When taking a gynaecological history, which points are important to cover in the history?
- Menstrual history
- Cervical smear history
- Sexual history and contraception history
- Previous treatment or surgery
What are the key symptoms and signs of anorexia nervosa?
- Weight loss
- Pallor of skin and conjunctiva
- Lanugo on face, arms and back
- Low BMI
What are the possible differential diagnoses for anorexia nervosa?
- Bulimia nervosa
- Chronic disease e.g. CKD
- Premature ovarian failure
At a very low body weight, how is GnRH secrection impacted in females and what is the impact of this?
It is decreased
FSH and LH secretions decline
Premature ovarian failure is associated with _________ symptoms
Premature ovarian failure is associated with menopausal symptoms
(night sweats, hot flushes, modd swings)
What are the key differential diagnoses for premature ovarian failure?
- Pelvic inflammatory disease
Why does hyperprolactinaemia result in amenorrhoea?
- High levels of prolactin inhibit GnRH
- Levels of LH and FSH fall
What are the main causes for premature ovarian failure?
- Genetic (Turner's syndrome)
- Autoimmune (adrenal insufficiency and thyroid disease)
Due to decreased oestrogen levels associated with premature ovarian failure, which signs and symptoms can be expected?
- Hair thinning
- Atrophic vaginitis
- Menopausal symptoms
Oestrodiol protects against what?
Bone and CV disease
In patients with primary ovarian failure, FSH and LH levels are _______
In patients with primary ovarian failure, FSH and LH levels are high
Ovarian failure is indicated by a FSH level of what?
>30u/L on 2 separate occasions
(normal level 2-8u/L; rises due to negative feedback as there is low oestrogen)
What is the main treatment option for premature ovarian failure?
Oestrogen-progestin replacement therapy (HRT)
What does oestrogen-progestin replacement therapy involve when used for premature ovarian failure?
- Oestrogen alone (days 1-14)
- Oestrogen and progesterone (days 14-28)
This (progesterone) causes a monthly bleed and has a protective effect on the endometrium
Oestrogen-progestin replacement therapy has which beneficial outcomes?
- Prevents osteoporosis
- Controls symptoms e.g. vaginal dryness
- Lowers CV risk
Why does hyperinsulinaemia cause increased androgen production?
Theca cells are stimulated by insulin
Free androgens and oestrogen rise for which reason in PCOS?
Sex-hormone binding globulin production decreases
Why can PCOS result in amenorrhoea?
High levels of oestrogen and androgens inhibit LH and FSH
PCOS may be associated with which skin change associated with insulin resistance?
What is the most appropriate test for PCOS?
(normally shows bilateral ovarian cysts)
Which lifestyle factors can be used to manage PCOS?
Moderate weight loss
Which medical therapies can be used to manage PCOS?