital
what is hydropsaplinx from pelvic inflamm disease
fallopian tube becomes blocked and filled with fluid
what are symptoms of hydropsaplinx from pelvic inflamm disease
abdo/ pelvic pain, febrile, vaginal discharge, infertility, ectopic pregnancy
what is endometriosis
endometrial tissue grows on other tissue eg fallopian tubes/ ovaries and swells when preparing for pregnancy
what are symptoms of endometriosis
dysmenorrhoea (v painful periods), mennorhagia, painful daefacation, chronic pain
what are fibroids
noncancerous growths in/ around uterus
what can cause fibroids
increased oestrogen
who typically gets fibroids
black woman 30-50 and overweight
what are symptoms of fibroids
heavy/ painful periods, lower abdo pain, increased urination, pain on sex, constipation
how do you treat fibroids
mini pill, progesterone only stuff, GnRG analogues
