Female reproductive system

Question 1

Functions of oestrogen:

Answer 1

Breast growth in pregnancy
Stimulates GH for bone growth in adolescence
Upregulates expression of uterine progesterone receptors and granulosa cell LH receptors
Causes fluid retention due to decreased kidney output

Question 2

Functions of progesterone:

Answer 2

Suppresses uterine contractile activity during pregnancy

Growth of glandular tissue in breasts

Question 3

Which ligament is involved in endometriosis and what are the symptoms?

Answer 3

Uterosacral

Painful intercourse and periods

Question 4

How do you measure ovulation?

Answer 4

Measure progesterone 7 days after ovulation

Full cycle - 14 +7

Question 5

Causes of anovulation:

Answer 5

PCOS
Premature ovarian failure
Hyperthyroidism
Hyperprolactinaemia
Hypothalamic amenorrhoea

Question 6

Cause of PCOS?

Answer 6

Aetiology unclear - hyperandrogegism, hyperinsulinaemia, obesity
No cyclical FSH or LH

Question 7

Presentation of PCOS?

Answer 7

Hirsutism
Infertility
Oligo/anovulation
(Rarer: menometrorrhagia - heavy and very frequent)
(Can have regular menses - diagnosis of exclusion)

Question 8

Rotterdam criteria for teenage PCOS:

Answer 8

Oligo/anovulation for at least 2 years after menarche
Increase in ovarian size (>10cm^3)
Acanthosis nigricans (obese more visible)

Question 9

Differentials for PCOS:

Answer 9

Thyroid dysfunction - test TSH
Hyperprolactinaemia - test Prolactin
21-hydroxylase-deficient adrenal hyperplasia - test 17-hydroxyprogesterone

Question 10

Associated symptoms of PCOS:

Answer 10

Acne
Scalp balding
Oily skin
Hypertension
Obesity
Acanthosis nigricans

Question 11

Investigations for PCOS:

Answer 11

Testosterone and DHEAS

Oral glucose tolerance test

Question 12

Diagnosis of PCOS:

Answer 12

Hyperandrogenism (hirsutism) / hyperandrogenaemia
Ovarian dysfunction - oligo/anovulation / polycystic morphology
Exclusion of other disorders

Question 13

What does treatment of PCOS depend upon?

Answer 13

Whether the woman currently wants fertility

Question 14

Treatment:

Answer 14

Mixture of:
Weight loss
Clomiphene citrate - blocks oestrogen receptors in the anterior pituitary which increases FSH
Letrazole - aromatase inhibitor
Metformin
GnRH analogues
Laproscopic ovarian drilling

Question 15

What is hypogonadatrophic hypogonadism?

Answer 15

Cause of infertility
Hypothalamic/pituitary problem resulting in low FSH, LH and oestrogen
Too much exercise
Treat with artificial FSH (hMG)

Question 16

What can cause hyperprolactinaemia?

Answer 16

Anti-psychotics - may need to give a dopamine agonist

Question 17

Diagnosis of menopause?

Answer 17

1 year of amenorrhoea since last menstrual period

Perimenopause if diagnosed based on symptoms if over 45

Question 18

Symptoms of menopause?

Answer 18

Hot flushes/night sweats
Headaches
Palpitations
Leg cramps
Urogenital symptoms
Reduced libido
Mood changes

Question 19

Long-term consequences of menopause:

Answer 19

Osteoporosis
CVD
Vaginal dryness and atrophy
Alzheimer’s

Question 20

Who needs non-hormonal treatment for menopause?

Answer 20

Those who have had breast cancer or thrombosis-embolic events

Question 21

What tests should be done when menopause is suspected?

Answer 21

Pregnancy test
Serum estradiol
FSH (raised suggests menopause)

Question 22

Non-hormonal menopause treatments:

Answer 22

Lifestyle
Vaginal lubricants
Alpha2 agonists for the vasomotor symptoms - clonidine
SSRI's
Gabapentin for joint/muscle aches

Question 23

Who has to have only oestrogen HRT? (i.e. no progesterone)

Answer 23

Women who’ve had a hysterectomy

Question 24

Effects of HRT:

Answer 24

Oestrogen - reverses symptoms and effects of low oestrogen
Progesterone - Protects the endometrium if the uterus is present and protects against oestrogen induced hyperplasia and adenocarcinoma
Testosterone - increases energy, sexual desire and arousal

Question 25

Benefits of HRT:

Answer 25

Protects against colorectal cancer and CVD

Question 26

Risks of HRT:

Answer 26

VTE
Breast cancer (only with progesterone)
Endometrial cancer

Question 27

Cyclical HRT:

Answer 27

Constant oestrogen with fortnightly two week courses of taking progesterone to induce bleeding
Can start in perimenopause

Question 28

Continuous:

Answer 28

Oestrogen and progesterone everyday with no bleeding

Must start at least 1 year into menopause