Ovulation Disorders Flashcards
How long does a regular cycle last
28-35 days
What is the definition of oligomenorrhoea
cycles of more than 35 days apart
What is the definition of amenorrhoea
Absent menstruation
What is GnRH
Gonadotrophin releasing hormone
Where is GnRH synthesised
By neurones in the hypothalamus
What does GnRH stimulate
FSH (low frequency) and LH (high frequency) synthesis / release
Describe the release of GnRH
Pulsatile
What are the 2 functions of FSH
Stimulate follicle development and thicken endometrium
What stimulates ovulation
Surge of LH levels
What hormone peaks before ovulation
Estradiol
What hormone peaks rolling ovulation
Progesterone
What secretes oestrogen
The ovaries and adrenal cortex
What does oestrogen do
Stimulates thickening of the endometrium
Causes thinning of the cervical mucus
What does high oestrogen concentrations inhibit
secretion of FSH and prolactin
What does high oestrogen concentration stimulate
secretion of LH
What secretes progesterone
Corpus luteum
What does progesterone inhibit
Secretion of LH (negative feedback)
What are some of the functions of progesterone
Thickens cervical mucus
Maintains thickness of endometrium
Has thermogenic effect (increases basal body temperature)
Relaxes smooth muscles
What are regular cycles suggestive of
ovulation
What percentage of infertile couples are affected by ovulatory dysfunction
25%
What does hypothalamic pituitary failure cause
Hypogonadotrophic hypogonadism
Why are there low levels of FSH /LH in hypothalamic pituitary failure
No stimulation at the pituitary level to produce them
What is a symptom of hypothalamic pituitary failure
Amenorrhoea
What are some causes of hypothalamic pituitary failure
Stress excessive exercise (olympic athletes) Anorexia / low BMI Brain/ pituitary tumours Head trauma Kallman's syndrome Drugs (opiates, steroids)
What are some of the management options of hypothalamic involution
Stabilise weight to above 18.5
Daily injection of gonadotrophin
Ultrasound monitoring of response
What happens in hypothalamic pituitary dysfunction
Inability to read signals that come from the pituitary
How many of all ovulatory disorders ar caused by hypothalamic pituitary dysfunction
85%
Describe the periods for someone with Hypothalamic pituitary dysfunction
Mixed pattern - none or irregular periods
What is a main cause of hypothalamic pituitary dysfunction
PCOS
How can we diagnose a patient with polycystic ovary syndrome
2 of:
oligo/amenorrhoea
US appearance of PCOS
Clinical / biochemical signs of hyperandrogenism
How does insulin have an effect on sex hormones
It lowers the sex hormone binding globulins
How common is insulin resistance in PCOS
50-80% of patients
How can we manage PCOS
Depends on the patients symptoms/ needs
What are some of the pre treatment options for PCOS
weight loss smoking cessation no alcohol folic acid 400mcg rubella immunity check prescribed drugs
How can we induce ovulation in PCOS
Clomifene citrate Gonadotrophin therapy (daily injections) Laparoscopic ovarian diathermy
What is the first line treatment for inducing ovulation
Clomifene citrate
What can we use in patients who have clomifene resistance
Metformin
Gonadotrophin therapy
Laparoscopic ovarian drilling
Assisted conception e.g. IVF
What percentage of patients do not ovulate on Clomifene
15-20%
What is the advantages of using metformin for inducing ovulation
Improves insulin resistance and therefore an increase in sex hormones should occur
reduces androgen production
What are the 3 main risks of ovulation induction
Ovarian hyperstimulation
multiple pregnancies
?Risk of ovarian cancer
How serious sis ovarian hyper stimulation?
You can become critically unwell or die from it
What are some of the risks of ovarian hyper stimulation
Age of less than 35
PCOS
What are some of the increased risk of a multiple pregnancy
Hyperemesis (morning sickness) Anaemia Hypertension / pre-eclampsia Gestational diabetes Mode of delivery - more likely to be c section Postnatal depression / stress early and late miscarriage low birth weight prematurity disability stillbirth / neonatal death twin-twin transfusion syndrome (TTTS)
If a US scan is lambda present, what does this mean
The pregnancy is dichorionic
What does it mean if there is a T present in the US
Monochorionic
What causes twin-twin tranfusion syndrome
Unbalanced vascular communications within placental bed
What are the treatment options for TTTS
laser division of placental vessels
Amnioreduction
Septostomy
What could happen if TTTS is left untreated?
Both babies could die
What are some short term problems with prematurity
Neonatal ICU
Require help with breathing
Respiratory distress syndrome
What are some long term problems of prematurity
Cerebral palsy Impaired sight congenital disease low IQ ADHD SALT required for language development
What are 3 important aspects of the history in hyperprolactinaemia
Amenorrhoea
Galactorrhoea
Current medication
What should be examined in hyperprolactinaemia
visual fields
What investigations should be carried out for hyperprolactinaemia
Normal FSH/LH
Low oestrogen
Raised serum prolactin
MRI to diagnose Micro/macro prolactinoma
What is the treatment for hyperprolactinaemia
Dopamine antagonist e.g. cabergoline twice weekly
What can be found in ovarian failure
High levels of gonadotrophins (raised FSH)
Low oestrogen
Amenorrhoea
Menopausal
What are some genetic causes of premature ovarian failure
Turner Syndrome
XX gonadal agenesis
Fragile X
What is the treatment for premature ovarian failure
HRT
Egg or embryo donation
Ovary/ egg/ embryo cryopreservation prior to cancer treatment
What are some important factors of taking a gynaecological history
Details of menstrual cycle amenorrhoea hirsuitism acne galactorrhoea headaches visual symptoms PMHx DHx
What is a normal response to the progesterone challenge test
Menstrual bleed in response to a five day course of progesterone (indicates oestrogen levels normal)
What would we want to look at measuring if the patient is not ovulation
The serum FSH, LH and estradiol levels
