Repro Physio Flashcards

Question

alveolar stimulation in breast milk

Answer 1

•You can see the blood vessels and the milk duct with lots of lobules that feed into the duct and go into the nipple. Around the lobules are blood vessels and myoepithelial cells. Myoepithelial cells are stimulated by oxytocin. In the lumen, it is filled with milk. **The alveolar cells will get stimulated by prolactin which will make the milk**. Oxytocin will cause contraction of the lobule, which will spill the milk down into the duct. • Usually we recommend a year of breast feeding, you can have pumps at home, 6 months, 6 weeks, 3 years. Once the baby has teeth, it is more challenging, but it depends on the individual. You can keep this going for a long time.

Answer 2

* Polycystic ovaries result when increased local androgens and decreased FSH prevent the development of a dominant follicle. * The increased local androgens can be the result of a genetic defect in ovarian steroidogenesis and/or the result of increased circulating insulin (insulin resistance). * The elevated local ovarian androgens “stunt” the ability of the follicle to grow beyond 2-10 mm . * This leads to the accumulation of 20-100 subcapsular “cysts” which give the ovary its characteristic “polycystic” appearance. * The ovary’s estradiol output is sufficient to exert low-level positive feedback on LH and negative feedback on FSH, resulting in an increased LH and decreased FSH * Increased LH levels then stimulate the ovarian stroma to increase its production of testosterone and androstenedione, perpetuating the unfavorable conditions for follicular development and keeping the woman in an anovulatory state. . * When released into the general circulation, these elevated androgens cause hirsutism, or the increased coarseness and pigmentation in hair on the face, chest, and abdomen. ---- This is a patient with polycystic ovary disease—instead of having one, big dominant follicle she has many small ones. We don’t know where the problem is with this disease. * Could be a problem in the ovary—it’s not picking one dominant follicle * Could be a problem with the message—LH or FSH is different and is causing multiple follicles instead of one dominant one * In PCO we have chronic anovulation, and high LH * There is so much LH telling the theca cells to overproduce testosterone * All of these follicles are trying to be the dominant ones and are working hard * Testosterone increases insulin (plus there’s a high insulin bc of the insulin resistance)àinsulin drives the theca cell to make even more testosterone * There is so much testosterone that the granulosa cell can’t keep up with the aromatase needed to make estradiol so we get a build up of testosterone, high androgens, hirsutism and acne and often hair loss

Answer 3

inhibits FSH LH, theca cells

Answer 4

appearance of breast tissue

Answer 5

beta subunit •Alpha unit: Identical to TSH, FSH, LH Encoded by a single gene on chromosome •Beta unit: Unique, encoded by several genes on chromosome 19

Answer 6

stimulation (make superovulate) retrieval (take eggs out) fertilization (surround egg w sperm or stick one in) transfer (1 if know it's normal or 2) give progesteron or HCG in luteal phase

Answer 7

• * On the top is progesterone synthesis. * The mom is supplying the cholesterol. The cholesterol from the mother goes to the placenta and the placenta is going to be able to make progesterone. That progesterone is going to be exposed to both the fetus and mom

Answer 8

dopamine agonist (bromocriptine, cabergoline)

Answer 9

hypogonadotropic hypogonadism males more effected anosmia - aplasia - **failed migration of GnRH neurons** from the olfactory placode to the medial basal hypothalamus **deficiency of GnRH = clinical feature** low FSH, low estradiol

Answer 10

premature sexual development which occurs at an age more than 2.5 SD below the mean age of puberty defined as the onset of pubertal development in girls before age 8, boys before age 9

Answer 11

progesterone

Answer 12

non estrogen option for vulvovaginal atrophy SERM - E agonist in some parts (vagina), E antagonist in others (breasts, bone)

Answer 13

independent of GnRH and gonadotropin caused by excess secretion of sex hormones (estrogens or androgens) derived from either the gonads or adrenal glands GnRH, FSH, LH still really low but have E and T i,e, McCune-Albrigh, polyostotic fibrous dysplasia = triad of periopheral precocious puberty, cafe au lait skin pigmentation and fibrous dysplasia of bone (autonomous g protein activation - always on, continued stim of endocrine function

