Ovulatory Disorders Flashcards
how long are most menstrual cycles?
28-35 days
when does ovulation typically occur?
day 14 of the cycle
what are the two phases of the menstrual cycle?
follicular phase
luteal phase
which phase of the menstrual cycle can vary in length?
follicular phase
luteal phase is ALWAYS 14 days
what is the first day of the menstrual cycle?
the first day of menstruation
what is oligomenorrhoea?
cycles lasting longer than 42 days
what is amenorrhoea?
the complete absence of menstruation
what is primary amenorrhoea?
periods never started
what is secondary amenorrhoea?
periods started but have stopped
what hormone in the HPO axis does the hypothalamus secrete?
GnRH
what does GnRH secretion cause?
LH/FSH secretion from the anterior pituitary
what does LH/FSH secretion cause?
secretion of progesterone and oestrogen
what do low frequency pulses of GnRH stimulate?
FSH release
what do high frequency pulses of GnRH stimulate?
LH release
what does FSH do?
stimulates follicular development
thickens the endometrium
what do peak levels of LH do?
stimulate ovulation
what does LH do?
stimulates development of the corpus lute
thickens the endometrium
what is basal body temperature?
the bodies temperature in the morning before moving or eating
what can cause the basal body temperature to increase?
ovulation
what does the LH surge trigger?
ovulation
when does oestrogen peak?
before ovulation
when does progesterone peak?
following ovulation
what produces progesterone?
the corpus luteum
how is ovulation confirmed?
measuring a midluteal serum progesterone - >30 suggests normal
when should a midluteal serum progesterone be measured?
around day 21
what are the three groups of ovulatory disorders?
group I
group II
group III
what causes group I ovulatory disorders?
hypothalamic or pituitary failure
what are the clinical features of group I ovulatory disorders?
amenorrhoea
low levels of FSH/LH
oestrogen deficiency
how is an oestrogen deficiency identified?
negative progesterone challenge test
what is another name for group I ovulatory disorders?
hypogonadotrophic hypogonadism
what should be done before initiating treatment for group I ovulatory disorders?
stabilise weight
folic acid 400mcg
lifestyle modifications
what do management strategies for group I ovulatory disorders require to see if they are working?
ultrasound monitoring - known as follicle tracking
what are the two possible management strategies for group I ovulatory disorders?
pulsatile GnRH
gonadotrophin daily injections
how does pulsatile GnRH therapy work?
pump worn continuously and a pulse is administered every 90 mins
what is there a risk of with gonadotrophin daily injections?
multiple pregnancies
what is the normal response in a progesterone challenge test?
withdrawal bleed in 7-10 days of stopping taking progesterone
suggests normal oestrogen
what causes group II ovulatory disorders?
hypothalamic pituitary dysfunction
what are the clinical features of group II ovulatory disorders?
oligomenorrhoea or amenorrhoea
normal gonadotrophin
normal oestrogen
what is the main cause of group II ovulatory disorders?
PCOS
what is the first line management of group II ovulatory disorders?
clomiphene citrate
what is the diagnostic criteria for PCOS called?
Rotterdam diagnostic criteria
when is PCOS diagnosed?
if patients meet 2/3 criteria
what are the criteria on the Rotterdam diagnostic criteria for PCOS?
oligomenorrhoea/amenorrhoea
polycystic ovaries on USS
hyperandrogenism
what do many patients with PCOS also suffer from?
insulin resistance
what is another name for group III ovulatory disorders?
ovarian failure
what are the clinical features of ovarian failure?
amenorrhoea
menopause
high gonadotrophin
low oestrogen
how is ovarian failure managed?
HRT
assisted conception
