Ovulation disorders Flashcards
1
Q
What is secondary amenorrhoea?
A
Cessation of periods for >6 months in someone who has menstruated
2
Q
What is oligomenorrhoea?
A
Less than 9 periods/year
3
Q
What congenital problems can cause primary amenorrhoea?
A
Turner’s syndrome
Kallman’s syndrome
4
Q
What intrauterine problem could cause 2o amenorrhoea?
A
Uterine adhesions
5
Q
What pituitary problems could cause 2o amenorrhoea?
A
high PRL, hypopituitarism
6
Q
How is a PRLoma excluded from history?
A
Presence of galactorrhoea
7
Q
What would be signs of oestrogen deficiency?
A
flushing
low libido
dyspareunia
breast atrophy
8
Q
What symptom can be a sign of Kallman’s syndrome?
A
Anosmia
9
Q
What tests should be ordered with ovulation disorders? (5)
A
LH FSH oestradiol
TFT prolactin
10
Q
What is a primary hypogonadism?
A
Problem with ovaries
11
Q
What hormone levels are present in 1o hypogonadism?
A
High LH and FSH
12
Q
What is a secondary hypogonadism?
A
Problem with hypothalamus or pituitary
13
Q
What hormone levels are present in 2o hypogonadism?
A
Low FSH and LH
14
Q
What are symptoms of premature ovarian failure?
A
Amenorrhoea, oestrogen deficiency and elevated gonadotrophins
15
Q
What causes premature ovarian failure?
A
Turner’s syndrome
Iatrogenic
Autoimmune e.g. Addisons
16
Q
What hormone levels are diagnostic of POF?
A
FSH 430 twice more than 1 month apart
17
Q
What can cause function 2o amenorrhoea?
A
Stress weight loss steroids recreational drugs sarcoidosis
18
Q
What is Kallman’s syndrome?
A
Genetic loss of GnRH
19
Q
Why might anosmia be a sign of Kallman’s?
A
Absence of olfactory bulbs
20
Q
Describe the release of GnRH from the hypothalamus
A
Pulsatile release.
Low frequency stimulates FSH
High frequency stimulates LH
21
Q
Where is FSH secreted from?
A
Anterior pituitary
22
Q
What does FSH do? (2)
A
Stimulates follicular development
thickens endometrium
23
Q
When LH is at its peak what happens?
A
Ovulation is stimulated
24
Q
What does LH do? (2)
A
Stimulates corpus luteum
Thickens endometrium
25
When is progesterone peaking?
Day 21
26
When is LH at its highest?
36 hours before ovulation
27
What produces progresterone?
Corpus luteum
28
Where does oestrogen come from? (3)
Follicles in ovaries
Adrenal cortex
Placenta
29
What does oestrogen do?
Thickens endometrium
| Makes cervical mucus fertile
30
When progesterone is high, what happens to LH?
Suppressed
31
What does progesterone do?
Makes cervical mucus infertile
| Increases basal temperature
32
What is a group I anovulatory disorder?
Hypothalamic pituitary failure e.g. hypogonadotrophic hypogonadism
33
In hypogonadotrophic hypogonadism, what are the hormone levels like?
Low FSH and LH
| Deficient in oestrogen
34
What clinical sign is present in hypogonadotrophic hypogonadism?
Amenorrhoea
35
What can cause hypothalamic pituitary failure?
```
Stress
exercise
anorexia
head trauma
steroids and opiates
Pituitary tumours
```
36
How can hypogonadotrophic hypogonadism be treated?
Pulsatile GnRH SC/IV
37
What is a group II anovulatory disorder?
PCOS
| ovaries do not respond to hormones from pituitary
38
What are hormone activities like in PCOS?
LH high
| oestrogen normal
39
What criteria must be filled to diagnose PCOS?
Rotterdam. 2 of
polycystic ovaries on USS
Oligo/Amenorrhoea
Clinical/biochem signs of acne or hirsuitsm
40
How may polycystic ovaries appear on USS?
12 or more of 2-9mm follicles
May be uni or bilateral
Increased ovarian volume
41
Why is DM2 more common in PCOS?
Insulin resistance common
| Insulin lowers SBGH so more free testosterone
42
What is the increased risk with amenorrhoea?
Endometrial hyperplasia may cause endometrial Ca
43
What folic acid are given if BMI >30?
5mg
44
What oral therapy is given for ovulation induction in PCOS?
Clomifene citrate
45
What are common side effects of clomifene citrate?
Visual disturbances & OHSS (withdraw both)
hot flushes
abdo pain
n&v
46
What other options are there for PCOS treatment?
Metformin
| FSH injections
47
What are the benefits of metformin in PCOS?
Improves insulin resistance
Reduction in testosterone- hirsuitsm
Restoration of menstruation
No wt gain
48
What is the risk of ovarian hyperstimulation?
