2: Ovulatory disorders (gynae)

Question 1

What is oligomenorrhoea?

Answer 1

Menstrual cycles lasting longer than 35 days

Question 2

What is amenorrhoea?

Answer 2

Absent menstruation

Question 3

Amenorrhoea can be either ___ or ___.

Answer 3

primary

secondary

Question 4

Which abnormal event of the menstrual cycle can cause oligomenorrhoea or amenorrhoea?

Answer 4

Anovulation

Question 5

GnRH is released from the hypothalamus in a pulsatile manner.

Which types of pulses cause the secretion of

a) FSH
b) LH?

Answer 5

a) FSH is secreted by low frequency GnRH pulses

b) LH is secreted by high frequency GnRH pulses

Question 6

Which hormones cause thickening of the endometrium during the menstrual cycle?

Answer 6

Oestradiol

FSH

LH

Progesterone

hCG

basically all of them

Question 7

Which organs secrete oestrogens?

Answer 7

Ovaries

Adrenal cortex

Placenta

Question 8

Oestrogens cause the (thickening / thinning) of the cervical mucus.

Answer 8

thinning

Question 9

Which process does high concentrations of oestrogen cause?

Which hormones are affected?

Answer 9

Negative feedback AND Positive feedback

FSH, Prolactin secretion inhibited

LH secretion stimulated

Question 10

Secretion of which hormone is inhibited by progesterone?

Answer 10

LH

seeing as LH surges to cause ovulation, and progesterone secretion marks the luteal phase and menstruation

Question 11

What effect does progesterone have on body temperature?

Answer 11

Increases body temperature

Question 12

Progesterone is a smooth muscle (relaxant / contractor).

Answer 12

smooth muscle relaxant

presumably to make menstruation easier

Question 13

Regular menstrual cycles suggests that ___ is occuring as normal.

Answer 13

ovulation

Question 14

Irregular menstrual cycles indicate that which abnormal event is occuring?

Answer 14

Anovulation

Question 15

___ disorders are a common cause of presumed infertility.

Answer 15

Ovulatory disorders

Question 16

What are three causes of anovulation according to the World Health Organisation?

Answer 16

I - Hypothalamic-pituitary failure - hypogonadotrophic hypogonadism

II - Hypothalamic-pituitary dysfunction - PCOS, hyperprolactinaemia

III - Ovarian failure - menopause, premature

Question 17

What is hypothalamic-pituitary failure, causing anovulation, also known as?

Answer 17

Hypogonadotrophic hypogonadism

Question 18

What are four important causes of hypogonadotrophic hypogonadism?

Answer 18

Stress

Low BMI (e.g anorexia nervosa)

Excessive exercise (often goes with the above, or eating disorders)

Kallmann syndrome (associated with anosmia)

Question 19

What hormone abnormalities are seen in hypogonadotrophic hypogonadism?

Answer 19

Low GnRH

Low FSH and LH

so low oestrogen

Question 20

What is the main symptom of hypogonadotrophic hypogonadism?

Answer 20

Amenorrhoea

Question 21

How can hypogonadotrophic hypogonadism be diagnosed?

Answer 21

Progesterone challenge test

Question 22

How is hypogonadotrophic hypogonadism treated?

Answer 22

Treat underlying causes (stress, sort BMI, hormone tests/USS for tumours)

GnRH pump

IV FSH/LH injections

Question 23

What are two ovulatory disorders which come under WHO II: Hypothalamic-pituitary dysfunction?

Answer 23

Polycystic ovary syndrome (PCOS)

Hyperprolactinaemia

Question 24

What is PCOS?

Answer 24

Polycystic ovary syndrome

Causes hyperandrogenism (acne, hirsutism) and oligo- or amenorrhoea

Question 25

What are the three diagnostic criteria for PCOS?

Answer 25

**1. Oligo-** or **amenorrhoea** **2. Evidence of polycystic ovaries on USS** **3. Hyperandrogenism symptoms** (acne, hirsutism)

Question 26

What is an endocrine complication of PCOS?

