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Endocrine > Reproduction: Ovulation Disorders > Flashcards

Reproduction: Ovulation Disorders Flashcards

1
Q

Oligomenorrhoea

A

Cycle lasts >35 days

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2
Q

Amenorrhoea

A

Absent menstruation
Primary: Never had a period
Secondary : Period has stopped

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3
Q

Gonadotrophin Releasing Hormone

A 
Synthesised by neurons in hypothalamus 
Pulsatile release 
Stimulates synthesis/ release of 
- FSH (low frequency)
-LH (high frequency)
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4
Q

Follicular Stimulating Hormone

A

Secreted by anterior pituitary
Stimulates follicular development
Thicken endometrium

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5
Q

luteinising hormone

A

Secreted by anterior pituitary
Peak (LH surge) stimulates ovulation
Stimulates corpus luteum developement
Thickens endometrium

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6
Q

Hormone Peaks during Menstrual Cycle

A

Estradoil peaks before ovulation
LH surge triggers ovulation
Progesterone peak follows ovulation

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7
Q

Estrogen

A

Secreted primarily by ovaries (follicles) and adrenal cortex
Stimulates thickening of endometrium
Responsible for fertile cervical mucus

High oestrogen concentration inhibits secretion of FSH and prolactin
(-ve feedback)

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8
Q

Progesterone

A

Secreted by corpus luteum to maintain early pregnancy
Inhibits secretion of LH
Responsible for infertile (thick) cervical mucosa
Maintains thickness of endometrium
Has thermogenic effect
- increases basal body temp
Relaxes smooth muscles

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9
Q

Assessing Ovulation

A

Regular cycles very suggestive of ovulation
- Confirm by midluteal (day 21) serum progesterone (>30nmol/l)

Irregular cycles: probably anovulatory: needs further hormone evaluation

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10
Q

Ovulatory Disorders Classifications

A

Group 1: Hypothalamic Pituitary Failure

Group 2: Hypothalamic Pituitary Dysfunction

Group 3 : Ovarian Failure

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11
Q

Group 1 ovulatory Disorders

A

hypogonadotrophic hypogonadism

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12
Q

Group 1 Ovulatory Disorders Finding

A 
Low levels LH/ FSH 
Oestrogen deficiency 
- negative progesterone challenge test 
Normal prolactin 
Amenorrhoea
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13
Q

Group 1 Ovulatory Disorders Aetiology

A 
Stress
Excessive exercise
Anorexia/low BMI 
Brain/ pituitary tumours 
Head trauma 
kallmanns syndrome 
Drugs (steroid, opiates)
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14
Q

Group 1 Disorder : Pre-treatment

A 
Stabilise weight 
Lifestyle modification (smoking, alcohol) 
Folic acid (400mcg daily) 
Check prescribed drugs 
Rubella Immune
Normal semen analysis
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15
Q

Group 1 Disorder: Medical Management

A

Pulsatile GnRH

  • SC or IV pump worn continuously
  • Pulsatile administration every 90 mins

Gonadotrophin (LH and FSH) daily injections

Pulsatile GnRH and gonadotrophin injections both need US monitoring of response
–> follicle tracking

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16
Q

Group 2 Ovulatory Disorder

A

Hypothalamic Pituitary Dysfunction

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17
Q

Group 2 Disorders Findings

A

Normal gonadotrophins
- possible excess LH

normal oestrogen levels

Oligomenorrhoea or Amenorrhoea

18
Q

Group 2 Disorders Example

A

PCOS

19
Q

PCOS

A

heterogenous disease characterised by hyperandrogegism and ovarian dysfunction which results in oligomenorrhoea or amenorrhoea and is associated with subfertility

20
Q

PCOS Presentation

A

Oligomenorrhoea (80- 90%)

Amenorrhoea (10-20%)

21
Q

PCOS Diagnosis

A

Requires 2 out of 3

Oligomenorrhoea or Amenorrhoea

polycystic Ovaries (US appearance)

  • 12 or more 2-9mm follicles
  • Increased ovarian volume (>10ml)
  • Uni or bilateral