Answer 14

appearace of pubic hair

Answer 15

breast enlargement maturation of vaginal mucosa growth acceleration advancement of skeletal maturation complete epiphyseal fusion

Answer 16

•Unable to hydrolyse DHEAS **•Low estriol levels** * Post Dates * Failure of cervical dilation or effacement * Occurs in 1:2,000 – 1:6,000 newborns * The babies are fine and grow normally—the only difference is that we see lower levels of estriol, the pregnancies tend to go post dates (sulfatase is probably involved in determining when pregnancy is over), and normal L&D doesn’t take place as well so the patients often need to be induced.

Answer 17

nuva ring - lowest patch pill - highest

Answer 18

in ovary theca cells: make androgens under direction of LH, send to granulosa cells granulosa cells aromatize to estrogens under FSH

Answer 19

* Improvement of fibroid symptoms * \*\* Reduction in frequency of epileptic seizures * \*\* Reduction in sickle crises * Reduction in symptoms of endometriosis * No known drug interactions

Answer 20

* This is days and months postpartum [no box]. * If a woman doesn’t breast feed, prolactin levels will fall on their own. * If a baby is sucking, the sucking will stimulate prolactin, which is important for milk production. * Milk will continue to be produced because of the sucking. * Prolactin inhibits the menstrual cycle (inhibits GnRH, FSH, estrogen), so a woman is not getting her period, but NOT adequate birth control because when someone is no longer breastfeeding, they will ovulate before getting 1st period and you don’t know when that ovulation will happen. Additionally, after months of breast feeding, we only need a little bit of prolactin to make milk, so the overall prolactin level will start to decrease and menstruation returns even though the sucking process is increasing these huge surges of prolactin

Answer 21

Myoepithelial cells are stimulated by oxytocin Alveolar cells are stimulated by prolactin

Answer 22

hysterosalpingogram laparoscopy

Answer 23

estriol - 100x

Answer 24

synctiotrophoblasts ## Footnote •aintains corpus luteum steroidogenesis until the placenta assumes this role (7-10.4 weeks) see it even at the 4 cell stage • * This is broken down into alpha hCG and beta hCG * Alpha HCG continues to rise * Beta HCG peaks early and then drops like the picture from above (Figure A) * We use this one.

Answer 25

for side effects! very small amount to stop breakthrough bleeding etc suppresses FSH, LH to suporess ovulation and endometiral changes at the cellular level

Answer 26

absent androgen receptors male genotype, fenal phenotyle high T levels female pattern with no uterus T= elevated

Answer 27

breast development endometrial gland maturation maintain uterus/inhibits lactation during preg contributes to insulin resistance increases body temp and minute ventilation

Answer 28

test urine ovulate 10-12 days after LH peak sperm day of surge and day after (may be on way up or down)

Answer 29

pulsatile release from anterior pituitary more than 70% of total daily gh secretion occurs at night - first few waves peak can be 100x low levels

Answer 30

We’re going to talk a little bit about the progestin-only contraceptives. Again, progestin being the workhorse, we’re not going to talk about estrogen-only contraceptives because they do not exist. Here we have some options: * Progestin only pills (POP) * Injectables * Implants * IUS (intrauterine systems) – the same as IUD except they decided to change it up because of the progestin •

Answer 31

* Estriol synthesis * Cholesterol will go to the placenta, which will start in it’s progesterone synthesis by making pregnenolone. * This is what confuses Nachtigall: The fetal adrenal gland is going to take over and make DHEA-S and the liver will convert it to a 16-hydroxy DHEA-S. Then, the placenta will get the sulfate with sulfatase and form estriol.

Answer 32

* placenta doesn’t have 17-hydroxylase or 17,20 desmolase à it cannot make the conversion from progesterone to estrogen. * That is why we need the fetus to be able to function and help us continue the conversion. * It is the fetal adrenal gland and liver that contribute.

