ovulation disorders Flashcards
what are group 1 ovulation disorders
pathology at the level of the hypothalamus and are characterized by low gonadal hormone levels - hypogonadotropic hypogonadism
- hypothalamic and pituitary failure
- Amenorrhoea
- Low levels FSH / LH
- Low levels Estrogen
what is group 2 ovulation disorders
essentially normal gonadal hormones
- hypothalamic pituitary dysfunction
- Oligo/amenorrhoea
- Normal gonadotrophins / excess LH
- Normal oestrogen levels
what are group 3 disorders
describe pathology relating to ovarian function characterised by high gonadal hormones - hypergonadotropic hypogonadism
- amenorrhea
- menopausal
- high levels of gonadotrophins
- low oestrogen levels
what is a progesterone challenge test
- involves administration of progesterone to induce a period
- tells you that estrogen levels are not low
- If no bleeding: low estrogen levels, uterine/endometrial abnormality or cervical stenosis
causes of hypothalamic pituitary failure
- Stress
- Excessive exercise
- Anorexia / low BMI
- Brain / pituitary tumours
- Head trauma
- Kallman’s syndrome
- Drugs (steroids, opiates)
pre-treatment for hypothalamic pituitary failure
-Stabilise weight BMI >18.5 -Lifestyle modification: smoking cessation, reduce alcohol consumption -Folic acid 400 mcg / 5mg daily -Check prescribed drugs -Cervical smear -Rubella immune -Normal semen analysis (Patent fallopian tube)
management of group 1 anovulation
pulsatile GnRH
- SC or IV pump worn continuously
- every 90 mins
gonadotrophin daily injections
diagnostic criteria for polycystic ovary syndrome
1.Oligo/amenorrhoea
2. Polycystic ovaries (USS appearance) 12/more 2-9mm follicles Increased ovarian volume >10ml Unilateral / bilateral 3. Clinical and/or biochemical signs of hyperandrogenism (acne, hirsutism)
what resistance is common in PCOS
insulin
management of PCOS
- SUBFERTILITY: OVULATION INDUCTION
- Oligomenorrhoea/amenorrhoea: risk endometrial hyperplasia
- Hirsutism
- Obesity
- Acne/alopecia
pre-treatment for PCOS
-Weight loss to optimise results
-BMI <35
-Lifestyle modification: smoking cessation, reduce alcohol consumption
-Folic acid 400 mcg / 5mg daily
-Check prescribed drugs
-Cervical smear
-Rubella immune
-Normal semen analysis
(Patent fallopian tube)
management of group 2 anovulation
- clomifene citrate
- gonadotropin therapy
- laparoscopic ovarian diathermy
- IVF
what is the role of metformin in ovulation induction
- reduces insulin resistance
- reduction in androgen
- can restore menstruation and ovulation
risks of ovulation induction
- ovarian hyperstimulation
- multiple pregnancy
- ovarian cancer
risks of multiple pregnancy
- hyperemesis
- anaemia
- hypertension
- gestational diabetes
- postnatal depression/stress
- miscarriage
- low birth weight
- prematurity
- disability
- stillbirth/neonatal death
