Female Reproduction Case Studies

Question 1

what is the immediate cause of menopause?

Answer 1

lack of estrogen production in the ovaries

Question 2

how is menopause diagnosed? why does this occur?

Answer 2

diagnosed by rise in FSH

occurs because there is a release of negative feedback by estrogen on the pituitary

Question 3

what is HRT therapy? what is it used for?

Answer 3

HRT therapy is a combination of estrogen and progesterone used to decrease the symptoms of menopause

Question 4

why is HRT therapy controversial?

Answer 4

because it increases the risk for CVD, cerebrovascular disease and breast cancer

Question 5

what therapy is replacing HRT therapy in menopausal women and what does it do?

Answer 5

selective estrogen receptor mediators (SERM)

mimic effects of estrogen on bone

Question 6

what hormonal change brings about puberty?

Answer 6

pulsitile GnRH secretion beginning at night and eventually moving into the day as well

Question 7

what happens if constant GnRH is given instead of pulsitile? what is this used to treat?

Answer 7

there is a decrease in receptors for GnRH in the anterior pituitary
used to treat precocious puberty

Question 8

what three lifestyle factors can decrease GnRH secretion after puberty? (hypothalamic amenorrhea)

Answer 8

significant weight loss, exercise and stress

Question 9

what is hypothalamic amenorrhea and how is it diagnosed?

Answer 9

it is a lack of menstrual and ovulatory cycles brought about by lack of hypothalamic secretion of GnRH.
test by giving the patient GnRH and then testing LH and FSH levels. `

Question 10

what is the most common cause of infertility? what happens in the ovarian cycle in these patients?

Answer 10

polycystic ovarian syndrome

many follicles mature but none become dominant and no follicle emerges

Question 11

what are some common clinical findings with polycystic ovarian syndrome?

Answer 11

irregular periods, abnormal body hair growth, persistent acne, infertility and overweight

Question 12

upon ultrasound of the ovaries and uterus, what is found in patients with polycystic ovarian syndrome?

Answer 12

2-5 fold ovarian enlargement with thickened tunica albuginea. many follicles without one emerging as dominant. thinning of the endometrium

Question 13

what hormonal abnormalities are found in women with polycystic ovarian syndrome?

Answer 13

elevated LH/FSH ratio, high testosterone, low estrogen and progesterone production and glucose intolerance due to insulin insensitivity

Question 14

why are testosterone levels high in polycystic ovarian syndrome?

Answer 14

because there is continued production of androgen by theca cells but it is not being turned into estrogen or progesterone

Question 15

what are the four treatments for polycystic ovarian syndrome?

Answer 15

birth control to restore period
clomiphene to restore ovulation
s alpha reductase to inhibit testosterone->DHT
weight loss to increase insulin sensitivity

Question 16

what are some clinical presentations of endometriosis?

Answer 16

intense pelvic pain accompanying menses that has gotten progressively worse, irregular and heavy periods, and infertility in 1/2 of cases

Question 17

what is the cause of endometriosis?

Answer 17

the spread of endometrial tissue into the peritoneal cavity

Question 18

why is there so much pelvic pain associated with endometriosis?

Answer 18

because blood pools in the peritoneal cavity and is not easily absorbed causing pain

Question 19

that is the accepted theory of the origin of endometriosis?

Answer 19

that it is caused by retrograde flow during menstruation seeding the peritoneal cavity with endometrial tissue

Question 20

what three treatments exist for endometriosis?

Answer 20

oral contraception to regulate hormones, over the counter pain medication and surgical removal of ectopic endometrial tissue

Question 21

what are the clinical findings associated with ectopic pregnancy?

Answer 21

severe left lower quadrant pain, abnormal vaginal bleeding, history of PID, missed period

Question 22

what are the treatments for ectopic pregnancy?

Answer 22

methotrexate to inhibit rapid production of cells (single or multi dose)
laproscopy and salpingectomy (removal of fallopian tube

Question 23

how do the levels of hCG in ectopic pregnancy compare to regular pregnancy? non pregnancy?

Answer 23

less than regular pregnancy but still more than a non pregnant woman

Question 24

what is culdocentesis?

Answer 24

withdrawal of fluid from the retrouterine pouch to test for blood

Question 25

where is the most dangerous area for ectopic pregnancy? why?

Answer 25

the interstitial area of the fallopian tube

because it is close to larger arteries that would be effected by a rupture

Question 26

what determines how long after fertilization the fallopian tube ruptures in ectopic pregnancy?

Answer 26

the size of the lumen at the point of implantation