Answer 33

Mirena – the levonorgestrel IUS – has about 20 micrograms per day of levonorgestrel. This suppresses the endometrium, thickens that cervical mucus – that’s the take home message of these progestrin-only methods. Does not reliably suppress ovulation. We know this because we’ve done ultrasound of women with the Mirena in place and about 50% of them have follicles. 50% of them don’t which means that their ovaries are suppressed. But 50% are still making follicles which means that it’s not suppressed so that means that prevention of ovulation is not a mechanism of action. It has an incredibly good success rate. The failure rate is very very low. It also has been used many times to help reduce heavy menstrual bleeding. It can reduce it to up to 90% and really has no long-term effects on fertility.

Answer 34

The progestin component varies. The progestins is very close to the androgens (in carbon structure) and that’s why there’s all these different kinds of progestins. They’re playing around with those side groups to try and decrease androgenic side-effects because progestins can act a lot like androgens. PMS (premenstrual syndrome) is a progesterone dominant syndrome. The progestins in pills – we’re trying to minimize these side effects. So if you’re thinking about what those side effects are, think PMS. Pills also come in either the same dose for each pill or there’s a biphasic or triphasic that changes doses every week for three weeks.

Answer 35

* hCG from the embryo is causing the corpus luteum to make progesterone. The corpus luteum is supplying the progesterone in the beginning part of pregnancy which is keeping the endometrium in a healthy state for the embryo to progress. * However, that will wear off around 8 weeks. At this point, the placenta is getting started and formed. The placental will start to be functional at 7.5 weeks. * There is a period of time between 7.5 weeks and 10 weeks, 4 days where the corpus luteum and the placenta are working together and one is taking over for the other (placenta is taking over for the corpus luteum).

Answer 36

1. breast 2. pubarche 3. growth spurt 4. menarche

Answer 37

2/3 of the following: 1. oligo/anovulation 2. clinical or biochem signs of hyperandrogenism (just acne and hirtuism or just high T) 3. polycystic ovarias (\>12 follocles on u/s) **exclusion of other causes**

Answer 38

postcoital test

Answer 39

•The major hormone of pregnancy is hCG—human chorionic gonadotropin. That is made very early on by the embryo. • •You see the increase over the 1st 10 weeks of pregnancy, then a plateau, then a decrease over time. • In addition, we see other key hormones like estrogens where Estriol is the predominant hormone and progesterone is the major hormone made by the placenta. There is also some prolactin, which has a big increase in pregnancy, but not from the placenta. This is actually maternal prolactin.

Answer 40

Day 3 FSH - if high = low ovarian reserve Estradiol AMH - reflects size of primordal follicle pool Antral follicle count (u/s)

Answer 41

looks for: concentration motility morphology

Answer 42

decreased hypothalamic GnRH secretion **hypogonadotropic hypogonadism** **low fsh, estradiol** **normal MRI** decreased pulses --\> absent midcycle surges in LH --\> absence of normal follicular development --\> anovulation --\> low serum estradiol concentrations *low body fat (under 17%)*, stress, *genetic*, systemic disease, hypothyroid

Answer 43

* Progestin-only pills * Combined methods – we don’t really use anymore, It used to be that if you had unprotected or underprotected sex, you could take 4 pills and then 12 hours later take another 4 pills, What might be the problem with that? It’s incredible nausea and vomiting. If you try and take all those hormones, you are just going to vomit those up and that would really decrease its efficacy, It was fine when we had no other option, but now we have options. * Copper IUD * Something relatively new – selective progesterone receptor modulator (SPRM)

Answer 44

a physical characteristic of insulin resistance

Answer 45

core needle biopsy - get more info! FNA - can't distinguish in situ from invasive surgical - usually not necessary

Answer 46

efficacy: how well CAN it work - with ideal/perfect use effectiveness: how well DOES it work - what hapens w typical use

Answer 47

central/true precocious puberty is caused by early maturation of the HPG axis same as it would be but happening to early

Answer 48

estrogen and progesterone both made by corpus luteum, both have ffect!

