Infertility Endometriosis PCOS Flashcards
(22 cards)
Endometriosis common presentation
nulliparity
early menarche
short menses
hx of dysmenorrhea, dyspareunia
typically will be able to get pregnant but not carry to term
may have genetic component
Endometriosis pathophysiology
inner lining of the uterine tissue is placed somewhere else - usually around the ovaries, colon, fallopian tubes but can be anywhere
benign, chronic, estrogen-dependent disorder
Endometriosis appearance:
Clear or white, dark red or brown lesions
described surgically as “cigarette burns”
What is the optimal method to confirm endometriosis?
Laparoscopy or exploratory surgery
Bx tissue for confirmation
Endometriosis treatment
dependent on individual patient case:
NSAIDs and OCP first-line
GnRH agonists
Danazol (supressess LH and FSH)
Surgery
Surgical therapy of Endometriosis can consist of
excision of visible lesions
cauterization or ablation of visible lesions
hysterectomy with/without BSO
(mostly reserved for extensive disease and when done with childbearing)
PCOS epidemiology:
important cause of:
most common endocrine/metabolic disorder of reproductive age women
important cause of menstrual irregularity, ovulatory dysfunction and androgen excess in women
PCOS complications:
increased risk for T2DM
increased risk of ovarian and breast cancers
increased mood disorders
PCOS pathophysiology
Altered LH function with insulin resistance and predisposition to hyperandrogenism
Insulin resistance exacerbates hyperandrogenism, increases adrenal and ovarian synthesis
increased androgens leads to irregular menses and physical sx
increased androgens in PCOS leads to
to irregular menses and physical sx
Clinical Presentation of PCOS
signs of androgens excess with oligo/amenorrhea and infertility (anovulation)
PCOS - need to r/o
need to r/o:
pregnancy
thyroid dysfunction
hyperprolactinemia
congenital adrenal hyperplasia
primary ovarian insufficiency, cushing’s acromegaly*
if rapid symptom onset or significant hyperandrogenism - need to r/o androgen secreting tumor
PCOS: Diagnosis/ Workup Rotterdam Criteria
(2 out of 3 diagnostic)
Oligomenorrhea and/or anovulation (ovulatory dysfunction)
Clinical or biochemical signs of hyperandrogenism
PCOS appearing ovaries on TVUS
Blood work for PCOS
LH/FSH ratio > 2 indicative of PCOS
PCOS treatment goals
decrease lifetime risks/ complications - obesity, DM, hyperlipidemia
manage menses and endometrial cancer risk - OCP, IUD, nexplanon
manage hyperandrogenism features - usually tx with metformin
PCOS treatment
first line - lifestyle modification - wt loss if overweight
infertility - endo referral, letrozole > Clomiphene
menstrual concerns/ endometrial prevention, hirsutism, acne - hormonal contraception, progesterone
Infertility: Female - by definition is
12 mos of unprotected intercourse without conception (< 35 yo)
6 mos of unprotected intercourse without conception (> 35 yo)
Infertility in females - most common causes include
PCOS
Hormonal factors impacting ovulation - thyroid, DM, etc
Endometriosis
Infertility Evaluation includes
history - medical/ reproductive/ surgical/ genetic
Hormonal testing (r/o endocrinopathy)
Genetic testing as indicated
Evaluation of uterine cavity and fallopian tubes - TVUS
Semen analysis
Infertility causes
ovulation regulation concerns are most common cause of infertility
hypothalamic dysfunction - abnormalities of wt and body composition, strenuous exercise stress and travel, hyperprolactinemia, hypothyroidism
Pituitary disease
Ovarian dysfunction
Most common causes of ovarian dysfunction and oocyte abnormalities
polycystic ovarian syndrome
premature ovarian failure
Infertility treatment:
identify and correct any underlying medical or surgical concerns
strongly consider specialist referral (reproductive endo)
Encourage good sleep habits, healthy eating/ exercise, encourage taking prenatal vitamin, stress management, correct timing of attempts (days 10-20 every other day)
