Clinical: PCOS and Oligomenorrhea Flashcards Preview

Block I: Reproduction & Sexuality > Clinical: PCOS and Oligomenorrhea > Flashcards

Flashcards in Clinical: PCOS and Oligomenorrhea Deck (32):
1

Treatment for PCOS anovulation

Clomiphene (effective ovulation induction agent in 70-80%)

2

Describe how clomiphene works

Anti-estrogen = increase in endogenous FSH --> induces follicular growth and then ovulation

3

2 adverse effects of clomiphene

  • Ovarian cancer risk
  • Risk of multiple pregnancy

4

3 reasons why Clomiphene-resistant PCOS may occur

  • Obesity
  • High insulin resistance
  • High free androgen index

5

Accepted first-line treatment for clomiphene-resistant PCOS

Gonadotropins (injected FSH)

6

2 risks of injected FSH

  • OHSS
  • Multiple pregnancy

7

3 findings of severe OHSS

  • Ascites
  • Pleural effusion
  • Tromboses

8

2 types of surgical treatments of CC-resistant PCOS

  • Wedge resection
  • Laparoscopic techniques

9

4 laparoscopic techniques to treat CC-resistant PCOS

  • Biopsy
  • Cauterization
  • Electrocoagulation
  • Laser

10

4 problems with surgical treatment for CC-resistant PCOS

  • Risks of anaesthesia and laparoscopy
  • Periadnexal adhesion formation
  • Ovarian failure/atrophy
  • Anti-ovarian antibodies

11

2 insulin sensitizing agents

  • Metformin
  • Troglitazone

12

Describe the function of metformin

Dereases peripheral insulin resistance and lowers serum glucose and therefore serum insulin

13

2 adrenal steroids to treat CC-resistant PCOS

  • Cortisone
  • Dexamethasone

14

5 causes of anovulation

  • Pituitary and hypothalamic
  • Weight and exercise-related
  • Systemic
  • Hyperprolactinemia
  • Polycystic ovary syndrome

15

5 causes of primary amenorrhea

  • Primary POF
  • Hypo-hypogonadism
  • PCOS
  • Hyperprolactinemia
  • Weight-related

16

6 causes of secondary amenorrhea

  • PCOS
  • POF
  • Hyperprolactinemia
  • Weight-related
  • Hypo-hypogonadism
  • Exercise-induced

17

4 causes of anovulatory infertility

  • PCOS
  • Ovarian failure/POF
  • Hypogonadism
  • Hyperprolactinema

18

Define hypogonadotropic hypogonadism (HH)

Generic term to describe various congenital and acquired defects in HPO axis leading to hypo-secretion of FSH and LH from the anterior pituitary

19

Typical values of FSH and LH in hypogonadotropihic hypogonadism

FSH < 3 IU/L and LH <1 IU/L

20

6 hypothalamic causes of HH

  • Weight loss
  • Intense exercise
  • Genetic (i.e. Kallmann's)
  • Chronic illness
  • Tumos
  • Irradiation

21

8 pituitary causes of HH

  • Hypopituitarism
  • Sheenhan's
  • Tumors
  • Cranial irradiation
  • Surgery
  • Head injury
  • TB
  • Sarcoidosis

22

Describe why ovulation usually returns with weight/fat gain (in a previously low BMI individual)

Increased leptin and decreased NPY activity -- and resumption of pulsatile GnRH secretion

23

5 physiological causes of hyperprolactinemia

  • Pregnancy
  • Lactation
  • Non-REM sleep
  • Stress
  • Nipple stimulation

24

6 pharmacological causes of hyperprolactinemia

  • Dopamine receptor antagonists (i.e. phenothiazine, haloperidol)
  • Dopamine depletors (i.e. methyldopa)
  • Cocaine
  • Verapamil
  • Opiates
  • Clomipramine

25

3 pathological causes of hyperprolactinemia

  • Stalk effect
  • Prolactinomas
  • Other pituitary tumors (i.e. increased PRL in 30% acromegaly cases)

26

Example of stalk effect

Tumor compressing/damaging stalk, stopping dopamine to anterior pituitary

27

2 treatments for hyperprolactinoma

  • Dopamine agonists (i.e. bromocriptine, carbegoline)
  • Transspenoidal hypophysecomy/pituitary radiotherapy

28

Dopamine agonist to treat hyperprolactinoma that is better tolerated

Carbegoline (bromocriptine can cause headache, naudea, and postural hypotension)

29

3 treatments for ovarian failure

  • Oocyte donation
  • HRT
  • Oral contraceptive pill

30

Physical elements to monitor in ovulation induction

  • Change in basal body temp
  • Change in cervical mucus

31

3 endocrinological elements to monitor in ovulation induction

  • Mid-luteal progesterone (>30 nmol/L)
  • Urinary analysis of LH
  • Estradiol blood levels

32

Size of follicular maturity

18 - 23 mm