Infertility, PCOS, Endometriosis Flashcards
what is the common presentation of endometriosis
nulliparity, early menarche, short menses, hx dysmenorrhea
what is the clinical presentation of endometriosis
may be symptomatic or asymptomatic: symptoms do not necessarily correlate with extent or location of disease
dysmenorrhea, dyspareunia, spotting/AUB, pelvic pain
infertility common
depression/anxiety issues
what is the internal appearance of endometriosis
varies:
clear or white, dark red or brown lesions
dark red or blue “domes”
described surgically as “cigarette burns”
on the ovary, cysts may develop - endometrioma
what is endometrioma
cysts that develop on the ovaries
what labs are ordered for endometriosis workup
quantitative hCG, UA, cervical cultures, CBC
what is seen on pelvic exam for endometriosis workup
usu. normal findings
may be fixed retroverted uterus, uncomfortable during pelvic exam
if something to find, maybe nodularity of uterosacral ligaments
what is the imaging used for endometriosis diagnosis
TVUS
what is the treatment for endometriosis
expectant, hormonal, surgical and combination medical-surgical
choice of treatment dependent on individual patient case
-NSAID and OCP - first line
What are complications of PCOS
4x increase risk of T2DM
increased risk of ovarian and breast cancers
increase prevalence NAFLD, OSA, dyslipidemia
Increased prevalence of CVD (but not increased mortality)
increased risk for mood disorders (esp. depression)
what is the pathophysiology of PCOS
altered LH function with insulin resistance and predisposition to hyperandrogegism
increased resistance exacerbates hyperandrogegism; increases adrenal and ovarian synthesis
increased androgens leads to irregular menses and physical symptoms
what is the clinical presentation of PCOS
asymptomatic to obvious
signs of androgen excess with oligo/amenorrhea and infertility (anovulation)
what are the goals for PCOS evaluation
exclude other manageable conditions
diagnosis/manage complications
what needs to be ruled out when working up PCOS
pregnancy
thyroid dysfunction
hyperprolactinemia
congenital adrenal hyperplasia
primary ovarian insufficiency, cushing’s, acromegaly
What is the Rotterdam criteria
2 out of 3 diagnostics for PCOS
-oligomenorrhea and/or anovulation (ovulatory dysfunction)
-clinical or biochemical signs of hyperandrogenism
-PCOS appearing ovaries on TVUS
What lab work is needed for the work up of PCOS
LH and FSH
LF/FSH ratio > 2 indicative of PCOS
what is the first line management for PCOS
lifestyle modification -> weight loss (if overweight)
what also needs to be discussed with the management of PCOS
infertility
menstrual concerns/endometrial prevention
Hirsutism
Acne
how is Hirsutism managed in PCOS
first line: oral contraceptives
spironolactone 100mg daily - monitor K
cosmetic treatment
what is the first line management for acne with PCOS
hormonal contraceptives
adjunctive tx: usu. topical acne therapies
what are routine screenings for PCOS
BP every visit
lipids
glucose testing (strongly consider 2hr OGTT at initial diagnosis)
depression
OSA
what is the definition of infertility
12 months of unprotected intercourse without conception (<35yo)
6 months of unprotected intercourse without conception (>35yo)
what are the main causes of infertility in women
PCOS
Hormonal factors impaction ovulation
endometriosis
what are the most common causes of ovarian and oocyte abnormalities
PCOS
premature ovarian failure
what are anatomical abnormalities for females
fallopian tube disease
endometriosis
uterine fibroids
asherman’s syndrome
other implantation abnormalities; luteal phase deficiencies
what are anatomical abnormalities for males
varicoceles
blockage of vas deferens or epididymis
damage to bladder neck or lumbar sympathetic nerve injury
gonadal failure
what is the treatment of infertility
identify and correct any underlying medical or surgical concerns
strongly consider specialist referral (reproductive endocrinology)
encourage: good sleep, healthy eating and exercise, prenatal vitamins
cycle and fertility awareness
STRESS management for both
correct timing of attempts (days 10 - 20, QOD)
