Reproductive Disorders Flashcards
ratio of LH:FSH in early follicular phase
equal days 1-5
granulosa cells make….?
luteal cells make…?
estradial
androgens: DHEA, androstendione, test, progesterone
folliculogenesis growth factors produced by ovary?
inhibin –> inhibit FSH
activin –> activate FSH
Inhibin during different parts of cycle
inhibin a –> luteal phase
inhibin b –> follicular phase
How to evaluate a woman with distrubance in menstrual cycle? (5 things)
- exclude pregnancy with BhCG
- r/o prolactinoma
- androgen levels if hirsutism/acne
- GnRH stim only in precoicious puberty
- Draw LH/FSH in first 5 days after menses
If there’s no menses, what can you use to induce bleeding?
medroxyprogesterone or estrogen + prog to trigger a follicular phase
hypogonadotropic hypogonadism (labs)
- low LH, FSH, estradiol
- amenorrhea
hypothalamic amenorrhea
- acquired GnRH def of pulses
- most common
- due to stress, exercise, poor nutrition
hypergonodotropic hypogonadism (labs)
- high FSH and/or LH
- low estradiol
- amenorrhea
hypergonodotropic hypogonadism (types)
- turners
- premature ovarian insufficiency
premature ovarian insufficiency
Ovarian failure before age 40
-req eventual HRT
signs and sx of POI
- irregular menses without molimal sx
- FSH rise BEFORE LH rise (loss of inhibin)
- look for other AI d/os
hyperandrogenic anovulation - what can cause this?
PCOS
tumors
obesity induced anovulation
PCOS (labs)
timed gonadotropin levels on day 1-5 of cycle
- labs show HIGH ratio of LH/FSH > 2.5/1
- increased androgens: test (ovarian) and DHEAS (adrenal)
risks assoc with PCOS
- endometrial cancer (estrogen unopposed by prog)
- insulin resistance
- htn
- premature cardiac dz
goals in PCOS treatment
- ensure endometiral shedding to prevent endometrial CA
- block effects of hyperandrogenization
Tumors that cause hirsituism
- virilizing tumors of ovary make testosterone (>200ng/dl)
- virilizing tumors of adrenal make DHEA-s (>800 ng/dl)
- RAPID ONSET/ pace of sx like male pattern balding, hair on chest and back, clitorromegally
obesity induced anovulation
- often misdx for PCOS
- normal puberty cycle until they exceed weight set point –> develop acne and hirsituism
- will have NORMAL/EQUAL LH/FSH
- xsaromatase and 5areductase activity in fat tissue
treatment for female hypogonadism
- no treatment
- estrogen
- fertility drugs
- pulsatile GnRH
how long until bone loss occurs after onset of estrogen defeicits?
6 months
Estrogen therapy
-BCP
how is estrogen therapy used in congenital defects?
low dose E alone for 12-18 mo to develop breasts
-add prog in cyclic fashion to develop ductules
progesterone alone therapy?
use for dysfunctional uterine bleeding and hyperandrogenic anovulation in pt who are not esstrogen deficient
HRT in women with POI?
give est and prog in physiologic manner similar to menopausal hormone therapy
clomiphene citrate (clomid)
- fertility drug
- mixed estrogen agonist/antagonist
- augments folliculogensis in pts with muted GnRH pulse generator
- fools repro axis into thinking there is est deficiency
on what days of the cycle and at what dose d you give clomiphene citrate
5-9
50-150 mg/day
-must monitor for anti-est effects on cervical mucus and ovulation rates
drug combo that stimulates folliculogenesis and ovulation for in vitro prp
human gonadotropins (pergonal) or recombinant FSH (menotropin) + hCG (profasi) -monitor with daily blood samples
pulsatile GnRH tx
- to induce ovulation in women with hypothalamic amenorrhea to replace bunk GnRH pulse generator
- IV admin with mump to mimic cycle signals
fertility drugs in women with PCOS
- prog
- GnRH agonist –> continuious Lupron to downreg GnRH receptor
- give above for ONE MONTH to suppress endogenous GnRh
- then give pulsative GnRH
- metformin or thiazoladinedione to improve ovulation rates