Answer 49

progesterone (indicates ovulation) TSH, Prolactin (ammenorrhea)

Answer 50

about 10-12 hours after LH surge 34-26 hours after LH obset one oocyte completes meiosis I and becomes haploid granulosa cells luteinized, progesterone secretion begins

Answer 51

shell of the egg * 2) The Ca inside of that sperm will allow for the acrosome reaction [indigo circle]—enzymes are created which will break down the zona pellucida and allow the special sperm to actually get through into the egg. * While it is coming through, the tail portion is important because it is actually fluttering and whipping itself—allowing for forward progression to make it more likely that the sperm will get through. * 4) Then, the sperm will actually enter and penetrate the egg. * 5) Once that happens, the Ca inside the egg will trigger a cortical reaction which causes the zona pellucida to prevent any other sperm from getting in. That is called the block to polyspermy—we only want 1 egg 1 sperm

Answer 52

menstrual irregularity (rarely primary) hirsuitism weight gain infertility usually begins at puberty and slowly progessive

Answer 53

Nexplanon is a single rod that has progestin called etonorgestrel. It used to be called Implanon. The difference is that it has slightly different dosing. It is also now radio-opaque so that you can find it in an X-ray or with an imaging technique. The implanon was all plastic and nearly impossible to find. If someone put it in incorrectly. You put it in between the bicep/tricep groove and it has that barium that allows localization with imaging. It’s good for 3 years. It decreases the amount of progestin that it releases depending on the year. It needs to be removed and, if desired, reinserted in the non-dominant arm

Answer 54

Breast cancer – huge issue. There has not been any increased lifetime risk of people who have been on the pill and breast cancer Ovarian cancer – it is protective. During ovulation, there is a huge eruption from the ovary and out comes the egg. There’s a huge crater in the ovary and as you enter your clinical years and see ovaries, you don’t see ovaries with these huge holes in them. The ovary repairs itself. It’s in that reparative process that the mutations occur. So if you don’t have that huge bomb to begin with, you’re not going to have that repair process, and you’ll decrease your chance of ovarian cancer.

Answer 55

•Within 3 days of delivery, estrogen and progesterone levels are right at the level of the beginning of a period. From 1000 to 30 pg/mL. That is a huge drop (see orange and blue bars). Prolactin shoots sky high and estrogen and progesterone go way down. If you give someone estrogen, you will inhibit the ability to make prolactin. Prolactin neg feedback and suppress estrogen and progesterone • •What about that change? Hormones really affect behavior and mood. While not everyone is affected by the changes in the cycle, when progesterone and estrogen start to fall, some women become very moody, but don’t have that sensation 3 days later. Now, that sensation is multiplied by 20 because the levels have a huge drop. •

Answer 56

**FSH** take androgens from theca cells and aromatize to make estrogens

Answer 57

for assessing ovarian reserve reflects size of the primordial follicle pool

Answer 58

sex hormone binding globulin bound to circulating T (some bound to albumin) only 1% of T unbound --\> bio activity * Normally testosterone circulates bound to sex hormone binding globulin (SHBG) * Anything that reduces SHBG, like the presence of insulin, will increase free testosterone * One free testosterone is increased so are the symptoms such as hirsuitism, acne * If you can increase SHBG, through exercise or b. control or any type of estrogen, you decrease free testosterone and decrease acne and hirsutism

Answer 59

The progestin-only pill (POP) is sometimes called the “minipill” because it doesn’t have any estrogen. We talked about the fact that it’s recommended for breastfeeding women. **No pill free interval** It may be less effective than the combined methods but one of the reasons why is because it needs very strict compliance. Its effectiveness tends to go down rapidly from pill to pill. You need to keep the system going. If you are more than 3 hours late in taking the pill, you have to use a backup for at least 48 hours because you could potentially have a breakthrough ovulation because you‘re not going to reliably suppress the ovulation. If you think about mothers who are dealing with young babies who are not sleeping and therefore they’re not sleeping, this is probably a really bad method. It’s something that you need to be so strictly timed. You give this to breastfeeding mothers because it doesn’t have any estrogen in it. There’s a thought that maybe estrogen can suppress breastfeeding. There’s controversy about that. You have to think about whether or not this is feasible for a new mom.

