reproductive treatment

Question 1

restore ovulation for PCOS

Answer 1

1) Lifestyle
2)metformin
3)letrozole (aromatase inhibitor)
4)clomiphene (oestradiol receptor modulator)
5) FSH stimulation

Question 2

restore ovulation for hypothalamic amenorrhoea

Answer 2

1.Lifestyle / Weight gain / reduce exercise
2.Pulsatile GnRH pump
3.FSH stimulation
4.Letrozole (Aromatase inhibitor)
5.Clomiphene (Oestradiol receptor modulator)

Question 3

IVF treatment

Answer 3

1. oocyte retrieval
2. fertilisation in vitro
3. embryo incubation
4. embryo transfer

Question 4

how does Oral contraceptive pill work

Answer 4

1. anovulation
2. thickening of cervical mucus
3. thinning of endometrial lining to reduce implant

has oestrogen/progesterone which negatively feedback and decreases LH/FSH

Question 5

non contraceptive use of OCP

Answer 5

• help make periods lighter and less painful
  -PCOS- reduce LH and hyperandrogenism (acne/hirsutism)

Question 6

difference between POP(mini pill) and OCP

Answer 6

POP
suitable if pt cannot take oestrogen
shorter acting- take same time everyday.
can be used while breastfeeding

OCP
cannot be used while breastfeeding
can take anytime everyday

Question 7

examples of LARC(long acting reversible contraceptives)

Answer 7

coils (IUD) (5-10 years)
Mirena coil (IUS) (5 years)

progestogen-only injectable contraceptives/
subdermal implants

Question 8

emergency contraception

Answer 8

1) IUD- up to 5 days after unprotected sex
2) ulipristal acetate - stops progesterone working normally and prevent ovulation. Taken within 5 days of unprotected sex
3) levonorgestrel - synthetic progesterone prevent ovulation- taken within 3 days

nausea, abdominal pain
if vomited within 2-3 hr: take another

Question 9

consideration for contraception choice

Answer 9

1. contraindication OCP
2. other condition that may benefit
   3.Check STI
3. concurrent med
4. ease of use

Question 10

when to avoid OCP

Answer 10

Migraine with aura (risk of stroke)
Smoking (>15/day) at age >35yrs
Stroke or CVD history
Current Breast cancer

(risk VTE/CVD/Stroke)

Question 11

pros of HRT

Answer 11

Pros
-symptom relief from low oestrogen
-reduce osteoporosis related fractures

Question 12

what is progestogens

Answer 12

synthetic progestins and natural progesterone

Question 13

cons of HRT

Answer 13

cons
1. VTE (DVT/PE) risk- as drug increases clotting factors
-transdermal oestrogen safer for VTE than oral

2.breast cancer-combined HRT.
ovarian cancer- LT use
-assess risk in individual before prescribing
endometrial cancer- prescribe progestogen. post-menopausal bleeding- indicate endometrial cancer

3. CVD
   decrease-younger women (POI)
   increase- started later after menopause

4.stroke risk
oral higher risk than transdermal

Question 14

Transgender Men: Treat with Masculinising Hormones :

Answer 14

1. Testosterone (injections, gels)
2. Progesterone- suppress menstrual bleeding if needed (endometrial hyperplasia 15%).

Question 15

Transgender Women: Treat with Feminising Hormones :

Answer 15

1. Reduce Testosterone
   GnRH agonist-desensitisation HPG axis.
   Anti-Androgen medications.
2. Estrogen (transdermal, oral, intramuscular)
   High dose oestrogen
   SE: risk VTE 2.6%