Hormonal control of menstrual cycle + disorders Flashcards

1
Q

What effect does oestrogen have on pit

A

Low oestrogen inhibits LH release

High oestrogen stimulates it (this feedback loop works by increasing no. of oestrogen receptors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What effects does progesterone have on pit

A

Low prog stimulates LH and FSH

High prog inhibits it (this feedback loop works by increasing sensitivity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most important hormone in follicular stage

A

FSH ( can rise as O, P and inhibin are low)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the two types of cell in follicle

A

Thecal - make androgens from cholesterol

Granulosa - make oestrogens from androgens (aromatisation) - under influence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What do inhibin and activin do

A

Both secreted by granulosa cells
Inhibin increases androgen synthesis and down regulates FSH
Activin increases FSH binding onto follicles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What causes LH surge

A

oestrogen exceeding positive threshold

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How and why does ovulation occur

A

after breakdown of follicle by LH, FSH, proteolytic enzymes and PG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the actions of LH

A

Luteneises follice - makes it start producing prog
Resumption of meiosis
ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why does corpus luteum degrade

A

Degrades as prog switches FSH and LH off and there’s no b-hCG to tell it to keep going on

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does menstrual cycle start again

A

Reduction of P + O and inhibin, brake taken off pituitary and FSH starts again

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What change occurs in proliferative endometrial phase

A

Single layer –> pseudostratified

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What happens in secretory endo. phase

A

Proliferation stops, start secreting stuff into glands and uterine lumen
Formation of decidua (temporary layer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the three layers of endometrium

A

Basalis (REMAINS)
spongiosum (stroma + exhausted glands)
compactum (decidua)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Definition of precocious puberty

A

Before 8 in a girl

before 9 in a boy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Definition of delayed puberty

A

No secondary sexual characteristics by age of 14

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes of delayed puberty

A

Central defect:
Anorexia
chronic illness
Kallmann’s

Failure of gonadal function:
turner’s (XX) ovarian dysgenesis
premature ovarian failure

17
Q

Non structural causes of DSD

A
Turner's (45X)
46 XY (gonadal dysgenesis due to SRY mutation)
androgen insensitivity
5 alpha reductase def
CAH
18
Q

Features of turner’s

A
wide carrying angle,
webbed neck
short
coarctation of aorta
thyroid problems
deafness
IBD
19
Q

Why does turner’s lead to DSD

A

STREAK GONADS

20
Q

What happen in 46 XY SRY def

A

absent anti-mullerian hormone so no prevention of development of uterus vagina, fallopian tube.
No testosterone so foetus virilise

21
Q

What happens in 46 XY DSD with androgen insensitivity

A

Uterus doesn’t form cause you have AMH
You develop testes due to testosterone
BUT you develop female external genitalia
Will see: female external genitalia, testes descending somewhere, no uterus

22
Q

What happens in 5-a reductase def

A

Normal male sexual genitalia but doesn’t virilise properly as you can’t make DHT (ambiguous genitalia)

23
Q

What happens in 46 XX DSD

A

Caused by CAH
Virilisation of female
Fused labia, enlarged clitoris

24
Q

What is primary amenorrhea

A

Girl that fails to menstruate by age of 16

25
Q

Secondary amenorrhea

A

absent menstruation >6 months

26
Q

oligomenorrhea

A

irregular periods for more than 35 days and 4-9 periods a year

27
Q

Causes of hypogonadotrophic hypogonadism

A
anorexia
head injuries
Kallmann's
systemic disorder (TB)
drugs (prog, dopamine antagonists
28
Q

Causes of pit. problems

A

adenomas (prolactinoma)
sheehan’s
damage (radio, surgery)
failure of development

29
Q

ovarian problems causing amenorrhea

A

PCOS - hypertrophic hypogonadism

30
Q

Endometrial disorders causing amenorrhea

A

primary can be caussed by mullerian defects (absent uterus causing haematocolpos)
secondary can be caused by scarring

31
Q

Ix for amenorrhea

A

Pregnancy test
Raised LH + test - PCOS
Riased FSH - POF

32
Q

Mx of POF

A

COCP or HRT

33
Q

What is the diagnositc criteria for PCOS

A
Rotterdam criteria 2/3
clinical/biochemical hyperandrogenism
Oligo/amenorrhea (>2 years)
US evidence of cystic ovaries
-12 or more follicular cysts+ increased ovarian stroma
34
Q

Mx of PCOS

A

COCP / cyclical oral progesterone (w/ withdrawal bleed 3-4 months)
This increass sex hormone binding globulin to relieve androgenic symtpoms
If not planning pregnancy:
Lifestyle, cream for hirsutism
Can give co-cyprindol - used in PCOS w/ hirsuitism and acne
GnRH analgoues - only if other treatments don’t work

If planning (help w/ subfertility)
encourage weight loss
clomiphene (SERM) if normal BMI
clomiphene increases fertility for 6 months, increases chance of multiple pregnancy, give w/ / w/o metformin
Laparoscopic ovarian drilling
35
Q

Mx of premenstrual symtpoms

A

conservative - reduce stress, caffeine, pain relief
moderate - COCP, refer for CBT
Severe- SSRI (but must monitor for 3 months)