L15 - Hormone Abnormalities 2

Question 1

Define menopause?

Answer 1

12 months since last menstruation.

Patient not pregnant and is not taking hormones which would induce amenorrhoea.

Question 2

Briefly summarise changes in hormones during menopause?

Answer 2

• As proportion of anovulatory menstrual cycles increases,
• progesterone production will decrease.
• Pituitary production of FSH & LH will increase
• due to diminished negative feedback loop from oestrogen / inhibin

Question 3

What is the clinical diagnosis of menopause?

Answer 3

Serum levels of FSH over 30 and irregular / absent periods.

Question 4

What is anti-mullerian hormone?

Answer 4

• Glycoprotein product
• of granulosa cells enveloping each egg.
• Good marker of follicular reserve.
• Only present in ovary until menopause

Question 5

What are some symptoms of menopause?

Answer 5

1. Vaginal bleeding
2. Hot flush
3. Genitourinary atrophy
   - urethra and bladder are oestrogen dependent
   - and will undergo gradual atrophy after menopause.
4. Osteoporosis
   - Bone resorption of osteoclasts in accelerated

Question 6

Describe basis of hormone therapy for menopausal women?

Answer 6

• Oestrogen supplementation.
• Given with progestogens
• to protect from endometrial hyperplasia that would result if just oestrogen was given.

Question 7

What are some risks of hormonal treatment?

Answer 7

• Endometrial carcinoma

- Venous thromboembolic disease

Question 8

Describe the onset of puberty?

Answer 8

> 8 years

GnRH pulses increase in amplitude and frequency such that FSH and LH release increases.

This stimulates oestrogen release from the ovary.

Question 9

Menorrhagia

Answer 9

Heavy bleeding

AKA HMB - heavy menstrual bleeding, usually > 80mls

Question 10

What may be some causes of heavy menstrual bleeding?

Answer 10

• Subtle abnormalities of endometrial haemostasis
• Uterine fibroids (30% women)
• Uterine polyps (10%)

Question 11

What is endometrial haemostasis?

Answer 11

• Cessation of menstrual bleeding
• achieved by endometrial haemostasis
• via
  1. platelet aggregation
  2. fibrin deposition
  3. thrombus formation.

Question 12

Describe what examination of a female patient may show?

Answer 12

• Irregular enlargement of uterus suggests fibroids.

- Tenderness without enlargement suggests adenomyosis

Question 13

Adenomyosis

Answer 13

Inner lining of uterus breaks through myometrium.

Question 14

State the stages of menopause

Answer 14

1. Perimenopause - first features, vasomotor symptoms and menstrual irregularity
2. Post menopause - 12 months after spontaneous amenorrhoea

Question 15

Why are periods in menopausal women shorter?

Answer 15

> 45 y/o
1. Inhibin B from granulosa cells falls

2. causing a rise in FSH.
3. Increased FSH stimulates increased oestradiol from remaining follicles.
4. Oestradiol released more rapidly, resulting in shorter menstrual cycles.

Question 16

Describe the production of oestrone in post menopausal women?

Answer 16

Perimenopausal women - oestrogen production by ovary is erratic

Without follicular source, oestrogen is derived from ovarian stromal and adrenal secretion of androstenedione.

This is aromatised to oestrone in peripheral tissues.

Question 17

What are the different modes in which HRT can be administered?

Answer 17

• oral
• transdermal (patch, gel or nasal spray)
• topical (ointments, medication applied to a particular place)
• intrauterine system (mirena coil)

Question 18

What are some benefits of HRT?

Answer 18

• Oestrogen can help with vaginal and urethral dryness

- and aids bone mineralisation.

Question 19

Why does HRT increase the risk of venous thromboembolism?

Answer 19

• Oestrogen increases coagulability

- hence risk of VTE increases.

Question 20

What are the two main mechanisms of premature ovarian failure?

Answer 20

1. Dysfunction of follicular maturation

2. Depletion in the follicular pool

Question 21

What is POF?

Answer 21

Premature ovarian failure

- loss of function of the ovaries before age of 40.

Question 22

Describe causes of POF?

Answer 22

Mainly idiopathic (88% cases)
Genetic rarer causes 
- X-chromosome 
- Turners syndrome 
- FSH receptor mutation 
Latrogenic 
- chemotherapy / radiotherapy 
- autoimmune causes

Question 23

Describe Turner’s syndrome?

Answer 23

• Only one normal X chromosome
• 1/2000 baby girls
• shorter than average
• accelerated atresia of primordial follicles later fetal life

Question 24

What is Fragile X syndrome?

Answer 24

Can cause range of developmental problems such as learning disabilities and cognitive impairment.
- males usually more affected than females

Question 25

What causes Fragile X syndrome?

Answer 25

Mutation in which DNA segment, known as CGG triplet repeat is expanded within the FMR1 gene.

Question 26

How may Galactosaemia be linked to POF?

Answer 26

Galactosaemia: body cannot process / metabolise galactose.

• Milk broken down into glucose and galactose
• Direct toxicity from increased metabolites
• aberrant glycosylation of glycoproteins / glycolipids involved in ovarian function
• activation of apoptosis of oocytes and ovarian stromal cells.

Question 27

State some measures which can be taken to avoid bone loss?

Answer 27

• Physical activity
• Calcium rich diet
• Vitamin D supplementation
• Avoiding smoking and alcohol

Question 28

What is the squamocolumnar junction?

Answer 28

Junction between the squamous epithelium and columnar epithelium.

Question 29

What is a cervical ectopy?

Answer 29

Condition in which cells inside the cervix develop outside it and form a red, inflamed patch.

Question 30

Fibroids

Answer 30

Non-cancerous growths that develop in or around womb.

- made up of muscle and fibrous tissue.

Question 31

Describe oligomenorrhoea?

Answer 31

Irregular vaginal bleeding.

Usually secondary to anovulatory cycles.