Ovulation Disorders Flashcards
how long does bleeding normally occur?
3-8 days
define oligomenorrhoea
infrequent menstrual periods - >35 days
define amenorrhoea
absent menstruation
amenorrhoea can either….
primary or secondary
progesterone only exerts negative feedback on the _________ whereas estradiol exerts it on the ____________ and _________
progesterone only exerts negative feedback on the PITUITARY whereas estradiol exerts it on the HYPOTHALAMUS and PITUITARY
GnRH stimulates what 2 things?
FSH and LH
low frequency pulses =
high frequency pulses =
low frequency pulses = FSH
high frequency pulses = LH
name the hormone:
secreted by anterior pituitary
stimulates follicular development
thickens endometrium
FSH
name that hormone:
secreted by anterior pituitary
peak stimulates ovulation
stimulates corpus luteum development
thickens endometrium
LH
ovulation predictor kits detects a surge of what?
LH
name that hormone:
peaks before ovulation
estradiol
name that hormone:
peaks after ovulation
progesterone
name that hormone:
produced by corpus luteum
progesterone
name that hormone:
secreted primarily by the ovaries (follicles) and adrenal cortex (and placenta in pregnancy)
stimulates thickening of the endometrium
responsible for the fertile cervical mucus
high estrogen concentration inhibits secretion of FSH and prolactin (-ve feedback)
estrogen
name that hormone:
inhibits secretion of LH
responsible for infertile (thick) cervical mucus
maintain thickness of endometrium
has thermogenic effect (increases basal body temperature)
relaxes smooth muscles
progesterone
what is the WHO group I classification of ovulation disorder?
hypothalamic pituitary failure
hypothalamic pituitary failure other name?
hypogonadotrophic hypogonadism
low FSH low LH oestrogen deficiency normal prolactin amenorrhoea
diagnosis?
hypogonadotrophic hypogonadism
what causes hypogonadotrophic hypogonadism?
stress excessive exercise low BMI brain/pituitary tumours head trauma kallman's syndrome drugs - steroids and opiates
hypogonadotrophic hypogonadism management?
stabilise weight
pulsatile GnRH - SC or IV
need US monitoring
what is the WHO group II classification of ovulation disorder?
hypothalamic pituitary dysfunction
normal gonadotrophins
excess LH
normal oestrogen levels
oligo/amenorrhoea
diagnosis?
PCOS
what is the diagnostic criteria for PCOS called?
rotterdam
oligo/amenorrhoea
polycystic ovaries
clinical/biochemical signs
resistance to what is seen in PCOS?
insulin
PCOS pre-treatment?
weight loss
lifestyle - smoking alcohol
folic acid
rubella immune
patent fallopian tube
name the 3 parts to ovulation induction in PCOS
clomifene citrate
gonadotrophin therapy by daily injections
laparoscopic ovarian diathermy
for those who do not ovulate on clomifene, what other drug options are there?
metformin
FSH injections
laparoscopic ovarian drilling
assisted conception treatment
name some increased maternal pregnancy complication in multiple pregnancies
hyperemesis anaemia hypertension pre-eclampsia diabetes depression/stress
Increased risk of:
early and late miscarriage low birth weight (<2.5kg) prematurity disability twin-twin transfusion syndrome (TTTS)
are all seen in what?
multiple pregnancy
difference between monochorionic and dichorionic?
dichorionic - each baby has a separate placenta and is inside a separate sac which has its own outer membrane (chorion)
monochorionic - babies share a placenta and chorion
name the scan finding in dichorionic twins
lambda sign
name the scan finding in monochorionic twins
T sign
TTTS treatment?
laser division of placental vessels
amnioreduction
septostomy
common syndrome seen in premature babies?
RDS - respiratory distress syndrome
common problems in premature twins?
cerebral palsy impaired sight congenital heart disease lower IQ ADHD speech development
amen/galactorrhoea visual fields normal FSH/LH low oestrogen Raised serum prolactin >1000 iu/l on 2 or more occasions TFT normal MRI to diagnose
diagnosis?
hyperprolactinaemia
hyperprolactinaemia drug treatment?
dopamine agonist
name a dopamine agonist
cabergoline
when should dopamine agonists be stopped?
when pregnancy occurs
what is the WHO group III classification of ovulation disorder?
ovarian failure
high level gonadotrophin
low oestrogen level
amenorrhea
menopausal
diagnosis?
ovarian failure
before what age classes premature ovarian failure?
age 40
premature ovarian failure treatment?
hormone replacement therapy
egg/embryo donation
counselling/support
what is the progesterone challenge test?
menstrual bleed in response to a five day course of progesterone: indicates estrogen levels normal
what investigation is good for examining the pelvic anatomy?
US
