Female reproductive system Flashcards
Functions of oestrogen:
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
Functions of progesterone:
Suppresses uterine contractile activity during pregnancy
Growth of glandular tissue in breasts
Which ligament is involved in endometriosis and what are the symptoms?
Uterosacral
Painful intercourse and periods
How do you measure ovulation?
Measure progesterone 7 days after ovulation
Full cycle - 14 +7
Causes of anovulation:
PCOS Premature ovarian failure Hyperthyroidism Hyperprolactinaemia Hypothalamic amenorrhoea
Cause of PCOS?
Aetiology unclear - hyperandrogegism, hyperinsulinaemia, obesity
No cyclical FSH or LH
Presentation of PCOS?
Hirsutism
Infertility
Oligo/anovulation
(Rarer: menometrorrhagia - heavy and very frequent)
(Can have regular menses - diagnosis of exclusion)
Rotterdam criteria for teenage PCOS:
Oligo/anovulation for at least 2 years after menarche Increase in ovarian size (>10cm^3) Acanthosis nigricans (obese more visible)
Differentials for PCOS:
Thyroid dysfunction - test TSH
Hyperprolactinaemia - test Prolactin
21-hydroxylase-deficient adrenal hyperplasia - test 17-hydroxyprogesterone
Associated symptoms of PCOS:
Acne Scalp balding Oily skin Hypertension Obesity Acanthosis nigricans
Investigations for PCOS:
Testosterone and DHEAS
Oral glucose tolerance test
Diagnosis of PCOS:
Hyperandrogenism (hirsutism) / hyperandrogenaemia
Ovarian dysfunction - oligo/anovulation / polycystic morphology
Exclusion of other disorders
What does treatment of PCOS depend upon?
Whether the woman currently wants fertility
Treatment:
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
What is hypogonadatrophic hypogonadism?
Cause of infertility
Hypothalamic/pituitary problem resulting in low FSH, LH and oestrogen
Too much exercise
Treat with artificial FSH (hMG)
What can cause hyperprolactinaemia?
Anti-psychotics - may need to give a dopamine agonist
Diagnosis of menopause?
1 year of amenorrhoea since last menstrual period
Perimenopause if diagnosed based on symptoms if over 45
Symptoms of menopause?
Hot flushes/night sweats Headaches Palpitations Leg cramps Urogenital symptoms Reduced libido Mood changes
Long-term consequences of menopause:
Osteoporosis
CVD
Vaginal dryness and atrophy
Alzheimer’s
Who needs non-hormonal treatment for menopause?
Those who have had breast cancer or thrombosis-embolic events
What tests should be done when menopause is suspected?
Pregnancy test
Serum estradiol
FSH (raised suggests menopause)
Non-hormonal menopause treatments:
Lifestyle Vaginal lubricants Alpha2 agonists for the vasomotor symptoms - clonidine SSRI's Gabapentin for joint/muscle aches
Who has to have only oestrogen HRT? (i.e. no progesterone)
Women who’ve had a hysterectomy
Effects of HRT:
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
Benefits of HRT:
Protects against colorectal cancer and CVD
Risks of HRT:
VTE Breast cancer (only with progesterone) Endometrial cancer
Cyclical HRT:
Constant oestrogen with fortnightly two week courses of taking progesterone to induce bleeding
Can start in perimenopause
Continuous:
Oestrogen and progesterone everyday with no bleeding
Must start at least 1 year into menopause
