Ovulatory Disorders Flashcards
what is oligmenorrhea?
cycles > 35 days
what is amenorrhea
no menstruation
what does GnRH do?
stimulate FSH and LH synthesis and release
what does FSH do?
follicular development
thickens endometrium
what does LH do?
stimulate ovulation
stimulate corpus luteum development
thickens endometrium
when does estradiol peak?
before ovulation
when does progesterone peak?
after ovulation
what does oestrogen do?
thickens endometrium
makes fertile cervical mucus
what does progesterone do?
makes infertile thick mucus
maintains endometrium thickness
increases basal body temp
relaxes smooth muscles
how can you confirm regular cycles?
midluteal serum progesterone (should be >30nmol/L) take 2 samples
group 1 WHO classification ovulatory disorders
hypothalamic pituitary failure
what type of ovulatory disorder is hypogonadotrophic hypogonadism
hypothalamic pituitary failure (group 1)
is there oestrogen deficiancy in hypogonadotrophic hypogonadism and low FSH and LH?
yes
what can cause hypogonadotrophic hypogonadism?
stress too much exercise anorexia brain/pituitary tumours head trauma kallmans syndrome drugs-steroid, opitaes
how can you manage hypogonadotrophic hypogonadism?
stabalise weight
gonadotrophin (FSH and LH) daily injections -needs Ultrasound monitoring
group 2 WHO classification ovulatory disorders
Hypothalamic pituitary dysfunction
what type of disorders account for most (85%) of ovulatory disorders?
Hypothalamic pituitary dysfunction
what is the main/ most common Hypothalamic pituitary dysfunction?
PCOS
is insulin resistance seen in PCOS?
YES- in 50-80% of cases
what is the first line treatment for ovulation induction in PCOS?
clomifene citrate
this can also be taken with metformin to improve insulin resistance
second treatment of ovulation induction in PCOS?
gonadotrophin injections (daily)
last resort treatment for ovulation induction in PCOS?
laparoscopic ovarian diatherny
risk of ovulation induction
multiple pregancy
ovarian hyperstimulation
ovary destruction
risk of multiple pregnancy
increase maternal complications increase miscarriage increase low birth weight increase prmaturity increase disability increase still birth
twin twin transfusion syndrome
lambda sign on USS
dichorionic
T sign on USS
monochorionic
what causes twin twin transfusion syndrome?
unbalanced vascular communications within placental bed- recipient gets more stuff so gets bigger, grows better and the donor has growth restriction
long term disabilities due to prematurity?
cerebral palsy
impaired eye sight
congenital heart disease
struggle with language development
medical treatment for hyperprolactinaemia?
dopamine agonist
group 2 WHO classification ovulatory disorders
ovarian failure
menopause before 40
premature ovarian failure
how do you treat premature ovarian failure?
hormone replacement
in the progesterone challenge test, if you bleed within 5 day course of progesterone what does this mean|?
oestrogen levels are normal
what is primary amenorrhea?
failure of menarche by age 16
what is secondary amenorrhea?
cessation of periods >6 months in an individual who previously menstruated
what can cause functional hypothalamic amenorrhea?
iatrogenic weight change stress exercise anabolic steroid systemic illness infiltrative disorders e.g sarcoidosis head trauma recreational drugs
what hormones should be checked in someone with oligo/amenorrhea?
LH FSH Oestradial thyroid function tests prolactin testosterrone if hairy/acne
difference between primary and secondary hypogondism?
primary- problem with ovaries, high FSH/LH e.g premature ovarian failure
secondary-problem with hypo/pit. low FSH/LH e.g high prolactin/hypopituitarism
what happens in kallmans syndrome?
loss of GnRH secretion and ansmia or hyposmia
common causes of hyperprolactinemia?
prolactinomas
drugs
hypothyroidism
idiopathic
what is hirsutism?
excess hair, females usually get it
short stature
webbed neck
shield chest, wide spaced nipples
XO chromosome
turners syndrome
difference between primary and secondary male hypogonadism?
primary- low testosterone with high LH and FSH
secondary- low testosterone and low LH and FSH
usually pituitary/hypo disease
what is the most common cause of male hypogonadism?
Klinefelters syndrome
reduced testicular volume
gynaecomastia
eunuchoidism
low testosterone, high LH and FSH
Klinefleters syndrome
health benefits of testosterone therapy?
improved sex function improved bone health decrease fat mass increase muscle strength small improvement in insulin sensitivity
causes of gynaecomastia?
drugs physiological hypogonadism tumours endocrine disorders systemic illness hereditary
