Ovulation Problems

Question 1

Why does anorexia nervosa/bulimia cause periods to stop?

Answer 1

Reduced GnRH -> reduced LH and FSH

is described as a hypothalamic cause

Question 2

How can anorexia nervosa affect hair on body?

Answer 2

Head hair can become brittle and fall out

Lanugo (fine hair) can grow all over bod

Question 3

What is the commonest endocrine condition in women? - it causes menstural cycle abnormalities

Answer 3

PCOS - affects 15% of women

Question 4

How is PCOS diagnosed?

Answer 4

2/3 of the following

• chronic anvoulation
• polycystic ovaries
• hyperandrogenism

Question 5

What genetic condition is premature ovarian failure associated with?

Answer 5

Turner’s syndrome

Question 6

What is the first line of treatment for PCOS in fertility?

Answer 6

Clomifene citrate (tablet taken daily on days 2-6)

Question 7

What is laproscopic ovarian diathermy?

What condition is it used as last line of treatment in?

Answer 7

AKA ovarian drilling

Involves laproscopic surgery to laser into ovaries -> improved hormonal profile ->

PCOS

Question 8

How is acne and hirstism managed in PCOS?

Answer 8

Combined oral contraceptive

Question 9

How long is the average menstrual cycle?

Answer 9

28-35 days

Question 10

What is the difference between primary and secondary amenorrhea?

Answer 10

Primary - never started

Secondary - periods started and now stopped

Question 11

Define oligomenorrhea

Answer 11

Periods >35 days/ <8 periods a year

Question 12

What are the three categories of ovulation problems?

Describe the LH and FSH levels that come with each

What category causes 85% of ovulatory problems?

Answer 12

Group I - HYPOTHALAMIC
- low FSH and LH

Group II - PITUITARY- HYPOTHALAMIC (85% of problems)
- normal FSH and LH

Group III - OVARIAN FAILURE
- high FSH and LH

Question 13

What would the periods be like in someone with hypothalamic cause of ovulatory problems?

Answer 13

Amenorrhea (absent periods)

Question 14

PCOS can also lead to insulin resistance (which in turn leads to increased blood sugar and ~T2DM esp. in overweight patients).

Describe the link between IR and hyperandrogenism

Answer 14

IR -> increase in insulin -> decreases SHBG (sex hormone binding globulin) -> increase free testosterone -> acne and hiristism

Question 15

When in the cycle should progesterone be measured to ensure ovulation has taken place?

Answer 15

Day 21

Question 16

When in the cycle should LH and FSH be measured to confirm what kind of avulation a patient has?

Answer 16

Early follicular phase - day 2-6

Question 17

How is hypothalamic causes of anvulation managed?

Answer 17

Pulsatile GnRH

Gonadotrophin injections daily

Question 18

What kind of periods do women with PCOS get?

Answer 18

Majority oligomenorrhoea

Question 19

What is premature ovarian failure?

What genetic condition is it assoc. with?

Answer 19

Early menopause (<40 yo)

Turner’s syndrome

Question 20

What charity can women suffering from premature ovarian failure get referred to?

Answer 20

Daisy Network

Question 21

How is premature ovarian failure managed?

Answer 21

HRT (hormone replacement treatment)

Egg/embryo donation