Ovulation disorders

Question 1

what hormone peaks before ovulation

Answer 1

estradiol

Question 2

what does a pregnancy test decte

Answer 2

LH surge

Question 3

function of FSH

Answer 3

thickens endometrium
stimulates follicular development

Question 4

what is FSH and lH secreted from

Answer 4

anterior pituitary

Question 5

what stimulates FSH and LH

Answer 5

gonadotrophin releasing hormone

Question 6

role of LH

Answer 6

peak level stimulate ovulation
stimulates corpus luteum development

Question 7

phases of ovulation

Answer 7

follicular phase -1st
ovulation
luteal phase-2nd

Question 8

oligomenorrhea

Answer 8

cycles lasting >42 days , 8 periods a year

Question 9

what are ovulation disorders associated with

Answer 9

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

Question 10

predominant hormone in second phase

Answer 10

progesterone

Question 11

what is progesterone produced by

Answer 11

corpus luteum

Question 12

regular period cycles

Answer 12

28- 35 days

Question 13

where is gnrh released from

Answer 13

hypothalamus

Question 14

what is estrogen secreetd by

Answer 14

ovaries and adrenal cortex and placenta in pregnancy

Question 15

role of estrogen

Answer 15

thickening of endometrium
fertile cervical mucous

Question 16

role of progesterone

Answer 16

inhibits secrettion of LH

Responsible for infertile (thick) cervical mucus

Maintain thickness of endometrium

Has thermogenic effect (increases basal body temperature)

Relaxes smooth muscles

Question 17

what can be used to detect ovulation

Answer 17

basal body temp shifts up by 0.2-0.4

Question 18

cervical mucous and course of cycle

Answer 18

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

Question 19

pre preg optimization

Answer 19

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)

Question 20

group 1 ovulation disorders

Answer 20

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

Question 21

group 2 disorders

Answer 21

have essentially normal gonadal hormones
hypothalamic pituitary dysfunction also

Question 22

group 3 disorders

Answer 22

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

Question 23

hypothalmic related ovulatory disorder assoc

Answer 23

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

Question 24

progesterone challenge test

Answer 24

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

Question 25

causes of hypothalmic disorders

Answer 25

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]

Question 26

management of hypothalmic disorders

Answer 26

Gonadotropins to induce ovulation in fertility cases.- daily injections

Pulsatile GnRH therapy to stimulate natural hormone production

Question 27

pituitary related disorders assoc

Answer 27

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

Question 28

hyperprolactinaemia ovarian disorder assoc

Answer 28

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

Question 29

hyperprolactinaemia management

Answer 29

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

Question 30

ovarian causes of ovarian disorders

Answer 30

5% ovulatory disorder
Amenorrhea
Menopausal

High levels gonadotrophins
Raised FSH>30IU/L x 2 samples
Low oestrogen levels

Question 31

premature ovarian insufficiency

Answer 31

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

Question 32

ROTTERDAM diagnostic criteria for PCOS

Answer 32

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)

Question 33

biggest cause of ovulatory disorders

Answer 33

PCOS
Oligo/amenorrhoea

Normal gonadotrophins / excess LH

Normal oestrogen levels
PCOS (5 – 15% women of reproductive age)
10-20% amenorrhoea
80-90% oligomenorrhoea

Question 34

what is seen in many people with PCOS

Answer 34

insulin resistance
give metformin

Question 35

management of pcos

Answer 35

clomifene citrate
gonadotrophin therapy

Question 36

laparoscopic ovarian diathermy

Answer 36

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.