menstrual cycle disorders W8

Question 1

name for absent periods?

Answer 1

amenorrhea

Question 2

endometrium measurements at different stages?

Answer 2

3mm - thin endometrium
6mm - growing endometrium (~9 days after period)
9mm - proliferative endometrium (~14 days)

Question 3

estrogens effects on the endometrium?

Answer 3

thicken and proliferate

Question 4

which cells in the follicle produce estradiol?

Answer 4

granulosa cells

Question 5

what is the precursor to estradiol and what enzyme converts it

Answer 5

androgen is converted to estradiol by aromatase

Question 6

where do granulosa cells get androgens from? what stimulates these cells to produce androgens?

Answer 6

theca cells
LH stimulates theca cells to produce androgens

Question 7

4 reasons for amenorrhea?

Answer 7

low LH, FSH & estradiol, normal prolactin

high LH and FSH, low estradiol, normal prolactin

low LH, FSH & estradiol, high prolactin

high LH, normal FSH, estradiol and prolactin

Question 8

cause for low LH, FSH and estrogen, normal prolactin?

Answer 8

hypogonadotropic hypogonadism

problem with hypothalamus causing low GnRH.

Question 9

history of females with hypogonadotropic hypogonadism?

Answer 9

low body fat, illness, stress (brain switches off reproduction - isn’t appropriate time to procreate)

Question 10

examination and management for hypogonadotropic hypogonadism?

Answer 10

examine BMI
management - lifestyle, HRT/COC, pulsatile GnRH or FSH/LH injections (for fertility)

Question 11

cause of high FSH and LH, low estradiol, normal prolactin?

Answer 11

premature ovarian insufficiency
problem in ovary - early menopause

Question 12

premature ovarian insufficiency examination and management?

Answer 12

atrophic vaginitis
give back estrogen - HRT, COC, egg donation for fertility

Question 13

premature ovarian insufficiency history?

Answer 13

treatment, family history, menopausal symptoms

Question 14

cause of low FSH, LH and estradiol, high prolactin?

Answer 14

hyperprolactinaemia
problem in pituitary (pituitary adenoma?)
prolactin switches of HPG axis

Question 15

history of hyperprolactinaemia?

Answer 15

galactorrhoea
(excessive or inappropriate production of milk)

Question 16

examination of hyperprolactinaemia?

Answer 16

galactorrhoea
visual assessment for bitemporal hemianopia
MRI

Question 17

management of hyperprolactinaemia?

Answer 17

dopamine agonist (bromocriptine)
dopamine inhibits prolactin

Question 18

cause of high LH, normal FSH, estradiol and prolactin

Answer 18

polycystic ovaries
high LH causes increased androgens affecting follicles. pauses growth of antral follicle but doesn’t pause growth of smaller follicles. results in grow/pause pattern and an ovary with lots of paused eggs in it

Question 19

most common reason for irregular periods?

Answer 19

polycystic ovary syndrome

Question 20

polycystic ovary syndrome - presentation?

Answer 20

general features of high androgens - receding hairline, hirsutism (excess hair around mouth and chin). gained weight (due to high androgens causing insulin resistance)

Question 21

polycystic ovary syndrome management?

Answer 21

COC
for fertility - raise FSH, using estrogen antagonist (clomiphene citrate). only take for 5 days at beginning of cycle (day 3-7)