Ovulation Disorders Flashcards
Oligomenorrhea.
Reduction in frequency of periods to >9 a year (cycles >35 days)
Primary amenorrhea.
Failure of menarche by the age of 16 years
Secondary amenorrhea.
Cessation fo periods for >6 months in an individual who has previously menstruated
What are the physiolgical causes of amenorrhea?
Pregancy or post-menopausal
Give the causes of primary amenorrhea?
Congenital problems:
Turner’s syndrome
Kallman’s syndrome
What can cause seconary amenorrhea?
Ovarian problem
Uterine problem
Hypothalamic dysfunction
What should be looked at in someone who presents with amenorrhea?
Body shape - Turner's Visual fields Ansomia - Kallman's Breast development Hirsuitism - PCOS Acne - PCOS Galactorrhoea - hypopituitarism/ pituitary tumour
What symptoms are suggestive of oestrogen deficiency?
Flushing
Libido
Dyspareunia
What investigations do all that present with oligo/amenorrhea undergo?
LH FSH Oestradiol TFT's Prolactin
What additional investigations can be used to determine the cause of oligo/amenorrhea?
Ovarian US +/- endometrial thickness
Testosterone - if hirsuitism
Pituitary funtion tests and MRI pituitary - if hpituitary problem suspected
Karyotype - Turner’s syndrome
In terms of LH/FSH how does primary hypogonadism preset and what can cause it?
High LH/FSH - hypergonatrophic hypogonadism
Premature ovarian failure
In terms of LH/FSH how does secondary hypogonadism preset and what can cause it?
Low/ normal LH/FSH and low oestradiol
Problem with hypothalamus or pituitary
What are the signs of premature ovarian failure?
Secondary amenorrhea
Oestrogen deficiency
Elevated gonadotrophins occurring < 40 years of age
How is premature ovarian failure diagnosed?
FSH 430 on 2 separate occasions >1 month apart
What can cause premature ovarian failure?
Chromosomal abnormalities (e.g. Turner’s syndrome, Fragile X) Gene mutations (e.g. FSH receptor/LH receptor) Autoimmune disease (e.g. association with Addison’s, thyroid, APS1/2) Iatrogenic (radiotherapy/chemotherapy)
What is secondary hypogonadism?
Hypogonadism as a result of hypothalamic or pituitary disease
What can cause secondary hypogonadism?
Hypothalamic problem (Functional hypothalamic disorders, Kallman’s syndrome, Idiopathic hypogonadotrophic hypogonadism (IHH), Pituitary problems)
Pituitary problems
Prader-Villi
Haemochromatosis
Give causes of functional hypothalamic amenorrhea?
Anabolic steroids Systemic illness Iatrogenic (surgery/radiotherapy) Recreational drugs Head Trauma Infiltrative disorders e.g sarcoidosis
What is Kallman’s syndrome?
A genetic disorder characterised by a loss of GnRH secretion +/- anosmia
How does pituitary dysfunction present in terms of LH/FSH?
Loss of LH/FSH stimulation leads to low or low normal LH/FSH and low oestradiol
What is the most common cause of hirsutism?
PCOS
What is Turner’s syndrome?
Women with Turner syndrome are XO
To diagnose PCOS, the Rotterdam criteria is used. What is it?
At least 2 of:
Menstrual irregularity
Hyperandrogenism (hirsutism, elevated free testosterone)
Polycystic ovaries
What cases Hirsuitism?
Due to excess circulating androgencausing increased peripheral conversion at the hair follicle
Give some clinical features of Turner’s syndrome?
Short stature Webbed neck Shield chest with wide spaced nipples Low hairline Underdeveloped breasts Lymphoedema
What is Congenital Adrenal Hyperplasia?
an inherited group of disorders characterized by a deficiency in one of the enzymes necessary for cortisol synthesis