Answer 26

**Insulin resistance**

Question 27

What two effects does **hyperinsulinaemia** have on the HPO axis?

Answer 27

**Elevates LH** **Reduces SHBG levels**, leading to increased levels of free testosterone \> **hyperandrogenism**

Question 28

What BMI must patients be **under** before they are considered for any sort of infertility treatment?

Answer 28

**\< 35, \<30** depending on some places

Question 29

What supplement are all pregnant women given? Why?

Answer 29

**Folic acid** **Helps to prevent birth defects**

Question 30

What general type of treatment is used for patients with PCOS?

Answer 30

**Ovulation induction**

Question 31

What is the first line type of ovulation induction in patients with PCOS?

Answer 31

**Clomiphene citrate** therapy

Question 32

If clomifene citrate isn't effective in women with PCOS, what other types of ovulation induction can be attempted?

Answer 32

**Gonadotrophin injections** As hyperandrogenism arrests follicular growth, FSH injections are used to restimulate it

Question 33

What is an uncommon type of ovulation induction?

Answer 33

**Laparoscopic ovarian drilling** somehow causes ovulation

Question 34

What are three complications of ovulation induction therapy?

Answer 34

**Ovarian hyperstimulation** (which can be lethal) **Multiple pregnancy** (woo twins) Possibly **ovarian cancer**

Question 35

What are the two types of twins?

Answer 35

**Monozygotic** (identical) **twins** - the one egg splits into two zygotes **Dizygotic** (fraternal) **twins** - two sperm cells fertilise two eggs

Question 36

What complication of multiple pregnancy involves transfusion of blood from one twin to another (& actually happened to me and scott lol)?

Answer 36

**Twin-twin transfusion syndrome**

Question 37

Apart from PCOS, what is another hypothalamic-pituitary disorder which can cause anovulation?

Answer 37

**Hyperprolactinaemia**

Question 38

Why does hyperprolactinaemia cause anovulation?

Answer 38

**Prolactin inhibits the secretion of GnRH**

Question 39

What should be assessed on examination of anyone with suspected pituitary gland swelling or tumours?

Answer 39

**Visual fields** for bitemporal hemianopia

Question 40

How is hyperprolactinaemia treated?

Answer 40

**Dopamine agonists** e.g CABERGOLINE

Question 41

In women with hyperprolactinaemia who are trying to conceive, when should the use of dopamine agonists be stopped?

Answer 41

**Once they become pregnant**

Question 42

What is the third cause of anovulation according to the WHO?

Answer 42

**Ovarian failure**

Question 43

What level of a) gonadotrophins b) oestrogen is seen in ovarian failure?

Answer 43

**a) High gonadotrophins** (in an attempt to compensate) **b)** **Low oestrogen** (because the ovaries can't produce any)

Question 44

When does ovarian failure occur normally?

Answer 44

**Menopause**

Question 45

When is ovarian failure **premature**?

Answer 45

When it occurs before the age of 40

Question 46

Ovarian failure causes (**oligomenorrhoea / amenorrhoea**).

Answer 46

**amenorrhoea**

Question 47

What are the "menopausal" symptoms of ovarian failure?

Answer 47

**Hot flushes** **Night sweats** **Vaginal dryness** Irritability Reduced libido

Question 48

What is a **genetic** cause of premature ovarian failure?

Answer 48

**Turner's syndrome**

Question 49

What is the karyotype of Turner's syndrome?

Answer 49

**45 XO**

Question 50

What is the presentation of someone with Turner's syndrome?

Answer 50

**Girl of short stature and undeveloped sexual characteristics** **Amenorrhoea**

Question 51

Apart from Turner's, what are some other causes of premature ovarian failure?

Answer 51

**Iatrogenic** - radio/chemotherapy, surgery ## Footnote **Autoimmune**

Question 52

How can women with premature ovarian failure raise their own family?

Answer 52

**Egg donation**

Question 53

What may women with premature ovarian failure be put on to control their symptoms?

Answer 53

**HRT** i.e oestrogen/progesterone via combined contraceptive pill