DVT risk
Ascites
ARDS
49
How might mild OHSS be recognised?
Abdominal bloating and pain
| On USS, follicles less 8cm
50
What are the risks of multiple pregnancy?
```
Anaemia
Low birth weight/premature
Pre-eclampsia
GDM
Caesarean more likely
TTTS
```
51
What does chorionicity mean?
Sharing of the same placenta
52
What is the most dangerous chorionicity to have?
Monoamnionic monochorionic
53
What is a lambda sign?
Dichorionic twins
54
What is the sign in monochorionic twins?
T sign
55
What is Twin-Twin Transfusion syndrome?
Two linked vascular supplies where one twin has the main one and drains from the other
56
True or False
| Twin pregnancies are more likely to have a child with a disability
True
Cerebral palsy
Congenital HD
57
What major complication is clomifene citrate associated with?
Ovarian cancer
58
What class of drug is given in hyperprolactinaemia?
Dopamine agonists
59
Name a dopamine agonist
Cabergoline
60
True or False
| Cabergoline is safe in pregnancy
False
61
What is a group III classification?
Ovarian failure
62
What can cause premature ovarian failure?
Turner syndrom
Chemotherapy
Autoimmune ovarian failure
63
What treatment is available for premature ovarian failure?
HRT
Assisted conception
Cryotherapy where POF anticipated
64
What is a progesterone challenge test for?
Menstrual bleed in response to 5 day course of progesterone to check normal oestrogen levels
65
What is secondary infertility?
Previous ability to concieve (not necessarily to term) and now no ability
66
What issues give a poor prognosis?
Male infertility
Endometriosis
Tubal factor infertility
67
When is the prime time for conception?
2 days before ovulation
68
What is Sheehan's syndrome?
Excessive blood loss during labour leading to low BP and postpartum hypopituitarism
69
What is the hormone activity in anorexia nervosa?
Low FSH, LH and oestradiol
70
What are the clinical features of premature ovarian failure?
Hot flushes
Night sweats
Atrophic vaginitis
71
What causes atrophic vaginitis?
Low oestradiol
72
What are infective causes of tubal disease?
STI
Transperitoneal spread e.g. appendicitis
IUCD insertion
73
What are non-infective causes of tubal disease?
Endometriosis
Fibroids
Polyps
Salpingitis isthmica nodosa
74
What is Salpingitis isthmica nodosa?
Nodular thickening of the Fallopian tube due to inflammation
75
What is a hydrosalpinx ?
Blocked fallopian tube filled with fluid
76
What are symptoms of a hydrosalpinx ?
Abdo pain
Dyspareunia
Febrile
Dysmenorrhoea
77
What is endometriosis?
Endometrial glands outside the uterine cavity
78
What are the clinical features of endometriosis?
Dysmenorrhoea
Dyspareunia
Painful defecation
79
What may show on a scan with endometriosis?
Chocolate cysts on ovary
| Fixed and retroverted uterus
80
What is the most common cause of male infertility?
Varicoele
81
What is cryptorchidism?
Missing testes
82
What is a variocele?
Abnormalities in the veins in the testes which distracts blood supply.
83
What is a normal testicular volume?
>8cm
84
If periods are irregular, when will progresterone be highest?
7 days prior to expected period
85
What is a hysterosalpingiogram?
X-ray of uterus and fallopian tubes
86
If PID is suspected which imaging would be done?
Laparoscopy
87
When would a chromosome analysis need to be done?
If primary amenorrhoea or azoospermic
88
What can a chlamydia infection lead to which may affect fertility/
Tubal block in men and women
89
How can rubella affect a neonate?
```
Microcephaly
PDA
Cataracts
Bulging fontanelle
Rash
```
90
How is rubella prevented?
MMR vaccine.
91
What cautions are needed with the MMR vaccine?
Contraception required for 1 month before concieving
92
How is chlamydia treated?
Azithromycin
93
What are the symptoms of chlamydia?
Dysuria
Abdo pain
Abnormal discharge
Haematuria
94
How is clomifene citrate taken?
Day 2 - day 6
95
Why is progesterone checked in clomifene citrate use?
To check dosage is high enough to stimulate ovulation
96
What is letrozole an example of?
Aromatase inhibitors
97
How do aromatase inhibitors work?
Prevents aromatase converting androgens from FSH to oestradiol so increases [FSH]
98
True or False
| There is no difference in FSH sensitivity in PCOS
False.
| PCOS sufferers have a higher FSH threshold
99
True or False
| PCOS has a higher sensitivity to exogenous gonadotrophins
True
100
When a sperm count is needed how is this carried out?
At home.
Keep in trousers.
To lab in
101
How many sperm need to be normal in 100 for the sample to be normal?
4
102
When can IU insemination be undertaken?
Sperm normal but blockage of vas deferens
103
Where is sperm recovered from surgically?
Epididymis
104
How many cells does a blastocyst have?
125