Answer 60

•You can see the blood vessels and the milk duct with lots of lobules that feed into the duct and go into the nipple. Around the lobules are blood vessels and myoepithelial cells. **Myoepithelial cells are stimulated by oxytocin.** In the lumen, it is filled with milk. The alveolar cells will get stimulated by prolactin which will make the milk. Oxytocin will cause contraction of the lobule, which will spill the milk down into the duct. • Usually we recommend a year of breast feeding, you can have pumps at home, 6 months, 6 weeks, 3 years. Once the baby has teeth, it is more challenging, but it depends on the individual. You can keep this going for a long time.

Answer 61

pulsitile secretion pulse generator is in the hypothalamus profertility when it's pusitile antifertility (pharmacologic) endo or exo - suppresses pituitary

Answer 62

TRH causes prolactin secretion if hypothyroid - high TRH will turn on prolactin which will inhibit GnRH (inhibits FSH and LH and leads to low estrogen) irregular periods if correct hypothyroid - restore cycles

Answer 63

when baby is ready to come out ## Footnote •Human, it is not that clear and we not sure what the 1st sign of parturition is, but this is about labor, delivery and then the post-partum period right after delivery. • * Labor, delivery, post partum period * Labor- rhythmic forceful contractions * Delivery * Immediate Hormonal Changes

Answer 64

hormone receptors for E and P! receptive for therapy

Answer 65

The ONLY antibiotic to ever have been shown to affect the efficacy of combined hormonal contraceptives is **rifampin (TB)**. Common antibiotics do not require that you use backup methods.

Answer 66

So because it doesn’t have that contaminant in it (estrogen) – one of the main side effects is bleeding irregularities. You can think about maybe giving estrogen to them or NSAIDs can sometimes help. It can give amenorrhea which some people don’t like – other people think it’s great. Otherwise, it’s similar to COCs but less common.

Answer 67

GnRH --\> AP makes FSH --\> FSH tells ovaries to have follicles grow and make estradiol --\> estradiol stimulates endometrial proliferation in uterus

Answer 68

bypass cervix mild male factor min endometriosis cervical factor unexplained infertility adjucnt to clomiphene

Answer 69

activation of the gonads by FSH and LH

Answer 70

outflow obstruction responsible for 7% of secondary amenorrhea endometrial lining scarred by surgery or infection for pregnancy related hemorrhage, abortion, utermine surgery, endometritis due to TB or schistisome bands of scarring - E is normal but no build up of lining

Answer 71

rise in estrogen increases production and causes thinning of cervical mucus which allows sperm to penetrate the cervic more easily the ability of cervical mucus to stretch is referred to as spinnbarkeit

Answer 72

increase in venous clotting contraindicated in: pregnancy estrogen dep malignancy (breast) history of thromboembolic events

Answer 73

Again, progestin-only method side effects: * Bleeding irregularities * Amenorrhea – about ¼ of women at 1 year * A little bit of expulsion rate but not bad * Perforation (putting a hole through the uterus) is very uncommon

Answer 74

increases by 50%

Answer 75

**OCPs** **androgen receptor blockers** **insulin sensitizers** **hair removals** suppress ovarian androgen cycle control (OCPs) or pregnancy elimunwatnd hair growth, hair loss, acne weight control - reg metabolic needs lifestyle protect endometrium(restore funtion with OCPs)

Answer 76

•estradiol, estriol, and estrone

Answer 77

for ovulation induction SERM - weak E and ER blocker - binds R and pituitary thinks there is no E --\> increases FSH --\> increases follicles twins and triplets possible superovulation

Answer 78

acne axillary, pubic, facial hair body odor voice changes growth acceleration maturation

Answer 79

activates FSH FSH/granulosa cells/activates aromatase

Answer 80

We do think the hyperinsulin state (associated with lower SHBG and higher free testosterone) may be part of the culprit—even if it is not the cause it perpetuates the cycle Higher the insulinà more testosterone, the less the ovary works The greater the androgens the more insulin resistance High insulin states have been associated with abnormal appetite control •People with high insulin may be eating more and as they gain weight they become more insulin resistant If you break the cycle at any one of these parts (lower androgens, lower insulin resistance, lower insulin) you can improve the cycle and improve ovulation and regain normal environment to keep the bones healthy chronic anovulatin - elevated estradiol and androgen - decrease SHBG - higher free E and T - high LH:FSH ratio - anovulation hyperinsulinemia is associated with lower SHBG and higher free T insulin augnemnts adrenal androgen production insulin stimulates LH secretion

