Group II and III Ovulatory Disorders

Question 1

what proportion of ovulatory disorders are group II

Answer 1

85%

Question 2

what are group II ovulatory disorders also called

Answer 2

group II hypothalamic pituitary dysfunction disorders

Question 3

what clinical features are seen in group II ovulatory disorders

Answer 3

oligo/amenorrhoea, normal gonadotrophins(maybe elevated LH), normal oestrogen, PCOS

Question 4

how common is polycystic ovary syndrome(PCOS) in females of reproductive age

Answer 4

5-15% of women

Question 5

what are the Rotterdam diagnostic criteria for PCOS

Answer 5

2 of;

• oligo/amenorrhoea
• polycystic ovaries
• clinical/biochemical signs of hyperandrogenism

Question 6

describe the USS appearance if polycystic ovaries

Answer 6

12 or more 2-9mm follicles, increased ovarian volume >10ml, unilateral or bilateral

Question 7

resistance to what hormone is seen in PCOS

Answer 7

insulin resistance(seen in 50-80% PCOS)

Question 8

describe what insulin resistance in PCOS leads to

Answer 8

hyperinsulinaemia and,
insulin lowers SHBG levels, increasing free/bioavailable testosterone, leads to hyperandrogenism
glucose intolerance(20%)

Question 9

what are some of the clinical features that can be seen in PCOS

Answer 9

oligo/amenorrhoea, hirsutism, obesity, acne/alopecia

Question 10

what pre-treatment can be used for group II ovulatory disorders

Answer 10

weight loss if obese, reduce alcohol, stop smoking, folic acid, rubella immunity, normal semen analysis of partner

Question 11

what are the pharmacological treatment options in the management of group II ovulatory disorders

Answer 11

clomifene citrate tablets, or gonadotrophin therapy(recombinant FSH) daily injections

Question 12

what is the role of metformin on ovulation induction

Answer 12

15-20% patients don’t ovulate on clomifene, metformin can be used to restore menstruation/ovulation
(also reduces insulin resistance and androgen, increases SBHG)

Question 13

what are the non-pharmacological treatment options for group II ovulatory disorders

Answer 13

laparoscopic ovarian diathermy(surgery), or IVF

Question 14

what are the risks of laparoscopic ovarian diathermy

Answer 14

general anaesthetic, ovarian destruction(irreversible)

Question 15

what are the risks of ovulation induction

Answer 15

ovarian hyperstimulation, multiple pregnancy, theoretical risk ovarian cancer

Question 16

what are some of the maternal risks of multiple pregnancy

Answer 16

hyperemesis, anaemia, hypertension, gestational diabetes, depression/stress

Question 17

what are some of the pregnancy risks increased in multiple pregnancy

Answer 17

early/late miscarriage, low birth weight, prematurity, disability, stillbirth/neonatal death

Question 18

what are some of the long term problems seen with prematurity in multiple pregnancy

Answer 18

disability, lower IG, ADHD, problems with language development

Question 19

what does group III ovulatory disorder refer to

Answer 19

ovarian failure

Question 20

what is group III ovarian failure characterised by

Answer 20

hypergonadotrophic hypogonadism

Question 21

what clinical features are seen group III ovarian failure

Answer 21

amenorrhoea, menopausal, high levels gonadotrophins(LH, FSH), low oestrogen levels

Question 22

what is the definition of premature ovarian failure

Answer 22

menopause before age of 40

menopause = end of menstruation

Question 23

what are some of the causes of premature ovarian failure

Answer 23

genetic, autoimmune ovarian failure, bilateral oophorectomy, pelvic radio/chemotherapy

Question 24

what treatment is used for premature ovarian failure

Answer 24

hormone replacement therapy, egg/embryo donation, ovary/egg cryopreservation prior to any radio/chemo to prevent