L15 - Hormone Abnormalities 2 Flashcards

1. Define normal menopause and the hormonal changes that occur and relate these to the clinical changes seen 2. Define both premature menopause and premature ovarian failure 3. Describe the common causes of premature ovarian failure (POF) and how it is diagnosed 4. Describe how the above hormonal changes lead to the long term complications of POF 5. Discuss possible causes, investigation and treatment options that are available. 6. Briefly discuss functional problems such as cervical ectopy

1
Q

Define menopause?

A

12 months since last menstruation.

Patient not pregnant and is not taking hormones which would induce amenorrhoea.

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2
Q

Briefly summarise changes in hormones during menopause?

A
  • As proportion of anovulatory menstrual cycles increases,
  • progesterone production will decrease.
  • Pituitary production of FSH & LH will increase
  • due to diminished negative feedback loop from oestrogen / inhibin
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3
Q

What is the clinical diagnosis of menopause?

A

Serum levels of FSH over 30 and irregular / absent periods.

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4
Q

What is anti-mullerian hormone?

A
  • Glycoprotein product
  • of granulosa cells enveloping each egg.
  • Good marker of follicular reserve.
  • Only present in ovary until menopause
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5
Q

What are some symptoms of menopause?

A
  1. Vaginal bleeding
  2. Hot flush
  3. Genitourinary atrophy
    - urethra and bladder are oestrogen dependent
    - and will undergo gradual atrophy after menopause.
  4. Osteoporosis
    - Bone resorption of osteoclasts in accelerated
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6
Q

Describe basis of hormone therapy for menopausal women?

A
  • Oestrogen supplementation.
  • Given with progestogens
  • to protect from endometrial hyperplasia that would result if just oestrogen was given.
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7
Q

What are some risks of hormonal treatment?

A
  • Endometrial carcinoma

- Venous thromboembolic disease

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8
Q

Describe the onset of puberty?

A

> 8 years

GnRH pulses increase in amplitude and frequency such that FSH and LH release increases.

This stimulates oestrogen release from the ovary.

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9
Q

Menorrhagia

A

Heavy bleeding

AKA HMB - heavy menstrual bleeding, usually > 80mls

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10
Q

What may be some causes of heavy menstrual bleeding?

A
  • Subtle abnormalities of endometrial haemostasis
  • Uterine fibroids (30% women)
  • Uterine polyps (10%)
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11
Q

What is endometrial haemostasis?

A
  • Cessation of menstrual bleeding
  • achieved by endometrial haemostasis
  • via
    1. platelet aggregation
    2. fibrin deposition
    3. thrombus formation.
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12
Q

Describe what examination of a female patient may show?

A
  • Irregular enlargement of uterus suggests fibroids.

- Tenderness without enlargement suggests adenomyosis

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13
Q

Adenomyosis

A

Inner lining of uterus breaks through myometrium.

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14
Q

State the stages of menopause

A
  1. Perimenopause - first features, vasomotor symptoms and menstrual irregularity
  2. Post menopause - 12 months after spontaneous amenorrhoea
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15
Q

Why are periods in menopausal women shorter?

A

> 45 y/o
1. Inhibin B from granulosa cells falls

  1. causing a rise in FSH.
  2. Increased FSH stimulates increased oestradiol from remaining follicles.
  3. Oestradiol released more rapidly, resulting in shorter menstrual cycles.
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16
Q

Describe the production of oestrone in post menopausal women?

A

Perimenopausal women - oestrogen production by ovary is erratic

Without follicular source, oestrogen is derived from ovarian stromal and adrenal secretion of androstenedione.

This is aromatised to oestrone in peripheral tissues.

17
Q

What are the different modes in which HRT can be administered?

A
  • oral
  • transdermal (patch, gel or nasal spray)
  • topical (ointments, medication applied to a particular place)
  • intrauterine system (mirena coil)
18
Q

What are some benefits of HRT?

A
  • Oestrogen can help with vaginal and urethral dryness

- and aids bone mineralisation.

19
Q

Why does HRT increase the risk of venous thromboembolism?

A
  • Oestrogen increases coagulability

- hence risk of VTE increases.

20
Q

What are the two main mechanisms of premature ovarian failure?

A
  1. Dysfunction of follicular maturation

2. Depletion in the follicular pool

21
Q

What is POF?

A

Premature ovarian failure

- loss of function of the ovaries before age of 40.

22
Q

Describe causes of POF?

A
Mainly idiopathic (88% cases)
Genetic rarer causes 
- X-chromosome 
- Turners syndrome 
- FSH receptor mutation 
Latrogenic 
- chemotherapy / radiotherapy 
- autoimmune causes
23
Q

Describe Turner’s syndrome?

A
  • Only one normal X chromosome
  • 1/2000 baby girls
  • shorter than average
  • accelerated atresia of primordial follicles later fetal life
24
Q

What is Fragile X syndrome?

A

Can cause range of developmental problems such as learning disabilities and cognitive impairment.
- males usually more affected than females

25
Q

What causes Fragile X syndrome?

A

Mutation in which DNA segment, known as CGG triplet repeat is expanded within the FMR1 gene.

26
Q

How may Galactosaemia be linked to POF?

A

Galactosaemia: body cannot process / metabolise galactose.

  • Milk broken down into glucose and galactose
  • Direct toxicity from increased metabolites
  • aberrant glycosylation of glycoproteins / glycolipids involved in ovarian function
  • activation of apoptosis of oocytes and ovarian stromal cells.
27
Q

State some measures which can be taken to avoid bone loss?

A
  • Physical activity
  • Calcium rich diet
  • Vitamin D supplementation
  • Avoiding smoking and alcohol
28
Q

What is the squamocolumnar junction?

A

Junction between the squamous epithelium and columnar epithelium.

29
Q

What is a cervical ectopy?

A

Condition in which cells inside the cervix develop outside it and form a red, inflamed patch.

30
Q

Fibroids

A

Non-cancerous growths that develop in or around womb.

- made up of muscle and fibrous tissue.

31
Q

Describe oligomenorrhoea?

A

Irregular vaginal bleeding.

Usually secondary to anovulatory cycles.