LECTURE- Female Endocrinology Testing Flashcards
average menstrual cycle length
28 (+/- 2d)
- more variation near menarche, menopause
what hormones do the ovaries produce?
estrogen
progesterone
testosterone
three distinct phases in the menstrual cycle =
follicular = vaariable
ovulation
luteal = same
test results regarding female endocrinology dependent on time in cycle
- important to know LMP when interpreting results
- cycle day one = first day of full flow of period
describe the follicular phase
- variable duration; 10-18 days
- development of egg/follicle; FSH key hormone
- estradiol is the most important estrogen
> increasing estrogen UNTIL ovulation (neg feedback) - proliferative pattern of endometrium
ovulation phase
- LH surge = early pregnancy, endocrine marker (15 U/L)
- starts 28-32 hrs before ovulation; coincidentally increased temp
- peaks 10-12 hrs pre-ovulation
to have an LH surge, need these at day 14:
- large enough follicle (ultrasound) = peak FSH
- sufficient estrogen levels (serum estradiol)
- fertility monitoring uses both
luteal phase
- constant length of menstrual cycle; 14 days from ovulation
- progesterone is the key hormone
> peaks 7 days post ovulation
> maintains endometrium - LH maintains progesterone production
> corpus luteum - endometrium = secretory changes
this is the phase we test
follicular phase
the inability to conceive after 12 months
- affects 10% of couples = look at tubal function, semen
- anovulation affects 20% = most have irregular periods
critical lab test in infertility
serum progesterone
- peak value 7 days before menses
- day 21 in typical 28 day cycle
what constitutes are oligomenorrhea
- fewer than 9 periods a year
- due to anovulation or irregular ovulation
- the commonest cause is polycystic ovary syndrome (6-10% of women)
-associated w high ovarian androgens = high testosterone, both total and free - abnormal LH/FSH ratio (>2/1)
> high H, with normal FSH
PCOS = polycystic ovarian syndrome
- anovulation, irregular menses, infertility
- hirsutism, acne
- insulin resistance is common
- weight loss = first line of treatment in obese patients
> NOT the answer, but may aid in conception
> metformin = insulin sensitizer - treat symptoms that bother patient *
menopause
- amenorrhea with high gonadotrophins; FSH >20U/L
- low estradiol levels
- day 3 FSH (if peiods still)
- random FSH if no periods
- mean age 51 yrs = Canada (.1/3 of ife)
symptoms of menopause
hot flashes, mood swings, vaginal changes
use of hormone replacement therapy
- short-term treatment for menopause
- progesterone and estrogen
- primarily used for symptoms (short term)
> vasomotor
> urogenital
> mood, sleep, concentration - PROBLEM: side effects!
> irregular bleeding
> breast pain, bloating - use estrogen only if no uterus (hysterectomy)
> not as many side effects
what are risks of HRT?
- breast cancer (use >5 yrs)
- CVD (heart attacks, strokes)
> new research = beneficial for circulation - reduced risk of osteoporosis
> after menopause = bone density deteriorates
> need estrogen to maintain bone density - less colon cancer
HRT for younger women
- acceptable for symptom control
- use minimum dose for the shortest time
- transdermal = fewer side effects
- may be less risky
amenorrhea
- absence of periods >6 months or 3 times usual menstrual interval
- pregnancy? = beta hCG level
- rule out thyroid disease = TSH
> very common; amenorrhea can be corrected - prolactin increased?
- use estradiol with FSH for diagnosis
> low estradiol = not producing estrogen
> high FSH = pituitary making lots to try to stimulate ovary to make estrogen
most common cause = menopause
central cause of amenorrhea
- low estradiol with low FSH
- hypothalamic problem = stress, extreme weight loss, anorexia, etc = prevent release of GnRH
- pituitary problem = microadenomas (PRL)
> panhypopituitarism = all pituitary hormones are not being produced or produced at extremely low levels
female athletic triaad
eating disorder and osteopenia + amenorrhea
ovarian failure
- low estradiol with high FSH
- ovary does not respond = few oocytes left
- regardless of age
> premature ovarian insufficiency <40 yrs - rare in young women
T or F. there is treatment for premature ovarian insufficiency
F! no treatment to induce ovulation bit can use donor eggs
T or F. Premature ovarian insufficiency patient benefit from HRT
T! until time of menopause
Turner’s syndrome
- one of the X chromosomes (sex) is missing or partially missing
- 99% miscarry or stillborn
- short height
- failure of ovaries to develop
- heart defects
- otherwise normal life
