Endocrine Control Female Reproduction 6

Question 1

What are the major categories of endocrine disorders of the HPG axis?

Answer 1

• Disruption of GnRH secretion
• Damage of the pituitary gonadotropes
• Damage to the ovary
• Androgen excess

Question 2

What is the most common cause of androgen excess?

Answer 2

• Polycystic ovary syndrome (PCOS)
  
  • ​one of the most common endocrine disorders
  • affects 5-10% of reproductive-age women worldwide
  • originally described as a reproductive disorder
  • now recognized as a major metabolic disorder

Question 3

What are the types of menstrual dysfunction?

Answer 3

• “Physiologic”
  
  • pregnancy
  • lactation
  • menopause
• Primary amenorrhea
  
  • no menarche by age 15-16 years
  • evaluation is appropriate if there are no secondary sex characteristics by age 13
• Secondary amenorrhea
  
  • arbitrarily defined as no menses for 6 months
  • the longer the time period, the lower the rate of undiagnosed pregnancy
• Oligomenorrhea
  
  • menses every 36 days to 6 months
• Anovulation
  
  • diagnosed by appropriately-timed serum P level and/or urinary LH measurments
  • body temperature increased by ~0.5 degrees F secondary to P
  • lack of basal body temperature increase is indicative of anovulation
  • amenorrhea and anovulation usually though not necessarily synonymous
  • can have cyclic anovulatory menses and, conversely, ovulation without menses

Question 4

What are the principles of evaluation of endocrine disorders of reproduction?

Answer 4

• FSH is the most sensitive parameter of ovarian follicular reserve
• Progestin challenge to assess estrogen secretion
  
  • if there has been stimulation of endometrial growth by estrogen, administration of progestin will usually result in menses
  • indirect assessment of residual estrogen production in women with amenorrhea