Ovulation Disorders- Types 2 and 3 Flashcards
What is the main type 2 ovulation disorder?
PCOS
What type of gonadotrophin gonadism is type 2?
Normogonadotrophic hypogonadism
Do type 2 ovulation disorders present with amenorrhoea, oligomenorrhoea or either?
Can be either
What are the oestrogen levels like in type 2 ovulation disorders?
Normal
PCOS is an inherited syndrome, exacerbated by what?
Weight gain
PCOS is diagnosed by having 2/3 of the Rotterdam criteria, what are these?
Oligo/amenorrhoea, polycystic ovaries, biochemical or clinical signs of hyperandrogenism
What are the two main clinical signs of hyperandrogenism?
Acne, hirsutism
What test is most useful to visualise ovarian cysts?
Ultrasound
What defines polycystic ovaries?
Increased ovarian volume (> 10ml), more than 12 follicles between 2-8mm in diameter, unilateral or bilateral
What are the levels of testosterone in PCOS? This feeds back on the pituitary which can lead to what?
High testosterone, can lead to insulin resistance
What are the levels of insulin in PCOS? What effect does this have on sex-hormone binding globulin?
High insulin- decreases SHBG
Decreased SHBG in PCOS results in what?
Increased free testosterone and hyperandrogenism
What are the 5 main symptoms of PCOS?
Obesity, hirsutism, acne, cycle abnormalities, infertility
Symptoms of PCOS get worse as weight increases. What are the first line treatments?
Weight loss and metformin
What are the levels of LH/FSH in PCOS?
High LH, normal FSH
What will the levels of progesterone be in PCOS?
Low
What are some ways to manage symptoms in a patient with PCOS?
Anti-androgens, contraceptive pill
When can anti-androgens cause a problem?
If the patient gets pregnant and the foetus is male
What should be given to women with PCOS who do not want to get pregnant?
Endometrial protection 4 times a year
What lifestyle modifications are used for pre-treatment to aid fertility in women with PCOS?
Weight loss, stop smoking, decrease alcohol
What supplement should be given in women with PCOS trying to get pregnant? What should you make sure they are immunised against?
Folic acid 5mg. Immunise against rubella.
What is the first line treatment for ovulation induction in PCOS?
Clomifene citrate: 50/100/150mg tablets day 2-6
If clomifene citrate treatment fails in PCOS, what can be used instead?
Metformin, gonadotrophin therapy, laparoscopic ovarian diathermy
What is given as gonadotrophic therapy if required in PCOS? What are the risks of this?
Daily injections of recombinant FSH. Risks include multiple pregnancy and ovarian hyper stimulation.
What is the main risk of laparoscopic ovarian diathermy? What is the advantage of this?
Ovarian destruction. The main advantage is singleton pregnancies.
Along with lifestyle modification, what are the advantages of metformin in PCOS?
Improve insulin resistance, reduced androgen production, restore menstruation and ovulation
What are the downsides of metformin in PCOS?
Does not help weight loss and may increase pregnancy rate
What are the 3 main risks of ovarian induction?
Hyperstimulation, multiple pregnancies and increased risk of ovarian cancer
When are you more likely to have ovarian hyper stimulation?
< 35 or if you have PCOS
What are the main risks associated with multiple pregnancies?
Increased risk of maternal complications, increased risk of foetus complications, risk of disability, increased postnatal depression, twin twin transfusion syndrome
When is the risk of ovarian cancer greatest in ovarian induction?
If fertility treatment is used for more than 12 months
If the problem is pituitary dysfunction, what will be the levels of LH/FSH/oestrogen?
LH and FSH = low/normal, oestrogen = low
What are some causes of loss of LH/FSH stimulation?
Non-functioning pituitary adenoma, empty sella or pituitary infarction
What will be the main presenting features of hyperprolactinaemia?
Amenorrhoea and galactorrhoea
What is a really important cause of hyperprolactinaemia which should be considered?
Drugs
What exams/tests should be done in a case of hyperprolactinaemia?
Visual fields, hormone levels and pituitary MRI
What will be the levels of LH/FSH/oestrogen in hyperprolactinaemia?
LH/FSH = normal, oestrogen = low
How should hyperprolactinaemia be managed? When should this be stopped?
Dopamine agonist- stop if patient becomes pregnant
What type of gonadotrophic gonadism is type 3 ovarian disorder?
Hypergonadotrophic hypogonadism
What is the main issue in group 3 ovarian disorders?
Premature ovarian failure
What are group 3 ovarian disorders?
Ovarian failure
What will the level of oestrogen be in premature ovarian failure?
Low
What will the levels of LH/FSH be in premature ovarian failure?
High
What is premature ovarian failure?
The menopause aged < 40
What FSH is diagnostic of premature ovarian failure?
> 30 on two separate occasions, more than 1 month apart
What are some causes of premature ovarian failure?
Idiopathic, chromosomal, autoimmune, iatrogenic
How can a mosaic of Turner’s syndrome present?
Secondary amenorrhoea (premature ovarian failure)
What are some symptoms of premature ovarian failure?
Hot flushes, night sweats, atopic vaginitis
As well as hormone levels, what are some other tests which may be useful in premature ovarian failure?
Karyotyping, DEXA scan, pituitary MRI
How do you treat premature ovarian failure?
Counselling, hormone replacement, oocyte donation, prevention of osteoporosis
Group 3 ovarian disorders can also be caused by what, as well as premature ovarian failure? Give examples.
Congenital problems: absence of a uterus or vaginal atresia. Also Turner’s, CAH, testicular feminisation.
