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Flashcards in hormonal abnormalities 2 Deck (14):

Definition of menopause

A transition period lasting for around 4 years
- hormones produced by ageing ovaries fluctuate as a result of reduced availability of follicles,
- Results in irregular periods



No period for a whole year



Transitional period 1-2 years prior to the onset of no periods, irregular periods
1. iniatially higher FSH levels stimulates remaining folicles to produce more oestrogen
2. Oestrogen release is rapid and short
3. Menstrual cycle gets shorter and shorter
Less oestrogen released each time and is derived from oesterone from the adipose tissue and is less active by its nature


Pathophysiology of menopause (4)

1. Decrease in the number / 0 of functional follicles
2. Decrease in production of oestradiol ( oestrogen) and progesterone
3. Less inhibition for FSH and LH from the pituitary gland and hypothalamus
4. Increasing levels of FSH and LH
( patterns of secretion are more erratic and less oestrogen is produces )


Clinical manifestation of low oestrogen levels (2)

1. Osteoporosis - severely decreases bone densitiy thus increasing the risk of fracture
2. CVS conditions - oestrogen helps keep blood vessels flexible


Clinical manifestation of menopause (3)

• Vaginal dryness - Dyspareunia
• Hot flushes and night sweats
• Irritability/ mood swings


Treatment for menopause

Hormone replacement therapy


Premature ovarian failure

loss of normal function of ovaries before the ages of 40 due to
1. Depletion of follicles
2. Dysfunctional follicles - don't respond to gonadotropins


Pathophys of ovarian failure

1. Follicles do not function properly
2. less oestrogen and progesterone released
3. Increased FSH and LH levels


Diagnosis of premature ovarian failure

Blood test
1. Low levels of oestrogen
2. High levels of LH and FSH


Causes of primary ovarian failure

• Chromosomal - Turner's syndrome
Genetic disorder of female with only one functional X chromosome
ovarian follicles depleted by puberty/may never have periods
• Fragile X syndrome
a genetic condition caused by mutation of CAG dna segments
• Autoimmune
1. Galactosaemia - galactose is formed, it attacks the ovaries and direct toxicity causes apoptosis of oocytes
2. Idiopathic addison's disease - steroid cell antibodies are targetted towards the follicular granulosa cells
• Iatrogenic


Investigation of POF

• HCG levels - check to see if not pregnant
•Thyroxine levels - hyperthyroidism may mean no periods
• Testosterone levels - PCOS??
• Karyotyping - check for turner's syndrom
• Anti mullerian hormone levels
• ANtibody screening


Treatment for POF

• Hormone replacement therapy - supplement women with ovarian failure


Hormone replacement therapy

Involves supplements oestrogen, progesterone and androgens
1. Oestrogen alone - only in women without a uterus (hysterectomy) as it increases risk of endometrial hyperplasia resulting in carcinoma
2. Progesterone and oestrogen - usually used
- helps reduce risk of osteoporosis, flushes and vaginal dryness
- Increases risk of venous thromboembolism and breast cancer