Chemical +/- biochemical signs of hyperandrogegism (acne, hirsutism)

22
Q

PCOS and insulin resistance

A

Insulin resistance seen in 50 to 80%

Diminished biological response to a given level of insulin

Normal pancreatic reserve
- hyperinsulinaemia

Insulin acts as co-gonadotrophin to LH

  • 60% elevated LH
  • 955 altered LH: FSh ratios

Insulin lowers SHBG levels: increased free testosterone leads to hyperandrogegism

23
Q

Group 2 (PCOS) Management

A

Treat patients symptoms/ needs

pre-treatment (lifestyle etc)

Subfertility: Ovulation Induction

24
Q

Ovulation Induction

A

1st Line: Clomiferene Citrate
2nd : Gonadotrophin Therapy (daily injections)
3rd: Laparoscopic Ovarian Diathermy

25
Q

Ovulation Induction Risks

A

Ovarian hyperstimulation
- affects 10% IVF
-Ranges from mild to severe
Multiple pregnancy

26
Q

Risks of multiple pregnancy

A

Increased maternal pregnancy complications
- hyperemesis, anaemia, hypertension, pre-eclampsia, gestational diabetes, postnatal depression/ stress

Increased risk of miscarriage

Risk of low birth weight and prematurity

Risk of still birth

Monochorionic

27
Q

Chorionicity

A

The number of chorionic (outer) membranes that surround babies in a multiple pregnancy

Monochorionic

  • Fetus share a chorion
  • Increased perinatal mortality
  • T sign on US

Dichorionic

  • Two placenta masses
  • Lambda sign on US
28
Q

Twin Twin Transfusion

A

Unbalanced vascular communications with placental bed

Recipient develops polyhydramnios
Donor develops oliguria, oligohydramnios and growth restriction

80-100% fatal if untreated

Treatment

  • laser division of placenta vessels
  • Amnioreduction
  • Septostomy
29
Q

Group 3 Ovarian Failure Findings

A

high level gonadotrophins
- Raised FSH >30IU/L

Low oestrogen levels

Amenorrhoea

menopausal

30
Q

Premature Ovarian failure

A

Menopause before age 40

31
Q

Premature Ovarian failure Aetiology

A 
Genetic
-Turner syndrome. 
-XX gonadal Genesis
- Fragile X 
Autoimmune ovariaan failure
Bilateral oophorectomy 
Pelvic chemotherapy/ radiotherapy
32
Q

Premature Ovarian Failure Management

A

Hormone replacement therapy

Counselling/ Support network

33
Q

Ovarian Failure; Gynaecological History

A 
Details of menstrual cycle 
Amenorrhoea
Hirsutism
Acne
Galactorrhoea
Headaches
Visual symptoms 
PMH and DHx
34
Q

Ovarian Failure Biochemistry

A

Mid luteal progesterone (day 21)

Early follicular phase(day 2 to 5)

  • serum TSH, oestradiol & LH
  • serum testosterone/ SHBG
  • prolactin

Gold Standard: Progesterone Challenge test
(menstrual bleeding in response to a 5 day course of progesterone: indicates oestrogen levels normal)

35
Q

Ovarian Failure Ultrasound

A

Transvaginal
Routine part of infertility consultation

Examines pelvic anatomy

  • uterus
  • ovarian morphology

Scan to look for follicular growth/ monitor ovulation induction

36
Q

Ovarian Failure Tests

A

Karyotype
ute-antibody screen
MRI of pituitary fossa
Bone density scan

37
Q

hyperprolactinaemia

A

Raised prolactin

Can cause ovulatory disorder

38
Q

hyperprlactinaemia history and exam

A

AAmenorrhoea
Oligomenorrhoea
Current medication

Examine visual fields

39
Q

Hyperproolactinaemia Investigations

A

Normal LH/FSH
Low oestrogen

Raised serum prolactin
- >1000iu/l on 2 or more occasions

TFT normal

MRI
- Diagnose micro/macro prolactinoma

40
Q

Hyperprolactinaemia management

A

Dopamine agonist

  • cabergoline (2x weekly)
  • stop when pregnancy occurs

Endocrine (25 decks)

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