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SM Endocrine > Ovulation Disorders > Flashcards

Ovulation Disorders Flashcards

1
Q

How long does a regular cycle last

A

28-35 days

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2
Q

What is the definition of oligomenorrhoea

A

cycles of more than 35 days apart

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3
Q

What is the definition of amenorrhoea

A

Absent menstruation

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4
Q

What is GnRH

A

Gonadotrophin releasing hormone

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5
Q

Where is GnRH synthesised

A

By neurones in the hypothalamus

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6
Q

What does GnRH stimulate

A

FSH (low frequency) and LH (high frequency) synthesis / release

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7
Q

Describe the release of GnRH

A

Pulsatile

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8
Q

What are the 2 functions of FSH

A

Stimulate follicle development and thicken endometrium

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9
Q

What stimulates ovulation

A

Surge of LH levels

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10
Q

What hormone peaks before ovulation

A

Estradiol

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11
Q

What hormone peaks rolling ovulation

A

Progesterone

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12
Q

What secretes oestrogen

A

The ovaries and adrenal cortex

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13
Q

What does oestrogen do

A

Stimulates thickening of the endometrium

Causes thinning of the cervical mucus

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14
Q

What does high oestrogen concentrations inhibit

A

secretion of FSH and prolactin

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15
Q

What does high oestrogen concentration stimulate

A

secretion of LH

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16
Q

What secretes progesterone

A

Corpus luteum

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17
Q

What does progesterone inhibit

A

Secretion of LH (negative feedback)

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18
Q

What are some of the functions of progesterone

A

Thickens cervical mucus
Maintains thickness of endometrium
Has thermogenic effect (increases basal body temperature)
Relaxes smooth muscles

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19
Q

What are regular cycles suggestive of

A

ovulation

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20
Q

What percentage of infertile couples are affected by ovulatory dysfunction

A

25%

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21
Q

What does hypothalamic pituitary failure cause

A

Hypogonadotrophic hypogonadism

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22
Q

Why are there low levels of FSH /LH in hypothalamic pituitary failure

A

No stimulation at the pituitary level to produce them

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23
Q

What is a symptom of hypothalamic pituitary failure

A

Amenorrhoea

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24
Q

What are some causes of hypothalamic pituitary failure

A 
Stress
excessive exercise (olympic athletes)
Anorexia / low BMI
Brain/ pituitary tumours 
Head trauma 
Kallman's syndrome 
Drugs (opiates, steroids)
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25
Q

What are some of the management options of hypothalamic involution

A

Stabilise weight to above 18.5
Daily injection of gonadotrophin
Ultrasound monitoring of response

26
Q

What happens in hypothalamic pituitary dysfunction

A

Inability to read signals that come from the pituitary

27
Q

How many of all ovulatory disorders ar caused by hypothalamic pituitary dysfunction

A

85%

28
Q

Describe the periods for someone with Hypothalamic pituitary dysfunction

A

Mixed pattern - none or irregular periods

29
Q

What is a main cause of hypothalamic pituitary dysfunction

A

PCOS

30
Q

How can we diagnose a patient with polycystic ovary syndrome

A

2 of:
oligo/amenorrhoea
US appearance of PCOS
Clinical / biochemical signs of hyperandrogenism

31
Q

How does insulin have an effect on sex hormones

A

It lowers the sex hormone binding globulins

32
Q

How common is insulin resistance in PCOS

A

50-80% of patients

33
Q

How can we manage PCOS

A

Depends on the patients symptoms/ needs

34
Q

What are some of the pre treatment options for PCOS

A 
weight loss 
smoking cessation 
no alcohol
folic acid 400mcg 
rubella immunity 
check prescribed drugs
35
Q

How can we induce ovulation in PCOS

A 
Clomifene citrate 
Gonadotrophin therapy (daily injections)
Laparoscopic ovarian diathermy
36
Q

What is the first line treatment for inducing ovulation

A

Clomifene citrate

37
Q

What can we use in patients who have clomifene resistance

A

Metformin
Gonadotrophin therapy
Laparoscopic ovarian drilling
Assisted conception e.g. IVF

38
Q

What percentage of patients do not ovulate on Clomifene

A

15-20%

39
Q

What is the advantages of using metformin for inducing ovulation

A

Improves insulin resistance and therefore an increase in sex hormones should occur
reduces androgen production

40
Q

What are the 3 main risks of ovulation induction

A

Ovarian hyperstimulation
multiple pregnancies
?Risk of ovarian cancer

41
Q

How serious sis ovarian hyper stimulation?

A

You can become critically unwell or die from it

42
Q

What are some of the risks of ovarian hyper stimulation

A

Age of less than 35

PCOS

43
Q

What are some of the increased risk of a multiple pregnancy

A 
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)
44
Q

If a US scan is lambda present, what does this mean

A

The pregnancy is dichorionic

45
Q

What does it mean if there is a T present in the US

A

Monochorionic

46
Q

What causes twin-twin tranfusion syndrome

A

Unbalanced vascular communications within placental bed

47
Q

What are the treatment options for TTTS

A

laser division of placental vessels
Amnioreduction
Septostomy

48
Q

What could happen if TTTS is left untreated?

A

Both babies could die

49
Q

What are some short term problems with prematurity

A

Neonatal ICU
Require help with breathing
Respiratory distress syndrome

50
Q

What are some long term problems of prematurity

A 
Cerebral palsy 
Impaired sight 
congenital disease 
low IQ 
ADHD
SALT required for language development
51
Q

What are 3 important aspects of the history in hyperprolactinaemia

A

Amenorrhoea
Galactorrhoea
Current medication

52
Q

What should be examined in hyperprolactinaemia

A

visual fields

53
Q

What investigations should be carried out for hyperprolactinaemia

A

Normal FSH/LH
Low oestrogen
Raised serum prolactin
MRI to diagnose Micro/macro prolactinoma

54
Q

What is the treatment for hyperprolactinaemia

A

Dopamine antagonist e.g. cabergoline twice weekly

55
Q

What can be found in ovarian failure

A

High levels of gonadotrophins (raised FSH)
Low oestrogen
Amenorrhoea
Menopausal

56
Q

What are some genetic causes of premature ovarian failure

A

Turner Syndrome
XX gonadal agenesis
Fragile X

57
Q

What is the treatment for premature ovarian failure

A

HRT
Egg or embryo donation
Ovary/ egg/ embryo cryopreservation prior to cancer treatment

58
Q

What are some important factors of taking a gynaecological history

A 
Details of menstrual cycle 
amenorrhoea 
hirsuitism
acne 
galactorrhoea
headaches 
visual symptoms 
PMHx
DHx
59
Q

What is a normal response to the progesterone challenge test

A

Menstrual bleed in response to a five day course of progesterone (indicates oestrogen levels normal)

60
Q

What would we want to look at measuring if the patient is not ovulation

A

The serum FSH, LH and estradiol levels

SM Endocrine (27 decks)

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