Gynae - Physiology & Pharmacology

Question 1

Most important natural estrogen in post menopausal women and why?

Answer 1

E1 (esterone)

After menopause —> ovarian failure —> E2 not produced
But adrenals synthesise androgens, which are converted to E1 in adipose tissue by aromatase.

Question 2

What are the Hyperestrogenic conditions seen in obese PCOS women?
What is the treatment?

Answer 2

1) Fibroids
2) Endometrial cancer
3) Ovarian cancer

Treatment: Aromatase inhibitor ie. Letrozole

Question 3

Insler score

Answer 3

It is a score used to assess suitability of cervical mucus for fertility

Question 4

Genitourinary syndrome of menopause

Answer 4

Aka atrophic vaginitis or senile vaginitis.

After menopause — decreased estrogen — decreased vaginal discharge — vaginal dryness — atrophic vaginitis (genitourinary syndrome of menopause)

Question 5

Which hormone causes ferning of cervical mucus?

When does ferning appear and disappear?

Answer 5

Estrogen causes ferning

Appears by day 8 of menstrual cycle and disappears by day 18

Question 6

In Turner’s syndrome, short stature is due to ________

Answer 6

Mutation in SHOX gene

Question 7

Maximum androgens produced by ovary

Answer 7

Androstenedione > Testosterone > DHEA

Question 8

DOC for anovulation/infertility due to PCOS

Answer 8

Letrozole

Question 9

DOC for anovulation in any condition with normal LH and FSH levels

Answer 9

Clomiphene

Question 10

Treatment of choice for unexplained infertility

Answer 10

Clomiphene citrate + artificial insemination for 3 cycles

Question 11

Treatment of choice for anovulation when HPO axis is not intact

Answer 11

Example of such conditions are:
1) Hypogonadotropic hypogonadism
2) Kallman syndrome
3) Pituitary ablation

TOC: Pulsatile GnRH or HMG (human menopausal gonadotropin)

Question 12

Dose of Clomiphene citrate and time of administration

Answer 12

Dose = 50 mg OD x 5 days
Max dose - 150 mg OD

Can be started anytime between Day 2 & day 5 of cycle.
Given for 5 days.
LH Surge occurs 5-12 days after stopping the drug.

Question 13

S/E of Clomiphene citrate

Answer 13

1) Hot flushes (m/c)
2) Increase in ovarian cysts (2nd m/c)
3) Vaginal dryness
4) Increased chances of multifetal esp. twin pregnancy
5) OHSS (rare)

Due to its central action:
6) Headache
7) Blurring of vision —> immediately stop the drug

Question 14

Max no of cycles for which Clomiphene can be tried

Answer 14

6 cycles

Question 15

HMG

Answer 15

• source : Urine of post menopausal women
• composition : 75 IU LH + FSH
• action : LH & FSH increase estrogen levels and cause ovulation
• indications
  1) Inducing ovulation in hypogonadotropic hypogonadism
  2) Inducing ovulation in PCOS (2nd line)
  3) IVF
• S/E
  1) 30% increased chances of multifetal pregnancy ie. Triplets and above
  2) Ovarian Ca
  3) OHSS (5-15% chance)