Female Reproductive Endocrinology

Question 1

When taking a gynaecological history, which points are important to cover in the history?

Answer 1

1. Menstrual history
2. Cervical smear history
3. Sexual history and contraception history
4. Previous treatment or surgery

Question 2

What are the key symptoms and signs of anorexia nervosa?

Answer 2

1. Weight loss
2. Lethargy
3. Pallor of skin and conjunctiva
4. Lanugo on face, arms and back
5. Halitosis
6. Low BMI

Question 3

What are the possible differential diagnoses for anorexia nervosa?

Answer 3

1. Depression
2. Pregnancy
3. Bulimia nervosa
4. PCOS
5. Chronic disease e.g. CKD
6. Premature ovarian failure
7. Hypothyroidism

Question 4

At a very low body weight, how is GnRH secrection impacted in females and what is the impact of this?

Answer 4

It is decreased

FSH and LH secretions decline

Question 5

Premature ovarian failure is associated with _________ symptoms

Answer 5

Premature ovarian failure is associated with menopausal symptoms

(night sweats, hot flushes, modd swings)

Question 6

What are the key differential diagnoses for premature ovarian failure?

Answer 6

1. Pelvic inflammatory disease
2. Hyperprolactinaemia
3. PCOS
4. Pregnancy

Question 7

Why does hyperprolactinaemia result in amenorrhoea?

Answer 7

1. High levels of prolactin inhibit GnRH
2. Levels of LH and FSH fall

Question 8

What are the main causes for premature ovarian failure?

Answer 8

1. Idiopathic
2. Genetic (Turner’s syndrome)
3. Autoimmune (adrenal insufficiency and thyroid disease)
4. Iatrogenic

Question 9

Due to decreased oestrogen levels associated with premature ovarian failure, which signs and symptoms can be expected?

Answer 9

1. Hair thinning
2. Atrophic vaginitis
3. Menopausal symptoms

Question 10

Oestrodiol protects against what?

Answer 10

Bone and CV disease

Question 11

In patients with primary ovarian failure, FSH and LH levels are _______

Answer 11

In patients with primary ovarian failure, FSH and LH levels are high

Question 12

Ovarian failure is indicated by a FSH level of what?

Answer 12

>30u/L on 2 separate occasions

(normal level 2-8u/L; rises due to negative feedback as there is low oestrogen)

Question 13

What is the main treatment option for premature ovarian failure?

Answer 13

Oestrogen-progestin replacement therapy (HRT)

Question 14

What does oestrogen-progestin replacement therapy involve when used for premature ovarian failure?

Answer 14

1. Oestrogen alone (days 1-14)
2. Oestrogen and progesterone (days 14-28)

This (progesterone) causes a monthly bleed and has a protective effect on the endometrium

Question 15

Oestrogen-progestin replacement therapy has which beneficial outcomes?

Answer 15

1. Prevents osteoporosis
2. Controls symptoms e.g. vaginal dryness
3. Lowers CV risk

Question 16

Why does hyperinsulinaemia cause increased androgen production?

Answer 16

Theca cells are stimulated by insulin

Question 17

Free androgens and oestrogen rise for which reason in PCOS?

Answer 17

Sex-hormone binding globulin production decreases

Question 18

Why can PCOS result in amenorrhoea?

Answer 18

High levels of oestrogen and androgens inhibit LH and FSH

Question 19

PCOS may be associated with which skin change associated with insulin resistance?

Answer 19

Acanthosis nigricans

Question 20

What is the most appropriate test for PCOS?

Answer 20

Transvaginal ultrasound

(normally shows bilateral ovarian cysts)

Question 21

Which lifestyle factors can be used to manage PCOS?

Answer 21

Moderate weight loss

Question 22

Which medical therapies can be used to manage PCOS?

Answer 22

1. Ovulation induction medication (Clomiphene)
2. Ovarian drilling
3. Metformin (to help insulin sensitise)
4. Oral contraceptive pill
5. Anti-androgens (Cryproterone, Ethinylestradiol)
6. Cosmetics and topical agents