Female Reproductive Endocrinology Flashcards
What is the prevalence of PCOS?
5-10%
What are the reproductive features of PCOS?
delayed menarche, menstrual irregularity, infertility, miscarriage, pregnancy complications, delayed menopause
What are the metabolic features of PCOS?
obesity, insulin resistance, dyslipidaemia, cardiovascular disease
What are the key features in PCOS pathogenesis?
dysregulation of ovarian steroidogenesis leading to hyperandrogenism
insulin resistant hyperinsulinaemia
What is required for diagnosis of PCOS?
chronic anovulation
clinical or biochemical hyperandrogenism
exclusion of other causes
What causes need to be excluded prior to a diagnosis of PCOS?
thyroid disorder, hyperprolactinaemia, cushing’s syndrome, non classic CAH, androgen secreting tumour
What are the clinical features of hyperandrogenism?
hirsutism, acne, male pattern hair loss
What is the management for PCOS?
weight loss COCP androgen blockade metformin ovulation induction
What can be used for infertility in PCOS?
letrozole clomiphene metformin gonadotrophin therapy IVF
What is required for long term management for PCOS?
check for diabetes every 2 years check lipid profile every 2 years measure blood pressure annually assess for sleep apnoea assess endometrial thickness assess for depression/anxiety
What investigations should be ordered for ammenorrhoea?
beta HCG, FSH/LH, TSH, prolactin, oestradiol, androgen profile, karyotyping if indicated, pelvic US
What is the definition of primary amenorrhoea?
absence of menses by age 16 years or
absence of breast develop or menses by age 13 years
What is the definition of secondary amenorrhoea?
absence of menstruation for greater than 6 months in women with past menses
Where is GnRH released from?
the hypothalamus
Where is FSH and LH released from?
the pituitary
What are the hypothalamic causes of amenorrhoea?
dysfunctional (exercise, weight loss, chronic illness) neoplasm gonadotrophin deficiency (kallmann syndrome)
What are the pituitary causes of amenorrhoea?
neoplasm (prolactinoma, macroadenoma)
post treatment of pituitary lesion
sheehan’s syndrome
What are the endocrine causes of amenorrhoea?
hypothyroidism
hyperprolactinaemia
What are the ovarian causes of amenorrhoea?
gonadal dysgenesis (Turner's syndrome) ovarian failure (idiopathic or treatment related) PCOS
What are the outflow tract obstruction causes of amenorrhoea?
mullerian agenesis
vaginal atresia
imperforate hymen
asherman syndrome
What is turner syndrome?
a genetic abnormality (45XO)
What is the incidence of turner syndrome?
1 in 2500
What are the clinical features of turner syndrome?
short stature, pubertal delay, primary or secondary amenorrhoea
What cardiac comorbidities is turner syndrome associated with?
coarctation of aorta bicuspid aortic valve mitral valve prolapse hypertension IHD dissection
