hormonal abnormalities 2

Question 1

Definition of menopause

Answer 1

A transition period lasting for around 4 years

• hormones produced by ageing ovaries fluctuate as a result of reduced availability of follicles,
• Results in irregular periods

Question 2

Postmenopause

Answer 2

No period for a whole year

Question 3

Perimenopause

Answer 3

Transitional period 1-2 years prior to the onset of no periods, irregular periods
1. iniatially higher FSH levels stimulates remaining folicles to produce more oestrogen
2. Oestrogen release is rapid and short
3. Menstrual cycle gets shorter and shorter
Less oestrogen released each time and is derived from oesterone from the adipose tissue and is less active by its nature

Question 4

Pathophysiology of menopause (4)

Answer 4

1. Decrease in the number / 0 of functional follicles
2. Decrease in production of oestradiol ( oestrogen) and progesterone
3. Less inhibition for FSH and LH from the pituitary gland and hypothalamus
4. Increasing levels of FSH and LH
   ( patterns of secretion are more erratic and less oestrogen is produces )

Question 5

Clinical manifestation of low oestrogen levels (2)

Answer 5

1. Osteoporosis - severely decreases bone densitiy thus increasing the risk of fracture
2. CVS conditions - oestrogen helps keep blood vessels flexible

Question 6

Clinical manifestation of menopause (3)

Answer 6

• Vaginal dryness - Dyspareunia
• Hot flushes and night sweats
• Irritability/ mood swings

Question 7

Treatment for menopause

Answer 7

Hormone replacement therapy

Question 8

Premature ovarian failure

Answer 8

loss of normal function of ovaries before the ages of 40 due to

1. Depletion of follicles
2. Dysfunctional follicles - don’t respond to gonadotropins

Question 9

Pathophys of ovarian failure

Answer 9

1. Follicles do not function properly
2. less oestrogen and progesterone released
3. Increased FSH and LH levels

Question 10

Diagnosis of premature ovarian failure

Answer 10

Blood test

1. Low levels of oestrogen
2. High levels of LH and FSH

Question 11

Causes of primary ovarian failure

Answer 11

• Chromosomal - Turner’s syndrome
Genetic disorder of female with only one functional X chromosome
ovarian follicles depleted by puberty/may never have periods
• Fragile X syndrome
a genetic condition caused by mutation of CAG dna segments
• Autoimmune
1. Galactosaemia - galactose is formed, it attacks the ovaries and direct toxicity causes apoptosis of oocytes
2. Idiopathic addison’s disease - steroid cell antibodies are targetted towards the follicular granulosa cells
• Iatrogenic
Chemotherapy/Radiotherapy/

Question 12

Investigation of POF

Answer 12

• HCG levels - check to see if not pregnant
• Thyroxine levels - hyperthyroidism may mean no periods
• Testosterone levels - PCOS??
• Karyotyping - check for turner’s syndrom
• Anti mullerian hormone levels
• ANtibody screening

Question 13

Treatment for POF

Answer 13

• Hormone replacement therapy - supplement women with ovarian failure

Question 14

Hormone replacement therapy

Answer 14

Involves supplements oestrogen, progesterone and androgens

1. Oestrogen alone - only in women without a uterus (hysterectomy) as it increases risk of endometrial hyperplasia resulting in carcinoma
2. Progesterone and oestrogen - usually used
   - helps reduce risk of osteoporosis, flushes and vaginal dryness
   - Increases risk of venous thromboembolism and breast cancer