Reproduction Disorders Flashcards
Define oligomenorrhoea
Reduced frequency of periods (less than 9/year)
Define primary amenorrhoea
Failure of having a period before the age of 16
Define secondary amenorrhoea
Cessation of periods for greater than 6mths in someone who has previously had a period
What is the main cause of primary amenorrhoea?
Congenital abnormality
Turner’s, Kallman’s
List ovarian causes of secondary amenorrhoea
Polycystic ovarian syndrome
Ovarian failure
High prolactin and hypopituitarism can cause amenorrhoea. True/False?
True
What triad of symptoms are classic of amenorrhoea/oestrogen deficiency?
Flushing
Lack of libido
Dyspareunia (painful sex)
List investigations that all patients with oligo-/amen- orrhoea get
LH, FSH, oestradiol levels
Thyroid function tests
Prolactin levels
List additional investigations for oligo-/amen- orrhoea
Ovarian USS, endometrial thickness
Testosterone levels if hirsutism
Pituitary function
In primary hypogonadism in females, the problem is arising from where - ovaries or pituitary/hypothalamus?
Ovaries
In secondary hypogonadism in females, the problem is arising from where - ovaries or pituitary/hypothalamus?
Pituitary/hypothalamus
Describe LH and FSH levels in primary hypogonadism
High LH
High FSH
i.e. hypergonadotrophic hypogonadism
Describe LH and FSH levels in secondary hypogonadism
Low LH
Low FSH
i.e. hypogonadotrophic hypogonadism
Give an example of a condition where primary hypogonadism occurs
Premature ovarian failure
What happens in premature ovarian failure?
Loss of ovarian function causes amenorrhoea, low oestrogen and elevated gonadotrophins
What is idiopathic hypogonadotrophic hypogonadism?
Absent/delayed sexual development assoc. with low levels of gonadotrophins in the absence of anatomical/functional defect in the H-P-gonadal axis
Which syndrome is like idiopathic hypogonadotrophic hypogonadism but includes anosmia (inability to smell)?
Kalmann’s syndrome
What is the major defect/identified cause of idiopathic hypogonadotrophic hypogonadism?
Mutated GnRH receptor (thus inability to sense GnRH from hypothalamus)
What is the function of kisspeptin?
Regulates GnRH secretion and thus puberty
Regulates fertility
What is Kallman’s syndrome?
Genetic disorder of loss of GnRH secretion characterised by anosmia and hyposmia
Males are more affected by Kallman’s syndrome. True/False?
True
4:1
What causes hirsutism?
Excess androgen at the hair follicle
What is the most common cause of hirsutism?
Polycystic ovarian syndrome
Which chromosome is missing in Turner syndrome?
X
so women only have one X
List clinical features of Turner syndrome
Short stature Failure/delayed puberty Coarctation of aorta Poor breast formation Infertility
Define primary hypogonadism in males in terms of testosterone and LH/FSH levels
Low testosterone
High FHS/LH
Define secondary hypogonadism in males in terms of testosterone and LH/FSH levels
Low testosterone
Low FSH/LH
What is the most common congenital form of primary hypogonadism?
Klinefelter’s syndrome (XXY)
List clinical features of Klinefelter’s syndrome
Reduced testicular volume
Gynaecomastia
Eunuchoidism
Infertility risk increases with chlamydia infections. True/False?
True
List some male factors contributing to infertility
Decreased quality sperm
Increased testicular cancer
Cryptoorchidism
Hypospadias
Define infertility
Failure to achieve pregnancy after 12 months of regular unprotected sex in a couple who have never had a child
What is the difference between primary + secondary infertility?
Primary: never conceived
Secondary: unsuccessful pregnancy
List factors increasing the chance of conception
Women less than 30yrs Less than 3yrs trying to conceive Intercourse during 6days before ovulation Women BMI 20-30 Non-smokers Low caffeine intake
What are the main causes of female infertility?
Ovulation failure (50%) Tubal damage (25%) Endometriosis (10%) Misc. (15%)
List hypothalamic causes of anovulatory infertility
Anorexia, bulimia
Excessive exercise
List pituitary causes of anovulatory infertility
Hyperprolactinaemia
Sheehan syndrome
Tumours
What is a hydrosalpinx?
Fallopian tube dilation by fluid (due to blockage)
What is endometriosis?
Condition where endometrial tissue grows outside of the womb/uterus
What is the characteristic sign of endometriosis on USS?
Chocolate cysts on ovary
What is the most common cause of male infertility?
Varicocele
What is a varicocele?
“varicose veins” of the testis
List endocrine disorders that can cause male infertility
Hypogonadotrophic hypogonadism (Kallman's) Testicular failure Klinefelter's syndrome (XXY) Hyperprolactinaemia Acromegaly Cushing's
List investigations for causes of infertility in females
Endocervical swab (chlamydia) Cervical smear Pelvic USS Bloods (rubella) Mid-luteal progesterone Hormone levels (PRL, FSH, LH) Hysterosalpingiogram (tubal patency)
List causes of WHO group I ovulatory disorders
(hypothalamic causes) Hypogonadotrophic hypogonadism Kallman's syndrome Anorexia, bulimia Excessive exercise
List causes of WHO group II ovulatory disorders
(pituitary dysfunction)
Normogonadotrophic hypogonadism
Polycystic ovarian syndrome
List causes of WHO group III ovulatory disorders
Hypergonadotrophic hypogonadism
Ovarian failure
