female ovulatory disorders and infertility

Question 1

what signifies ovarian failure

Answer 1

high LH and FSH, low oestrogen, amenorrhea

Question 2

what defines infertility

Answer 2

absence of pregnancy after trying for 12 months in a couple who have never conceived

Question 3

what is primary vs secondary infertility

Answer 3

primary = never conceived, secondary = miscarried

Question 4

what is the most common form of primary (hypergonadotrophic) hypogonadism

Answer 4

premature ovarian failure

Question 5

what is premature ovarian failure

Answer 5

menopause before 40

Question 6

what can cause premature ovarian failure

Answer 6

idiopathic, genetic (turners, fragile X), chemo, radio

Question 7

what are symptoms of premature ovarian failure

Answer 7

hot flushes, night sweats, atrophic vaginitis, decreased periods, vaginal dryness, headaches

Question 8

how do you diagnose premature ovarian failure

Answer 8

high FSH/ LH + low oestrogen, progesterone challenge test, USS for follicular growth

Question 9

how do you treat premature ovarian failure

Answer 9

HRT and egg/ embryo donation

Question 10

what is secondary hypogonadism

Answer 10

problem from pituitary/ hypothalamus

Question 11

name some common secondary hypogonadism causes in woman

Answer 11

PCOS (most common), anorexia, overeating

Question 12

what are symptoms of PCOS

Answer 12

obesity, hirsutism (androgens), acne (testosterone), oligomenorrhoea/ amenorrhea, diabetes

Question 13

what hormone abnormalities are found in PCOS

Answer 13

high androgens, high LH< impaired glucose tolerance (T2DM)

Question 14

how do you diagnose PCOS

Answer 14

need 2/3: chronic anovulation, polycystic ovaries on scans, hyperandrogegism (testosterone)

Question 15

what treatment can be given to manage PCOS (6)

Answer 15

weight loss, stop smoking/ alcohol, folic acid, rubella vaccine, metformin (if needed)

Question 16

what is given to induce ovulation in ovulation disorders

Answer 16

clomiphene citrate/ LH+FSH daily injections/ laparoscopic ovarian diathermy

Question 17

what are risks associated with ovulation induction

Answer 17

hyperstimulation, multiple pregnancy (hyperemesis, hypertension, miscarriage, twin transfusion syndrome)

Question 18

what is twin transfusion syndrome

Answer 18

unbalanced communications with twins and placenta: recipient twin has poyhydramnios and pressure on heart. donor twin doesn’t have enough blood for growth

Question 19

how do you treat twin transfusion syndrome surgically

Answer 19

laser division of placenta, amnioreduction, septosomy

Question 20

where is the problem with PCOS

Answer 20

pituitary

Question 21

what are symptoms of hyperprolactinaemia

Answer 21

amenorrhea, galactorrhea, vaginal dryness, visual field disruption

Question 22

how do you diagnose hyperprolactinaemia

Answer 22

normal FSH/ LH, low oestrogen, raised prolactin, MRI of head

Question 23

how do you treat hyperprolactinaemia

Answer 23

dopamine agonist eg cabergoline (Stop in pregnancy)

Question 24

what can cause hypogonadotrophic (secondary) hypogonadism that affects the hypothalamus

Answer 24

stress, anorexia, over-exercise, tumours, Kallman’s, drugs

Question 25

what happens to hormone balance in secondary hypogonadism

Answer 25

low FSH LH and oestrogen

Question 26

what can cause infertility in women (3)

Answer 26

ovulatory disorders (premature ovarian failure/ PCOS), tubal disease and

Question 27

what is tubal disease

Answer 27

damaged/ blocked fallopian tubes

Question 28

what infective causes can cause tubal disease (3)

Answer 28

pelvic inflam (chlamydia, gonorrhoea)/ transperitoneal spread (appendicitis)/ after procedures (coil)

Question 29

what non-infective causes can cause tubal disease

Answer 29

endometriosis, surgical sterilisation, polyps, congenital

Question 30

what is hydropsaplinx from pelvic inflamm disease

Answer 30

fallopian tube becomes blocked and filled with fluid

Question 31

what are symptoms of hydropsaplinx from pelvic inflamm disease

Answer 31

abdo/ pelvic pain, febrile, vaginal discharge, infertility, ectopic pregnancy

Question 32

what is endometriosis

Answer 32

endometrial tissue grows on other tissue eg fallopian tubes/ ovaries and swells when preparing for pregnancy

Question 33

what are symptoms of endometriosis

Answer 33

dysmenorrhoea (v painful periods), mennorhagia, painful daefacation, chronic pain

Question 34

what are fibroids

Answer 34

noncancerous growths in/ around uterus

Question 35

what can cause fibroids

Answer 35

increased oestrogen

Question 36

who typically gets fibroids

Answer 36

black woman 30-50 and overweight

Question 37

what are symptoms of fibroids

Answer 37

heavy/ painful periods, lower abdo pain, increased urination, pain on sex, constipation

Question 38

how do you treat fibroids

Answer 38

mini pill, progesterone only stuff, GnRG analogues