Ovulation disorders Flashcards

1
Q

what hormone peaks before ovulation

A

estradiol

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2
Q

what does a pregnancy test decte

A

LH surge

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3
Q

function of FSH

A

thickens endometrium
stimulates follicular development

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4
Q

what is FSH and lH secreted from

A

anterior pituitary

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5
Q

what stimulates FSH and LH

A

gonadotrophin releasing hormone

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6
Q

role of LH

A

peak level stimulate ovulation
stimulates corpus luteum development

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7
Q

phases of ovulation

A

follicular phase -1st
ovulation
luteal phase-2nd

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8
Q

oligomenorrhea

A

cycles lasting >42 days , 8 periods a year

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9
Q

what are ovulation disorders associated with

A

oligomenorrhea and ammenorhea - failure of reach of period at certain age

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10
Q

predominant hormone in second phase

A

progesterone

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11
Q

what is progesterone produced by

A

corpus luteum

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12
Q

regular period cycles

A

28- 35 days

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13
Q

where is gnrh released from

A

hypothalamus

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14
Q

what is estrogen secreetd by

A

ovaries and adrenal cortex and placenta in pregnancy

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15
Q

role of estrogen

A

thickening of endometrium
fertile cervical mucous

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16
Q

role of progesterone

A

inhibits secrettion of LH

Responsible for infertile (thick) cervical mucus

Maintain thickness of endometrium

Has thermogenic effect (increases basal body temperature)

Relaxes smooth muscles

17
Q

what can be used to detect ovulation

A

basal body temp shifts up by 0.2-0.4

18
Q

cervical mucous and course of cycle

A

changes across course
important for couples trying to concieve
becomes thin slippery and stretchy during time of ovulation

19
Q

pre preg optimization

A

Stabilise weight
BMI >18.5
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)

20
Q

group 1 ovulation disorders

A

pathology at the level of the hypothalamus
characterised by low gonadal hormone levels - hypogonadotropic hypogonadism

21
Q

group 2 disorders

A

have essentially normal gonadal hormones
hypothalamic pituitary dysfunction also

22
Q

group 3 disorders

A

describe pathology relating to ovarian function characterised by high gonadal hormones - hypergonadotropic hypogonadism
high gonadal hormones

23
Q

hypothalmic related ovulatory disorder assoc

A

assoc with amenorrhoea
low levels FSH/LH
low levels esrtogen
hypogonadotrophic hypogonadism
10% of disorders

24
Q

progesterone challenge test

A

Involves administration of progesterone to induce a period
Provera 5mg BD x 5 days

If no bleeding: low estrogen levels, uterine/endometrial abnormality or cervical stenosis

25
causes of hypothalmic disorders
Causes include [GAIN FIT PIE] Kallman’s syndrome [G] Drugs (steroids, opiates) [I] Brain / pituitary tumours [N] Stress [F] Head trauma [T] Excessive exercise [P] Anorexia / low BMI [P]
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management of hypothalmic disorders
Gonadotropins to induce ovulation in fertility cases.- daily injections Pulsatile GnRH therapy to stimulate natural hormone production
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pituitary related disorders assoc
amenorrhoea low levels FSH/LH Possible co-existent abnormalities in other anterior pituitary hormones ACTH, TSH, GH, prolactin Low levels Estrogen Negative progesterone challenge test
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hyperprolactinaemia ovarian disorder assoc
History Amenorrhoea Galactorrhoea Current medication Examination Visual fields Investigations Low/normal FSH/LH, low oestrogen Raised serum prolactin >1000 iu/l (2 or more occasions) TSH normal MRI to diagnose micro/macro prolactinoma
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hyperprolactinaemia management
dopamine agonist Bromocriptine Normal PRL in 59% Ovulation in 53% within 6/12 Cabergoline (longer acting preparation, twice weekly) Normal PRL in 83% Ovulation in 71% within 6/12 SHOULD BE STOPPED WHEN PREGNANCY OCCURS
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ovarian causes of ovarian disorders
5% ovulatory disorder Amenorrhea Menopausal High levels gonadotrophins Raised FSH>30IU/L x 2 samples Low oestrogen levels
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premature ovarian insufficiency
Menopause before age 40y Causes of POI Genetic Turner syndrome (46XO) XX gonadal agenesis Fragile X Autoimmune ovarian failure Bilateral oophrectomy Pelvic radiotherapy, chemotherapy Unclear aetiology: family history? isnt really a treatment
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ROTTERDAM diagnostic criteria for PCOS
NEED TWO OF: 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 - HIGH TESTOSTERONE (acne, hirsutism)
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biggest cause of ovulatory disorders
PCOS Oligo/amenorrhoea Normal gonadotrophins / excess LH Normal oestrogen levels PCOS (5 – 15% women of reproductive age) 10-20% amenorrhoea 80-90% oligomenorrhoea
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what is seen in many people with PCOS
insulin resistance give metformin
35
management of pcos
clomifene citrate gonadotrophin therapy
36
laparoscopic ovarian diathermy
heat treatment minimally invasive surgery for pcos Small punctures or controlled burns are made in the ovaries (typically 4–10 per ovary). This helps to reduce the excess androgen-producing tissue in the ovaries and can improve hormone balance.
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