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Endocrine: Reproductive Glands > Ovulatory Disorders > Flashcards

Ovulatory Disorders Flashcards

1
Q

what are ovulatory disorders associated with?

A

oligomenorrhoea

amenorrhoea

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2
Q

define oligomenorrhoea

A

cycle lasting more than 35 days

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3
Q

define amenorrhoea

A

absent menstruation

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4
Q

two types of amenorrhoea

A

primary- never had a period

secondary- used to have periods but have now stopped

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5
Q

three groups of anovulatory disorders

A
  1. hypothalamic pituitary failure (hypogonadotropic hypogonadism)
  2. hypothalamic pituitary dysfunction
  3. ovarian failure
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6
Q

describe hypothalamic pituitary failure

A

no GnRH secretion leading to no FHS/LH and oestrogen
normal prolactin
amenorrhoea

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7
Q

diagnosis of hypothalamic pituitary failure (using a challenge test)

A

negative progesterone challenge

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8
Q

causes of hypothalamic pituitary failure

A 
stress
excessive exercise
low BMI
tumours
trauma
Kallman's syndrome
drugs (steroids and opiates)
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9
Q

pre-treatment management of hypothalamic pituitary failure

A 
stabilise weight
lifestyle (smoking and alcohol)
folic acid
check prescribed drugs
rubella immunity (IgG)
chlamydia analysis (azithromycin)
normal semen analysis
patent Fallopian tubes
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10
Q

management of hypothalamic pituitary failure

A

pulsatile GnRH via SC/IV pump worn continuously (90minutes)
gonadotrophin daily injection (FSH/LH): higher risk of multiple pregnancies
both need USS monitoring of response (follicle tracking)

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11
Q

define hypothalamic pituitary dysfunction

A

ovary does not respond to LH and FSH

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12
Q

diagnosis of hypothalamic pituitary dysfunction

A 
high LH
high FSH
normal oestrogen
oligo/amenorrhoea
PCOS associated
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13
Q

define PCOS

A

inherited condition where females produce more than normal male hormones, it is a condition exacerbated by weight gain

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14
Q

presentation of PCOS

A

obesity
hirsutism/acne
cycle abnormalities
infertility

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15
Q

diagnosis of PCOS (biochemically)

A

high LH
high free androgens
impaired glucose tolerance

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16
Q

diagnosis of PCOS 2/3 must be present

A

oligo/amenorrhoea
polycystic ovaries on USS with 12 or more 2-9mm follicles and increased ovarian volume
hyperandrogenism biochemically or clinically

17
Q

what is commonly seen in PCOS

A

insulin resistance

18
Q

how does insulin resistance occur in PCOS?

A

normal pancreatic reserve so hyperinsulinaemia, but sensitivity is decreased as insulin acts on the same receptor as LH and lowers SHBG levels so there is increased free testosterone (hyperandrogenism)

19
Q

management of PCOS

A

weight loss, lifestyle
folic acid 400mcg/5mg
reverse excess androgens
ovulation induction

20
Q

how can excess androgens be reduced in PCOS?

A

oral contraceptive pill
anti-androgen e.g. cyproterone acetate
cosmetic e.g. laser hair removal and creams

21
Q

three ways to do ovulation induction in PCOS

A 
clomifene citrate (alternatives are tamoxifen and letrozole)
gonadotrophin daily injections
laparoscopic ovarian diathermy
22
Q

describe clomifene citrate

A

increases FSH
conception in first few months, if resistant consider metformin (improves insulin resistance, reduces androgens and increases SHBG) and other therapies

23
Q

what do gonadotrophin daily injections risk?

A

multiple pregnancies

overstimulation

24
Q

what does laparoscopic ovarian diathermy risk?

A

ovarian destruction

25
Q

adverse effects of ovulation induction

A 
ovarian overstimulation (below 35 and PCOS)
multiple pregnancies (USS lambda sign dichorionic, T sign monochorionic)
twin-twin transfusion syndrome in monozygotic
ovarian cancer
26
Q

what does hyperprolactinaemia present with?

A

amenorrhoea (inhibits GnRH)
galactorrhea
visual fields (macro)

27
Q

diagnosis of hyperprolactinaemia

A 
normal FSH/LH
low oestrogen
raised prolactin
TFT normal
MRI
28
Q

management of hyperprolactinaemia

A

dopamine agonist e.g. cabergoline (stopped when pregnancy occurs)

29
Q

define ovarian failure

A

ovaries have no eggs left

30
Q

presentation of ovarian failure

A

hot flushes
night sweats
atrophic vaginitis

31
Q

diagnosis of ovarian failure (biochemically)

A

high FSH/LH
low oestrogen
amenorrhoea

32
Q

causes of ovarian failure

A

menopause

33
Q

causes of premature ovarian failure

A
  • genetic= Turner’s, XX gonadal genesis, fragile X
  • AI ovarian failure
  • bilateral oophorectomy
  • pelvic radiotherapy/chemotherapy
34
Q

management of premature ovarian failure

A

hormone replacement
egg/embryo donation
cryopreservation
counselling

35
Q

define progesterone challenge testing

A

menstrual bleed in response to a 5-day course of progesterone indicates normal oestrogen

Endocrine: Reproductive Glands (6 decks)

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