Ovulation Disorders Flashcards
What us oligomenorrhea?
reduction in periods
Less than 9 per year
What is primary amenorrhea?
Failure to start periods by age 16
What is secondary amenorrhea?
Cessation of periods for >6 months
What are physiological causes of amenorrhea?
Pregnancy
Post-menopausal
Whats a classic history for amenorrhoea?
Oestrogen deficiency
weight loss/stress
etc.
Whats classical examination findings for amenorrhoea?
Body habitus/ turners
Visual fields/anosmia
breast development
Hirsutism/acne/androgen excess
What investigations should be done with suspected amenorrhoea?
LH, FSH, Oestradiol
Thyroid function, Prolactin
What other investigations may help with amenorrhoea?
Ovarian ultrasound +/- endometrial thickness
if hirsutism then testosterone
Pituitary function tests
Karyotype if primary with turner’s features
How is hypogonadism identified in females?
Low levels of oestrogen
What is primary hypogonadism?
Problem with ovaries
High LH/FSH - hypergonadotrophic hypogonadism
e.g. premature ovarian failure
What is secondary hypogonadism?
Problem with hypothalamus or pituitary
Low FH/FSH - hypogonadotrophic hypogonadism
e.g. high PRL, hypopituitarism
What is Premature Ovarian Failure (POF)
Amenorrhoea, oestrogen deficiency and elevated gonadotrophins occuring under 40 y/o as a result of loss of ovarian function
What investigation result should be checked for POF?
FSH 430 on 2 separate occasions
What are causes of POF?
Turners syndrome, fragile X
Gene mutations
AI disease e.g. Addisons, thyroid, APS1/2
Latrogenic (radio/chemotheraoy
What is secondary hypogonadism?
Result of hypothalamic or pituitary disease
Characterised by low oestradiol with low/normal LH/FSH
What can cause secondary hypogonadism?
Hypothalamic problems
e.g. Kallman/s syndrome
Idiopathic hypogonadotrophic hypogonadism (IHH)
Pituitary problems
Mischellaneous - Prader-Willi + Haemachromatosis
Describe Kallman’s syndrome?
Genetic disorder - loss of GnRH secretion +/- anosmia
Absence of olfactory bulbs
May be associated with family history
Genetic heterogeneity
What is PCOS?
Polycystic Ovary Syndrome
What are pre-treatments for PCOS?
Life style advice
Folic acid 400mcg/5mg daily
Rubella immune
What can be used for Ovulation induction in PCOS?
Clomifene citrate
Gonadotrophin therapy
Laparoscopic ovarian diathermy
What bad things can be caused by ovarian induction?
Ovarian hyperstimulation
Multiple pregnancy
Ovarian cancer risk increase
What complications can arise from multiple pregnancy?
Hyperemesis
Anaemia
Hypertension
Gestational diabetes
What sign is Dichorionic?
Lambda sign
What sign is monochrionic?
T sign
