Menstrual cycle disorders Flashcards
where is oestradiol produced
granulosa cells in the follicle
what is required for oestradiol production
cholesterol
all granulosa cells can do is turn androgens in oestradiol via the enzyme aromatase
granulosa cells get androgens from theca cells as they cannot produce them
what is hypogonadotropic hypogonadism
decreased LH, FSH and oestradiol, but normal prolactin
problem with hypothalamus
GnRH would also be low
normal pre-puberty, pos-pubertal women are often asymptomatic
what does a typical history of hypog hypog look like
weight loss
over-exercise
stress
chronic illness
what is the examination for hypog hypog
BMI (will be low), look for signs of anorexia
what is the management of hypog hypog
lifestyle
HRT
combined oral contraceptive
pulsatile GnRH
FSH/LH injections
what is premature ovarian insufficiency
increased FSH and LH, decreased oestradiol, normal prolactin
due to a problem with the ovary
happens naturally at menopause but can happen earlier
women can go through the menopause before they even reach puberty (Turner syndrome)
what is a typical history of someone with premature ovarian insufficiency
treatment (surgery, chemo or radiotherapy)
family history of early menopause
menopausal symptoms
what is the examination and management for POI
atrophic vaginitis seen on examination
management - HRT, COC
egg donation required for fertility
what is hyperprolactinaemia
problem often due to pituitary, mimicking hormones of breast feeding
decreased FSH, LH and oestradiol, increased prolactin
what is typical of hyperprolactinaemia upon history/examination
galactorrhea (milk production from breast unrelated to pregnancy or lactation
bitemporal hemianopia (MRI)
what is the management for hyperprolactiaemia
dopamine agonist (bromocriptine)
what is the pathophysiology of polycystic ovaries
increased LH, normal FSH, oestradiol and prolactin
ovaries have lots of eggs paused halfway through maturation due to too many androgens
what is a typical history for polycystic ovaries
hirsutism (excess hair on face, particularly around mouth)
receding hairline
acne
weight
what is the examination and management for polycystic ovaries
examination - BMI, skin, ultrasound
management - contraceptive pill
to become pregnant FSH must be increased, oestrogen agonist is used to achieve this (clomiphene citrate)
