Ovulation disorders Flashcards
what hormone peaks before ovulation
estradiol
what does a pregnancy test decte
LH surge
function of FSH
thickens endometrium
stimulates follicular development
what is FSH and lH secreted from
anterior pituitary
what stimulates FSH and LH
gonadotrophin releasing hormone
role of LH
peak level stimulate ovulation
stimulates corpus luteum development
phases of ovulation
follicular phase -1st
ovulation
luteal phase-2nd
oligomenorrhea
cycles lasting >42 days , 8 periods a year
what are ovulation disorders associated with
oligomenorrhea and ammenorhea - failure of reach of period at certain age
predominant hormone in second phase
progesterone
what is progesterone produced by
corpus luteum
regular period cycles
28- 35 days
where is gnrh released from
hypothalamus
what is estrogen secreetd by
ovaries and adrenal cortex and placenta in pregnancy
role of estrogen
thickening of endometrium
fertile cervical mucous
role of progesterone
inhibits secrettion of LH
Responsible for infertile (thick) cervical mucus
Maintain thickness of endometrium
Has thermogenic effect (increases basal body temperature)
Relaxes smooth muscles
what can be used to detect ovulation
basal body temp shifts up by 0.2-0.4
cervical mucous and course of cycle
changes across course
important for couples trying to concieve
becomes thin slippery and stretchy during time of ovulation
pre preg optimization
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)
group 1 ovulation disorders
pathology at the level of the hypothalamus
characterised by low gonadal hormone levels - hypogonadotropic hypogonadism
group 2 disorders
have essentially normal gonadal hormones
hypothalamic pituitary dysfunction also
group 3 disorders
describe pathology relating to ovarian function characterised by high gonadal hormones - hypergonadotropic hypogonadism
high gonadal hormones
hypothalmic related ovulatory disorder assoc
assoc with amenorrhoea
low levels FSH/LH
low levels esrtogen
hypogonadotrophic hypogonadism
10% of disorders
progesterone challenge test
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
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]
management of hypothalmic disorders
Gonadotropins to induce ovulation in fertility cases.- daily injections
Pulsatile GnRH therapy to stimulate natural hormone production
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
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
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
ovarian causes of ovarian disorders
5% ovulatory disorder
Amenorrhea
Menopausal
High levels gonadotrophins
Raised FSH>30IU/L x 2 samples
Low oestrogen levels
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
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)
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
what is seen in many people with PCOS
insulin resistance
give metformin
management of pcos
clomifene citrate
gonadotrophin therapy
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.
