menstrual cycle disorders W8 Flashcards
name for absent periods?
amenorrhea
endometrium measurements at different stages?
3mm - thin endometrium
6mm - growing endometrium (~9 days after period)
9mm - proliferative endometrium (~14 days)
estrogens effects on the endometrium?
thicken and proliferate
which cells in the follicle produce estradiol?
granulosa cells
what is the precursor to estradiol and what enzyme converts it
androgen is converted to estradiol by aromatase
where do granulosa cells get androgens from? what stimulates these cells to produce androgens?
theca cells
LH stimulates theca cells to produce androgens
4 reasons for amenorrhea?
low LH, FSH & estradiol, normal prolactin
high LH and FSH, low estradiol, normal prolactin
low LH, FSH & estradiol, high prolactin
high LH, normal FSH, estradiol and prolactin
cause for low LH, FSH and estrogen, normal prolactin?
hypogonadotropic hypogonadism
problem with hypothalamus causing low GnRH.
history of females with hypogonadotropic hypogonadism?
low body fat, illness, stress (brain switches off reproduction - isn’t appropriate time to procreate)
examination and management for hypogonadotropic hypogonadism?
examine BMI
management - lifestyle, HRT/COC, pulsatile GnRH or FSH/LH injections (for fertility)
cause of high FSH and LH, low estradiol, normal prolactin?
premature ovarian insufficiency
problem in ovary - early menopause
premature ovarian insufficiency examination and management?
atrophic vaginitis
give back estrogen - HRT, COC, egg donation for fertility
premature ovarian insufficiency history?
treatment, family history, menopausal symptoms
cause of low FSH, LH and estradiol, high prolactin?
hyperprolactinaemia
problem in pituitary (pituitary adenoma?)
prolactin switches of HPG axis
history of hyperprolactinaemia?
galactorrhoea
(excessive or inappropriate production of milk)
examination of hyperprolactinaemia?
galactorrhoea
visual assessment for bitemporal hemianopia
MRI
management of hyperprolactinaemia?
dopamine agonist (bromocriptine)
dopamine inhibits prolactin
cause of high LH, normal FSH, estradiol and prolactin
polycystic ovaries
high LH causes increased androgens affecting follicles. pauses growth of antral follicle but doesn’t pause growth of smaller follicles. results in grow/pause pattern and an ovary with lots of paused eggs in it
most common reason for irregular periods?
polycystic ovary syndrome
polycystic ovary syndrome - presentation?
general features of high androgens - receding hairline, hirsutism (excess hair around mouth and chin). gained weight (due to high androgens causing insulin resistance)
polycystic ovary syndrome management?
COC
for fertility - raise FSH, using estrogen antagonist (clomiphene citrate). only take for 5 days at beginning of cycle (day 3-7)
