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Endocrinology > Reproduction > Flashcards

Reproduction Flashcards

1
Q

What is the length of a regular menstrual cycle?

A

28-35 days

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2
Q

What s the definition of oligomenorrhoea?

A

cycle>35 days

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3
Q

What is amenorrhoea?

A

absent menstruation

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4
Q

What is the HPO axis?

A

Hyp: GnHR+
Pit: LH+,FSH+
Ovaries: eostradiol and progesterone

nb, negative feedback

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5
Q

What are the 2 phases of the menstrual cycle?

A

follicular (1-14)

Luteal (14-28)

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6
Q

What triggers ovulation?

A

Surge in LH (36hrs before ovulation)

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7
Q

When do eostradiol levels peak?

A

before ovulation

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8
Q

When do progesterone levels peak? where are the produced?

A

after ovulation

produced by corpus luteum

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9
Q

How is ovulation assessed in regular cycles?

A

midluteal serum progesterone (>30nmol/L) x2 samples

Day 21

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10
Q

How is ovulation assessed in irregular cycles?

A

probably anovulatory

need further hormone investigation

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11
Q

When is the early follicular phase and what is assessed here?

A

2-5 days
serum FSH, LH, eostradiol
Serum PRL, TSH
Free androgen index

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12
Q

What is the progesterone challenge test?

A

menstrual bleed in response to 5 day course progesterone

indicates normal eostrogen levels

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13
Q

What radiological investigations can be done to assess ovulation?

A

TVUS of ovaries
MRI pit fossa
DEXA scan

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14
Q

What other types of tests can be used to assess ovulation?

A

karyotyping
visual field
autoantibodies

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15
Q

What happens in hypothalamic pituitary failure?

A 
Hypogonadotrophic hypogonadism
low levels gonadotrophins
oestrogen deficiency
normal PRL
Amenorrhoea
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16
Q

What can cause hypothalamic pituitary failure?

A 
stress
exercise
anorexia
brian tumours
head trauma
Kallman's syndrome
drugs (steroids, opiates)
17
Q

How do you manage hypothalamic anovulation?

A

Stabilise weight (BMI>19)
pulsatile GnRH if hypog hypog (administer every 90 mins, IV or SC pump worn continuously)
Gonadotrophin daily injections (FSH+LH)
US monitoring for follicle tracking

18
Q

What is hypothalamic pituitary dysfunction?

A

Normal gonadotrophins
Normal oestragen
Anovulation (oligo/amenorrhoea)
PCOS

19
Q

How is polycystic ovary syndrome diagnosed?

A 
2+ of: oligo/amenorrhoea
polycystic ovaries (USS)
-12/more 2-9mm follicles
-increased ovarian volume >10ml
-uni/bilateral
Clinical +/- biochemicalsigns hyperandrogenism (acne/hirsutism)
20
Q

What is the significance of insuin resistance in PCOS?

A

hyperinsulinaemia as normal pancreatic reserves compensate
insulin is cogonadotrophin to LH (inc LH, alther LH:FSH)
Insulin lowers SHBG levels, inc testoterone, hyperandrogensim

21
Q

What are the symptoms of PCOS?

A 
subfertility 
oligo/amenorrhoea
hirsutism
obesity
acne
alopecia
22
Q

How is PCOS pre treated?

A

weight loss (BMI

23
Q

How is ovulation induced in PCOS?

A 
*Clomifene citrate (50-100mg tab days 2-6)
Gntrophin therapy (daily injections)
Laparoscopic ovarian diathermy (risk destruction)
24
Q

How can metformin be used to induce ovulation in PCOS?

A

improves insulin resistance

restores menstruation and ovulation

25
Q

What happens in ovarian failure?

A

High gonadotrophins

Low oestragen

26
Q

What can cause ovarian failure?

A 
Premature menopause
Turner's syndrome
Autoimmune 
pelvic radiotherapy
chemo
27
Q

How is premature ovarian failure defined?

A

menopause before 40yrs
amenorrhoea
raised FSH >30 x2 samples
Low eostradiol

28
Q

How can premature ovarian failure be treated?

A

HRT*
assisted conception
cryopreservation

29
Q

How is reduced overain reserved diagnosed?

A

raised FSH
low Anti Mullerian Hormone (AMH)
reduced antral follicle count on USS

30
Q

What are the risks of stimulating ovulation?

A

ovarian hyperstimulation
multiple pregnancy
Cancer

31
Q

What are the complications with multiple pregnancy?

A 
miscarriage
HT/preeclampsia
Gestational diabetes
Low birth weight
prematurity
stillbirth
32
Q

What is the definition of infertility?

A

failure to achieve pregnancy in 12 months unprotected sex with no other reason

33
Q

What is the difference between primary and secondary infertility?

A

P:never conceived before
S: conceived before (not necessarily successful)

34
Q

What decreases chance of conception?

A 
F >35yrs
No previous pregnancy
More than 3 years trying
intercourse incorrectly timed
F BMI 30
Smoking
Caffeine
Alcohol
35
Q

What are the female causes of infertility?

A

ovulation failure
endometriosis
tubal damage

36
Q

How does anorexia affect fertility?

A

low FSH, LH and oestradiol

37
Q

What can cause tubal disease?

A

Infective (STD, TB, transperitioneal spread, following procedure)
Noninfective (endometriosis, surgical,fibroids, polyps)

Endocrinology (17 decks)

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