w5 - ovulation disorders Flashcards

1
Q

ovulatory disorders associated oligomenorrhea and amenorrhea. define each

A

amenorrhea - absent menstruation, either primary or 2ndary

oligomenorrhea - infrequent periods, >35d in between

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2
Q

outline HPO axis (hypothal-pit-ovarian)

A

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

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3
Q

GnRH stimulates FSH at __ frequency pulses, and LH at __ frequency pulses

A

FSH = LOW

LH = HIGH

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4
Q

other than stimulating follicuular development, function of FSH

A

thickens endometrium

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5
Q

other than stimulating corpus luteum development, 2 functions of LH

A

ovulation

thickens endometrium

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6
Q

LH surge is usually __ before ovulation

A

36hr

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7
Q

what else peaks prior ovulation, other than LHV

A

estradiol

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8
Q

progesterone peaks following ovulaton, what produces this

A

corpus luteum

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9
Q

oestrogen is primarily ecreted by the ___ and adrenal cortex. What else produces it?
Function? (2)
high oestrogen inibits what (2)

A

ovaries (follicles)

placenta in pregnancy

endometrium thickening
responsible for fertile cervical mucus

FSH + prolactin

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10
Q

progesterone secreted by _ __, why?
what does it inhibit?

function?

effect on temp

A

corpus luteum
maintains early pregnancy

LH

infertile (thick) cervical mucus
maintain thickness
myometrium relaxation

incr basal body temp

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11
Q

assesing ovulation

A

regular cycles

confirm by midluteal serum progesterone

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12
Q

hypothalamic pituitary failure will have low levels of __ and __, with __ deficiency, normal __

will it have amenorrhoea or oligomenorrhea?

A

FSH + LH
oestrogen deficiency
normal prolactin
amenorrhea

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13
Q

7 causes of hypothal-pit failure

A
stress 
excessive exercise 
anorexia 
brain/pit tumours 
head trauma 
kallmans syndrome 
drugs (opiates, steroids0
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14
Q

management of hypothalamic anovulation

A

stabilise weight
pulsatile GnRH if hypogonadotrophism hypogonadism

Gonadotrophin (LH +FSH) daily injections

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15
Q

what is required alongside management of hypothalamic anovulation

A

US

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16
Q

group 1 is hypothalamic pit failure, group 2 is hypothalamic pit dysfunction. biochem of this. would you expect olgo/amenorrhoea?

A

(85% ovulatory disorders)

normal gonadotrophin / excess LH
normal oestrogen

oligo/amenorrhoea

17
Q

PCOS is diagnosed when there is 2/3 of

A

cysts present
oligo/ amenorrhoea
hyperandrogenism (ACne, hirsutism)

18
Q

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

A

insulin resistance

dimihsed response, but normal pancreatic reserve

glucose

true

iiinsulin lowers SHBH, incr free testosterone leading to hyperandrogenism

19
Q

pre treatment management of PCOS

A
weight loss 
life style mod (smoking, alcohol) 
folic acid 400mcg/5mg /d 
check prescribed drugs 
rubellla immune 
normal semen analysis
20
Q

3 ways to induce obulation in PCOS

A
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

21
Q

options for clomifene resistant cases

A

metformin (incr clomi’s sensitivity)
gonadotrophin therapy
laparoscopic ovarian drilling
assisted conception treatment

22
Q

lamba sign on US indicates

T sign indicates

A

dichorionic twins (from 2 eggs)

monochorionic

23
Q

twin-twin transfusion is a possible complication of hyperstimulation. outlin pathophysiology nd treatment (3)

A

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)

24
Q

3 big complis from hyperstimulation

A

ovarian cancer
prematurity
twin transfusion syndrome

25
Q

hyperprolactinaemia
history (3)
examination - must check what
investigations 5

A

history
amenorrhoea
galactorrhea
current medication

examin
visual fields

invest
normal FSH/LH
low oestrogen 
raiseed serum prolactin (2 occasions)
TFT normal 
MRI - diagnosis
26
Q

treatment for hypperprolactinaemia

A

dopamine agonist
cabergoline (2/wk)

bromocriptine

shd be stopped when preg occurs

27
Q

group 3 is ovarian failure, accounts for 5% of ovulatory disorders, what is seen biochem
amenorrhea?
other aspect

A

high gonadotrophins (2 occasions)
low oestrogen
yes amenorrhea

menopauusal

28
Q

premature ovarian failure occurs when menopause <40yrs. give causes

A

genetics (turner, fragile X, XX gonadal agenesis)
autoimmune
bilateral oophrectomy
pelvic radio/chemo

29
Q

treatment for prem. ovarian failure

A

hormone replacement
egg/embryo donation
cyropreservation prior chemo/radio if POF anticipated
counselling

30
Q

key factors for gynaecological history

A
details of menstrual cycle 
amenorrhoea 
hirsutism 
acne? 
galactorrhoea 
headaches 
visual symptoms
PMH 
D historyb
31
Q

biochemistry for POF should be carried out on day 2-5, and on day 21 of cycle. what for each?

A
day 2-5
serum FSH, LH, estradiol 
serum testosterone/SHBG 
prolactin 
TSh 

day 21
progesterone

32
Q

progesterone challenge test also used, what is this? what does it indicate

A

5d progesterone course -> menstrual bleed

indicates oestrogen levels