Ovulatory disorders and Group I

Question 1

how long does bleeding typically last in the menstrual cycle

Answer 1

<5 days

Question 2

what does amenorrhoea mean

Answer 2

absent menstruation

Question 3

what does oligomenorrhoea mean

Answer 3

menstrual cycle >42days, ie <8 periods/year

Question 4

what do ovulation predictor kits measure and how reliable are they

Answer 4

detects LH surge(24-36hr before ovulation), reliable 97% of women

Question 5

what does a history of regular or irregular menstrual cycles suggest about ovulation

Answer 5

regular = highly suggestive of ovulation
irregular = probably anovulatory

Question 6

how can ovulation that is suggested by regular cycles be confirmed

Answer 6

by midluteal serum progesterone(30nmol/l) in 2 samples

Question 7

how can anovulation suggested by irregular cycles be investigated

Answer 7

hormone evaluation; FSH, LH, TSH, prolactin, estradiol, testosterone, SHBG, FAI

Question 8

how often is ovulatory dysfunction the cause of infertility

Answer 8

in aroudn25% cases

Question 9

what do group 1 ovulation disorders describe

Answer 9

pathology at the level of the hypothalamus

- hypothalamic pituitary failure

Question 10

what are group 1 ovulation disorders characterised by

Answer 10

low levels of gonadal hormones, ie hypogonadotrophic hypogonadism

Question 11

what % of ovulatory disorders are group 1 type

Answer 11

around 10%

Question 12

what clinical features are seen in type 1 ovulatory disorders

Answer 12

amenorrhoea, low levels of FSH/LH, oestrogen deficiency, hypogonadotrophic hypogonadism

Question 13

what test is used to check for oestrogen deficiency

Answer 13

negative progesterone challenge test

Question 14

describe what the progesterone challenge test involves

Answer 14

administration of progesterone to induce menstruation, bleed usually within 7-10days, if no bleed then oestrogen low

Question 15

what are some of the causes of group 1 ovulatory dysfunction(hypothalamic pituitary failure)

Answer 15

stress, excessive exercise, anorexia, brain/pituitary tumour, head trauma, Kallmanns syndrome, drugs

Question 16

what is pre-treatment for group 1 ovulatory dysfunction

Answer 16

life style modification(stable weight, smoking, alcohol), folic acid, check for rubella/chlamydia, normal semen analysis of partner

Question 17

what are the treatment options for group 1 hypothalamic pituitary failure if hypogonadotrophic hypogonadism present

Answer 17

pulsatile GnRH, or gonadotrophin(FSH, LH) daily injections

Question 18

describe the pulsatile GnRH treatment used for group 1 ovulatory dysfunction

Answer 18

SC or IV pump worn continuously, pulsatile administration every 90mins
(highly successful)