ovarian conditions

Question 1

premature ovarian insufficency

Answer 1

defined as the onset of menopausal symptoms + elevated gonadotrophin levels before the age of 40yrs

Question 2

causes of premature menopause

Answer 2

idiopathic = commonest, may be FH
bilateral oophorectomy
radio/chemotherapy
infection - mumps
autoimmune disorders

resistant ovary syndrome - due to FSH receptor abnormalities

Question 3

premature ovarian insufficency presentation

Answer 3

climatcteric sx - hot flushes, night sweats
infertility
2nd amenorrhoea

raised FSH, LH levels
- FSH >30
- elevated FSH should be demonstrated on 2 blood samples taken 4-6wks apart

low oestradiol <100

Question 4

management of premature ovarian insufficiency

Answer 4

HRT or COCP until age of menopause (51)

• HRT does NOT provide contraception

Question 5

ovarian torsion

Answer 5

partial/complete torsion of ovary on its supporting ligaments that may compromise blood supply

• if fallopian tube involved then = adnexal torsion

Question 6

risk factors for ovarian torsion

Answer 6

ovarian mass (90% of torsions)
being of a reproductive age
pregnancy
ovarian hyperstimulation syndrome

Question 7

ovarian torsion presentation

Answer 7

sudden onset deep-seated colicky abdo pain
- assoc vomiting+ distress

vag exam = adnevial tenderness

Question 8

ovarian torsion investigations

Answer 8

US = whirlpool sign, free fluid

laparoscopy = diagnostic + therapeutic

Question 9

ovarian hyperstimulation syndrome

Answer 9

complication seen in some forms of infertility treatment
- presence of multiple luteinised cysts within the ovaries results in high levels of oestro + progest
- ALSO vasoactive substances like VEGF

–> results in increased membrane permeabilityy + loss of free fluid from the intravascular compartment

Question 10

different classes of ovarian hyperstimulation syndrome (OHSS)

Answer 10

mild - abdo pain + bloating

mod - mild + N+V, US showing ascites

severe - mod + clinical ev of ascites, oliguria, haematocrit >45%, hypoproteinaemia

critical - severe + VTE, acute resp distress, anuria, tense ascites

Question 11

management of ovarian enlargement in postmenopausal women

Answer 11

any postmenopausal woman with an ovarian cyst regardless of nature or size should be referred to gynae

• physiological cysts are unlikely

Question 12

mx of ovarian cyst in premenopausual

Answer 12

malignancy uncommon in young, if cyst small (<5cm) + reported as simple then likely benign

–> repeat US for 8-12wks + refer if persists