Ovulatory Disorders Flashcards
what are these disorders associated with in terms of presentation?
oligomenorrhoea
amenorrhoea
two types of amenorrhoea
- primary= never occurred
2. secondary= used to have periods but have now stopped
classification of ovulatory disorders
- hypothalamic pituitary failure (hypogonadotrophic hypogonadism)
- hypothalamic pituitary dysfunction
- ovarian failure
what is hypothalamic pituitary failure (hypogonadotrophic hypogonadism)
no GnRH secretion so no FSH/LH
diagnosis of hypothalamic pituitary failure (hypogonadotrophic hypogonadism)
negative progesterone challenge
what is a progesterone challenge?
5 day course of progesterone should elicit a menstrual bleed
causes of hypothalamic pituitary failure (hypogonadotrophic hypogonadism)
stress excess exercise low BMI tumours trauma Kallman's syndrome drugs (steroids, opiates)
consider prolactinoma as this inhibits GnRH
management of hypothalamic pituitary failure (hypogonadotrophic hypogonadism)
stabilise weight
lifestyle
pulsatile GnRH via SC/IV pump
daily gonadotrophin injections (FSH/LH)
what do pulsatile GnRH via SC/IV pump and daily gonadotrophin injections (FSH/LH) both need?
follicle tracking (USS)
what is hypothalamic pituitary dysfunction?
ovary does not respond to LH and FSH
causes of hypothalamic pituitary dysfunction
PCOS
what is PCOS?
inherited condition exacerbated by weight gain
diagnosis of PCOS
2/3 must be present:
- oligo/amenorrhoea
- polycystic ovaries on USS
- hyperandrogenism clinically or biochemically
polycystic ovaries appearance on USS
12 or more follicles and increased ovarian volume
why does insulin resistance develop in PCOS?
insulin acts on the same receptor as LH and lowers SHBG so there is increased free testosterone
reduced sensitivity
management of PCOS
weight loss management
folic acid 5mg if trying to conceive
hyperandrogenism management
ovulation induction
hyperandrogenism management in PCOS
OCP
anti-androgen e.g. cyproterone acetate or cosmetics
ovulation induction options in PCOS
- clomifene citrate
- gonadotrophin daily injections
- laparoscopic ovarian diathermy
adverse of ovulation induction
ovarian overstimulation
multiple pregnancies
risk of ovarian cancer
what is ovarian failure?
the ovaries have no eggs left
causes of ovarian failure?
menopause
presentation of ovarian failure/ menopause
hot flushes
night sweats
atrophic vaginitis
diagnosis of ovarian failure
high FSH/LH
low oestrogen
causes of premature ovarian failure
Genetic conditions= Turner’s, XX gonadal agenesis, fragileX
AI ovarian failure
bilateral oophorectomy
pelvic chemo/radiotherapy
management of premature ovarian failure
hormone replacement
egg/embryo donation
cryopreservation
counselling