Answer 81

1st half: hormones decreased, mucus thick and scanty, poor sperm survival ovulation: estrogen increasd, cervical mucus thin and copious, excellent sperm survival 2nd half: decreased progesterone level, mucus is thick, poor sperm survival

Answer 82

clomiphene citrate (anovulatory, nl estradiol) gonadotropins (low estradiol, low weight, stress) = give LH and FSH to induce ovulation intrauterine insemination

Answer 83

Increased: Minute ventilation Decreased: Intestinal motility, uterine contractions Causes: Compensated respiratory alkalosis, smooth muscle relaxation, lower sphincter relaxation, urinary collecting system stasis

Answer 84

encoded by KISS 1 gatekeeper of puberty modulates GnRH secretion, feedback?

Answer 85

The progestin-only you can do within the first 5 days. The sooner you do it, the better it works. It will NOT interrupt a pregnancy! If the pregnancy has already implanted, it will not affect that. There are no contraindications to this medication. The mechanism of action may depend on where a woman is in her cycle: * May prevent ovulation * May prevent implantation (but won’t affect once implantation has occurred) * May affect sperm transport It is now over-the-counter but it was a huge battle to get this OTC.

Answer 86

•Breakthrough bleeding –Reassure; Rule out pregnancy, pathology; confirm correct use –increase estrogen •Nausea (E) –Reassure; take in evening; lower estrogen •Breast tenderness (E/P) –Reassure; check pregnancy test; lower estrogen dose •Headaches (E/P) –if severe, frequent, worsening à change method –if not, can reassure; check BP •Hypertension (E/P) –if high BP x 1, ok to continue COC, but recheck –if persistently high, consider method switch •Weight gain - (?) –May see cyclic changes due to fluid retention (E/P) * Some women may have increased appetite * Often can’t blame on pill

Answer 87

for amenorhea - tests estrogen status and outflow tract! estrogen alone increases the endometrium estrogen + progesterone - withdrawl results in bleed * If this is an individual and you do not know the estrogen status, if you give then a week of progesterone exposure, or 10 days of exposure, and then you stop the progesterone for a week, and you wait and you see what happens, if they have a withdrawal bleed, which is a period, it’s an induced period but it’s still a period, what do you know? * You know there was estrogen priming the endometrium to accept the progesterone and then the lack of it allowed for a bleed. So it’s just like the end of a cycle in the luteal phase where estrogen and progesterone lower and the lining sloughs. So that let’s you know, yes, there was estrogen. It also gives you a very important finding, that the outflow tract is working, and that’s key. So that’s something that we use… So this is the outflow tract [right image, uterus and vagina], the lining can slough, and there is no cervical blockage and no vaginal blockage and the blood was able to escape from the uterus down into the vagina and have a visible period. So

Answer 88

There are lots of other things that hormonal contraceptives can do. * It can make your cycle more regular– less heavy, less painful * It’s been shown to suppress endometriosis * If you have a patient who makes a lot of ovarian cysts, it can help suppress formation of new cysts because it suppresses ovulation and that’s where those cysts come from * Cycle control –shorter, more regular menses •Dysmenorrhea –60-90% reduction in dysmenorrhea •Menorrhagia: –38-50% reduction in blood loss –improvement in anemia * Endometriosis suppression * Prevention of functional ovarian cysts There are other things that it does besides birth control, although birth control was really a huge huge thing.

Answer 89

20-39: monthly breast exam, clinical breast exam q 3 yeras 40+ annual mammogram, annual clinical breast exam, monthly self breast exam high risk: imaging and clinical exam starting at age 35 or younger (u/s, MRI too)

Answer 90

lobular - has more open space, can be bigger before we see it!

