Reproductive Tutorials Flashcards
what are the key features of PCOS
Acne (especially back), high BMI, hirsutism, irregular painful or no periods - hyperandrogenism
what FSH is suggestive if PCOS
if high twice 6 weeks apart
is tubal disease anovulatory
no as egg released it just cant get through - if fertilised will case ectopic pregnancy
what are the pituitary causes of anovulation
prolactinoma, pituitary tumour/ mass
what are the key features of anorexia
low BMI, hair loss, increased lanugo, low pulse and BP (hypothyroid), anaemia (vit deficiency), halitosis (ketones), low mood, food restriction, excessive exercise
why does anorexia develop amenorrhoea
Hypothalamus- lack of gonadotrophin releasing hormone, loss of GnRH pulsatile release= low FSH and LH = hypothalamic hypogonadotropic failure. Low oestradiol, low BMI
what are other complications of anorexia
hypothalamic disorder, bone loss, GH resistance, stunted growth, hypercortisolaemia, renal failure, hepatic failure, starvation ketoacidosis, muscle wasting, pancreatic failure, death
what are the main features of menopause
Hot flushes, night sweats, atrophic vaginitis, irritable, irregular periods, amenorrhoea
what would hormone tests show in premature ovarian failure
High FSH, high LF, low oestradiol
what does anti mullerian hormone show
egg reserve
what are the long term complications of ovarian failure
osteoporosis, vaginal prolapse
what is at risk in obese patient with high oestrogen levels
endometrial cancer - importance to release calcium
what should a gynaecological history should include
menstrual history: age of menarche, last period, regularity and length of cycle, dysmenorrhoea/ menorrhagia, discharge
cervical smear history
sexual history (inc contraception, frequency, libido, dyspareunia, STIs)
previous gynae treatment or surgery
obstetric history: previous pregnancies, year, gestation, outcome, antenatal/intrapartu,/postnatal problems, previous miscarriages, previous terminations
how are oestrogens produced
androgens converted into it by granulosa cells via the enzyme aromatase
what is oestradiol
the most potent form of oestrogen produced by the ovaries
what happens to hormones in the follicular phase
GnRH increases causes the ant pit to release more FSH and LH
LH causes the theca cells to prosuce androgens
FSH stimulates the granulosa to convert the androgens to oestrogen
in this phase oestrogen will rise casugn FSH to be inhibited
how does FSH affect follicles
stimulates them to mature
when is there a surge in LH
between day 12 and 14, triggers ovulation
what triggers the formation of the corpus luteum
LH
what does progesterone do to the endometrium
induces a secretory effect, prepares it for egg implantation
what happens to the endometrium during the luteal phase
thickens
when is the luteal phase
after ovulation (day 15-28)
what are the other roles of progesterone
increases basal body temp
increases thickness of cervical mucous
glandular development of the breasts
what will high levels of progesterone inhibit
FSH and LH production
what happens to hormones as the endometrium is shed
levels of FSH and LH increase as no longer inhibited by progesterone - allows cycle to begin again
what does corpus luteum secrete
progesterone
how does insulin drive an increase in androgens
drives the thecal cells of the follicle to produce more androgens
is PCS usually bilateral or unilateral
bilateral
how can hyperandrogenism be managed
oral contraceptive pill (decreases free testosterone and increases SHBG)
can be combined with anti-androgen: cyrpterone acetate
why does low weight cause amenorrhoea
as hypothalamic-pituitary axis is disturbed, levels of GnRH fall
why is full blood count done in anorexia
as bone marrow components may be compromised
how can chronic dehydration affect U&Es
hypokalaemia and hyponatraemia
what is trousseaus signs
in hypocalcaemia
inflating BP cuff causes the fingers to flex and draw together
what ECG signs show hypokalaemia
small or inverted T waves
what are tented T waves a sign of
hyperkalaemia
