184- anovulation Flashcards
FSH: what cells does it stimulate? Stimulates production of what else?
proliferation of granulosa cells
aromatase and estradiol, granulosa cell FSH/LH receptors, activin and inhibin
primary vs secondary amenorrhea
primary: no menses by 16, no breasts by 14
secondary: no menses for 6 months
things to rule out when someone presents with secondary amenorrhea? what are disease/disfunction causes?
pregnancy, breast feeding, OCP, IUDs, progestin pill
hypogonadotropic hypogonadism, hyperprolactinemia, PCOS, POF, Asherman’s
Hypogonadotropic hypogonadism: most common cuases? LH/FSH levels? Estogen levels? Other findings?
weight loss, exercise, stress
Low, low. Thin endometrial stripe
Hyperprolactinemia: what drugs cause it? what else?
prolactinomas and antipsychotics: phenothiazines, haloperidol, risperidone. Clozapine is only transient
Criteria for PCOS
anovulation, androgen excess, polycystic ovaries (multiple large follicles)
Treatment of PCOS
Weight loss is first (5% wt loss leads to regular menses). OCPs for anovulation and hirsutism. Possible metformin for insulin resistance.
Premature ovarian failure: define? What chromosomal abnormalities can cause it? What other autoimmune syndromes present with it? Are POF ppl at risk of anything else?
menopause before 40 or two FSH levels >40 one month apart
15% of Fragile X (FMR1) premutations have POF. 45XO is at risk for CV issues
Hypothyroidism
Osteoporosis
Asherman’s syndrome
adhesions from abortions or other procedures
most common causes of primary amenorrhea
gonadal dysgenesis (often from abnormal karyotype), hypogonadotropic hypogonadism, anatomic (imperforate hymen, MRKH absence of vagina)
ovulation induction in PCOS: what meds can you use?
aromatase inhibitors: anastrozole, letrozole
Gonadotropin injections
Clomiphene citrate