Answer 91

1. continuation of meiosis (reduction division) in the oocyte 2. the movement of the follicle to the surface of the ovary 3. a rapid increase in follicular fluid volume 4. an increased dispensability of the follicle wall 5. the activation of the proteilytic enzymes and prostaglandins

Answer 92

Human placental lactogen is very similar to insulin antagonists. As pregnancy continues, human placental lactogen (HPL) continues and it is one of the growth factors so it regulates fetal and maternal metabolism ## Footnote –Is an Insulin antagonist: Increases glucose to the fetus •HPL is thought to contribute to the increase in maternal insulin resistance that occurs as pregnancy progresses if risk for T2D may develop gestational diabetes!

Answer 93

gestational week 4 levels low until puberty becomes pulsitile at puberty

Answer 94

8 cell stage

Answer 95

when estrogen peaks it's the only time there is a reversal to POSITIVE feedback causing LH surge may be rate of rise of estrogen ovulation about 10-12 hours after LH surge

Answer 96

estrogen and progesterone - causes endometrail proliferation --\> hyperplasia/endometrial cancer estrogen unopposed is not safe in a patient with a uterus therefore progesterone is necessary

Answer 97

tubal factor severe endometriosis unexplained infertility male factor decreased ovarian reserve

Answer 98

Her2 therapy - very treatable now

Answer 99

primary amenorrhea classification FSH \> 20 primary gonadal insufficiency - gonadal failure

Answer 100

primary amenorrhea classification FSH \<5 primary hypothalamic-pituitary dysfunction low FSH, low E hypothalamic level (body fat, stress, illness) pituitary level (large pituitary tumors, hyperprolactinemia)

Answer 101

early blastocyst grow more and more likely to make it!

Answer 102

prolactin inhibits FSH, LH breast secretions in 80% of women with hyperprolactimeia prolactin secreting pituitary tumor primary hypothyroidism, meds that affect dopamine, acromegaly

Answer 103

5 levels of puberty development to stage 5 = fully developed

Answer 104

A newer IUD is something called the Skyla, the first new IUD to be approved since 2001. It has 13.5 micrograms of Levonorgestrel vs. the 20 micrograms of the Mirena. It’s smaller, slightly different failure rate but still good. It is thought as the nulliparous IUD because it’s smaller. But we’re doing studies to see if it really makes a difference in terms of insertion pain, etc.

Answer 105

Some of the side effects after 1year, up to 50% can have amenorrhea and after 5 years, it’s almost 80%. The biggest side effects are: * Irregular bleeding * People report weight gain * Some studies show bone mineral density changes. However, they did the study on adolescents and that was a black box warning that got put on Depo that you always use it for 2 years because your bone mineral density in these young teenagers decreased. What it also showed was that once they stopped the Depo and they repeated their bone mineral density, their density actually rebounded to HIGHER than it was pre-Depo. It’s not a lasting effect. * One of the things to think about is if somebody wants to use this but they really want to be pregnant in 6 months, do not use Depo because you can have a delayed return to fertility. You want to use something you can reverse more rapidly. * Also, you need to think about lipids. You can have a decrease of the good cholesterol and increase of the bad cholesterol.

Answer 106

luteal phase if doesn't rise - not ovulating

Answer 107

stimuated by **LH** take cholesterol and make androgens - send to granulosa cells

Answer 108

12 m of amenorrhea after the final menstrual period average age in US = 51 POI = before age 40 diagnosis usually made by history and confirmed w FSH (high!)

Answer 109

The progestin * Also suppresses LH * Can thicken that cervical mucus, making it harder for sperm to penetrate * It can affect the capacitation of sperm, so how the sperm actually behaves Also works on the endometrium to make changes in the endometrium

Answer 110

1. has the highest concentration of FSH receptors 2. has the highest level of aromatase activity 3. has the greatest estradiol production one follcle per month devlops to maturity and ovulation

Answer 111

primary amenorrhea - mullerian agenesis - can be complete or partial missing upper 2/3 of the vagina and uterus normal hpg axis!! can have pregnancy with carriers

Answer 112

primary ovarian insufficiency hypergonadotropic hypogonadoism must get karyotype (abnl: 45XO - most, 46XX, 45XO, 45XY) must check for presence of a Y chronosome - requires gonad removal due to malignant transformation! (i.e. Turners - High LH, FSH, low estradiol, abnl karyotype)

Answer 113

semen analysis

Answer 114

* It prepares the endometrium for implantation, continued growth and maintenance of pregnancy. * It suppresses the internal immune system so that the mother doesn’t reject the growing fetus. * It acts as a substrate for fetal adrenal gland to form glucocorticoids and mineralocorticoids. * It really is the hormone that maintains pregnancy.

