Female Repro Questions

Question 1

Hypothalamic amenorrhea

Answer 1

• 17 year old girl, really active and losing weight
• absence of pulsatile GnRH secretion
• GnRH stimulates FSH and LH secretion in utero and during the first 18 months post partum
• after puberty, hypothalamic GnRH secretion can be diminished by significant weight loss, exercise or stress
• cease menstruation
• injection of GnRH stimulates the release of both FSH and LH

Question 2

Polysystic ovary syndrome

Answer 2

• irregular menstrual periods
• dark coarse hair growing on face, upper arms, chest and abdomen
• persistent ache
• difficulty getting pregnant
• numerous follicle begin the maturation process and no follicle emerges as the dominant follicle -> no ovulation
• reduced estrogen production by granulosa cells
• reduced progesterone production by granulosa + thecal cells
• continued production of androgen by thecal cells
• Treat with combination birth control pills, fertilitiy with clomiphere to restore ovulation, 5 alpha reductase inhibitors to block conversion of testosterone to DHT
• weight loss- they frequently have polycystic ovary syndrome frequently have decreased insulin sensitivity and increased insulin production, as is characteristic with type 2 diabetes

Question 3

Endometriosis

Answer 3

• pelvic pain accompying menses
• no longer regular or consistent menses
• discomfort during intercourse
• started six months ago after menstruation- retrograde menstruation
• ectopic endometrial tissue is often found around the ovaries and in the dependent portions of the peritoneum
• as progesterone levels fall at the end of the secretory phase, the ectopic endometrial tissue remains in the peritoneum but still necrotized, setting up inflammatory response
• surgical removal of endometrial tissue

Question 4

Ectopic Pregnancy

Answer 4

• extreme lower quadrant pain
• abnormal vaginal bleeding
• positive hCG
• no interuterine pregnancy, swollen left fallopian tube with apparent masses
• PIV risk factor
• congential abnormality
• STI chlamydia
• unsuccessful ligation or previous ectopic pregnancy
• the interstitial area which generally ruptures at 12-16 weeks gestation
• 1:150, most in fallopian tubes
• hCG production is diminished, nutrient availability as vascular supply is low and impedes fetal development
• isthmic 6-8 weeks, ampullary 8-12, interstitial 12-16 weeks
• transvaginal ultrasonography