w5 - ovulation disorders Flashcards
ovulatory disorders associated oligomenorrhea and amenorrhea. define each
amenorrhea - absent menstruation, either primary or 2ndary
oligomenorrhea - infrequent periods, >35d in between
outline HPO axis (hypothal-pit-ovarian)
hypothalamus secretes GnRH, pit then secretes FSH + LH, causing ovary in follicular phase to secrete estradiol (inhibited in L.phase) and progesteone in L.phase
GnRH stimulates FSH at __ frequency pulses, and LH at __ frequency pulses
FSH = LOW
LH = HIGH
other than stimulating follicuular development, function of FSH
thickens endometrium
other than stimulating corpus luteum development, 2 functions of LH
ovulation
thickens endometrium
LH surge is usually __ before ovulation
36hr
what else peaks prior ovulation, other than LHV
estradiol
progesterone peaks following ovulaton, what produces this
corpus luteum
oestrogen is primarily ecreted by the ___ and adrenal cortex. What else produces it?
Function? (2)
high oestrogen inibits what (2)
ovaries (follicles)
placenta in pregnancy
endometrium thickening
responsible for fertile cervical mucus
FSH + prolactin
progesterone secreted by _ __, why?
what does it inhibit?
function?
effect on temp
corpus luteum
maintains early pregnancy
LH
infertile (thick) cervical mucus
maintain thickness
myometrium relaxation
incr basal body temp
assesing ovulation
regular cycles
confirm by midluteal serum progesterone
hypothalamic pituitary failure will have low levels of __ and __, with __ deficiency, normal __
will it have amenorrhoea or oligomenorrhea?
FSH + LH
oestrogen deficiency
normal prolactin
amenorrhea
7 causes of hypothal-pit failure
stress excessive exercise anorexia brain/pit tumours head trauma kallmans syndrome drugs (opiates, steroids0
management of hypothalamic anovulation
stabilise weight
pulsatile GnRH if hypogonadotrophism hypogonadism
Gonadotrophin (LH +FSH) daily injections
what is required alongside management of hypothalamic anovulation
US
group 1 is hypothalamic pit failure, group 2 is hypothalamic pit dysfunction. biochem of this. would you expect olgo/amenorrhoea?
(85% ovulatory disorders)
normal gonadotrophin / excess LH
normal oestrogen
oligo/amenorrhoea
PCOS is diagnosed when there is 2/3 of
cysts present
oligo/ amenorrhoea
hyperandrogenism (ACne, hirsutism)
what is seen in 50-80% PCOS?
how does it lead to hyperinsulinaemia?
20% have __ intolerance
t,f insulin acts as co-gonadotrophin to LH?
how does hyperandrogenism occur in PCOSS
insulin resistance
dimihsed response, but normal pancreatic reserve
glucose
true
iiinsulin lowers SHBH, incr free testosterone leading to hyperandrogenism
pre treatment management of PCOS
weight loss life style mod (smoking, alcohol) folic acid 400mcg/5mg /d check prescribed drugs rubellla immune normal semen analysis
3 ways to induce obulation in PCOS
clomifen citrate(1st line) (anti-oestrogen, binds to receptors, prevents -ve feedback) (tamoxfien, letrozole also)
gonadotrophin therapy (recombinant FSH) risks: multiple preg, overstim.
laparosopic ovarian diathermy
options for clomifene resistant cases
metformin (incr clomi’s sensitivity)
gonadotrophin therapy
laparoscopic ovarian drilling
assisted conception treatment
lamba sign on US indicates
T sign indicates
dichorionic twins (from 2 eggs)
monochorionic
twin-twin transfusion is a possible complication of hyperstimulation. outlin pathophysiology nd treatment (3)
unablancd vascular communications within placental bed
recipient - polyhydramios
donor- oliguria, oligohydroamnios (no amniotic fluid), growth restriction
treatment
laser division
amnioreduction
septostomy
(80-100% mortaility if untreated)
3 big complis from hyperstimulation
ovarian cancer
prematurity
twin transfusion syndrome
hyperprolactinaemia
history (3)
examination - must check what
investigations 5
history
amenorrhoea
galactorrhea
current medication
examin
visual fields
invest normal FSH/LH low oestrogen raiseed serum prolactin (2 occasions) TFT normal MRI - diagnosis
treatment for hypperprolactinaemia
dopamine agonist
cabergoline (2/wk)
bromocriptine
shd be stopped when preg occurs
group 3 is ovarian failure, accounts for 5% of ovulatory disorders, what is seen biochem
amenorrhea?
other aspect
high gonadotrophins (2 occasions)
low oestrogen
yes amenorrhea
menopauusal
premature ovarian failure occurs when menopause <40yrs. give causes
genetics (turner, fragile X, XX gonadal agenesis)
autoimmune
bilateral oophrectomy
pelvic radio/chemo
treatment for prem. ovarian failure
hormone replacement
egg/embryo donation
cyropreservation prior chemo/radio if POF anticipated
counselling
key factors for gynaecological history
details of menstrual cycle amenorrhoea hirsutism acne? galactorrhoea headaches visual symptoms PMH D historyb
biochemistry for POF should be carried out on day 2-5, and on day 21 of cycle. what for each?
day 2-5 serum FSH, LH, estradiol serum testosterone/SHBG prolactin TSh
day 21
progesterone
progesterone challenge test also used, what is this? what does it indicate
5d progesterone course -> menstrual bleed
indicates oestrogen levels