Answer 115

male pattern hair growth/acne/frontal balding sexual hair growth stim by 5alpha-reductase catalyzed conversion of T to DHT in hair follicle pattern of hair growth and follicle density is genetically determined and varies between races and ethnic groups Remember individuals are born with their hair follicles and receptors and it’s what circulates through the blood that determines the hair pattern

Answer 116

inhibits pulsatile GnRH! ihibits FSH and LH - no ovulation low estrogen production!! high prolactin = low FSH, LH, estradiol see it in: hypothyroid pregnancy lactation breast stimulation

Answer 117

anterior pituitary cells GnRH binds to G protein linked GnRH receptors on the surface of gonadotrophs make FSH, LH

Answer 118

High FSH low estradiol (hot flushes) ovary is not functioning

Answer 119

* Estradiol is the most important biologically in a non-pregnant woman * It has the most effect when we want to measure total levels because this seems to reflect what is happening at the biologic level

Answer 120

We’ll talk about which ones, suppress ovulation. But also it works to thicken and decrease the cervical mucus. Does anyone know during ovulation what the cervical mucus is like? Spinnbarkeit – stretchability. Why is the mucus like that? It has a lot of water because we have sperm trying to get places. This enhances sperm forward motion into the tube where the ovum has exploded out of the ovary and picked up by the fimbrae. What happens once the LH surge happens and the progesterone kicks in? What does the cervical mucus look like? It’s thick and clumpy. A lot of these progestin methods make the mucus similar to what happens when you have progesterone after the LH surge – makes it thick and clumpy and really difficult for sperm to get through it. It has a much smaller water content. It also changes the lining of the uterus and makes it really difficult for any kind of implantation if the sperm were to actually get past that mucus. There are very few contraindications. It’s a common method to give to women right after pregnancy when they’re breastfeeding. It can control heavy menstrual bleeding.

Answer 121

•This happens through the brain. When the baby sucks, you get a message through spinal cord. This increases prolactin, and increases milk. There is also an increase in oxytocin and increase in excretion that way. • * In the beginning, the mom can respond to a baby cry. What’s been shown that any baby can cause milk coming out of nipples (milk let down). Because the mother is anticipating the feeding. * Within 3-4 days, mom can unknowingly differentiate her baby’s cry from other babies cry. * But, there are lots of mistakes so in the beginning of breast feeding, many women will have breasts that leak. * Over time, this response becomes fine-tuned so the basal prolactin level is only slightly above normal * When sucking occurs, prolactin increases, oxytocin is there and milk is excreted.

Answer 122

inhibited by dopamine stimulated by TRH **prolactin inhibits GnRH!** levels rise during pregnancy!!

Answer 123

Why do people get hot flushes? We think it has something to do with the hypothalamic thermoregulatory zone [specifically the anterior hypothalamic nucleus] and the sensation of where temperature is. As this zone diminishes or decreases, the sweating threshold definitely lowers, and so the same temperature will feel hot. -/- This graphic demonstrates that in symptomatic women the thermoneutral zone is narrower. The sweating threshold deceases and the shivering threshold increases. It demonstrates how small core body temperature elevations can trigger hot flashes more easily within the narrow thermoneutral zone. Freedman and colleagues suggested that elevated norepinephrine in the brain narrows the thermoregulatory threshold zone in symptomatic postmenopausal women.

Answer 124

aka polyostotic fibrous dysplasia triad: peripheral precocious puberty, cafe au lait skin pigmentation, fibrous dysplasia of bone autonomous g protein activation --\> continued stim of granulosa cells --\> E use continuous GnRH to shut puberty off (but won't turn off E)