Ovulation Disorders

Question 1

How long does a regular cycle last

Answer 1

28-35 days

Question 2

What is the definition of oligomenorrhoea

Answer 2

cycles of more than 35 days apart

Question 3

What is the definition of amenorrhoea

Answer 3

Absent menstruation

Question 4

What is GnRH

Answer 4

Gonadotrophin releasing hormone

Question 5

Where is GnRH synthesised

Answer 5

By neurones in the hypothalamus

Question 6

What does GnRH stimulate

Answer 6

FSH (low frequency) and LH (high frequency) synthesis / release

Question 7

Describe the release of GnRH

Answer 7

Pulsatile

Question 8

What are the 2 functions of FSH

Answer 8

Stimulate follicle development and thicken endometrium

Question 9

What stimulates ovulation

Answer 9

Surge of LH levels

Question 10

What hormone peaks before ovulation

Answer 10

Estradiol

Question 11

What hormone peaks rolling ovulation

Answer 11

Progesterone

Question 12

What secretes oestrogen

Answer 12

The ovaries and adrenal cortex

Question 13

What does oestrogen do

Answer 13

Stimulates thickening of the endometrium

Causes thinning of the cervical mucus

Question 14

What does high oestrogen concentrations inhibit

Answer 14

secretion of FSH and prolactin

Question 15

What does high oestrogen concentration stimulate

Answer 15

secretion of LH

Question 16

What secretes progesterone

Answer 16

Corpus luteum

Question 17

What does progesterone inhibit

Answer 17

Secretion of LH (negative feedback)

Question 18

What are some of the functions of progesterone

Answer 18

Thickens cervical mucus
Maintains thickness of endometrium
Has thermogenic effect (increases basal body temperature)
Relaxes smooth muscles

Question 19

What are regular cycles suggestive of

Answer 19

ovulation

Question 20

What percentage of infertile couples are affected by ovulatory dysfunction

Answer 20

25%

Question 21

What does hypothalamic pituitary failure cause

Answer 21

Hypogonadotrophic hypogonadism

Question 22

Why are there low levels of FSH /LH in hypothalamic pituitary failure

Answer 22

No stimulation at the pituitary level to produce them

Question 23

What is a symptom of hypothalamic pituitary failure

Answer 23

Amenorrhoea

Question 24

What are some causes of hypothalamic pituitary failure

Answer 24

Stress
excessive exercise (olympic athletes)
Anorexia / low BMI
Brain/ pituitary tumours 
Head trauma 
Kallman's syndrome 
Drugs (opiates, steroids)

Question 25

What are some of the management options of hypothalamic involution

Answer 25

Stabilise weight to above 18.5 Daily injection of gonadotrophin Ultrasound monitoring of response

Question 26

What happens in hypothalamic pituitary dysfunction

Answer 26

Inability to read signals that come from the pituitary

Question 27

How many of all ovulatory disorders ar caused by hypothalamic pituitary dysfunction

Answer 27

85%

Question 28

Describe the periods for someone with Hypothalamic pituitary dysfunction

Answer 28

Mixed pattern - none or irregular periods

Question 29

What is a main cause of hypothalamic pituitary dysfunction

Answer 29

PCOS

Question 30

How can we diagnose a patient with polycystic ovary syndrome

Answer 30

2 of: oligo/amenorrhoea US appearance of PCOS Clinical / biochemical signs of hyperandrogenism

Question 31

How does insulin have an effect on sex hormones

Answer 31

It lowers the sex hormone binding globulins

Question 32

How common is insulin resistance in PCOS

Answer 32

50-80% of patients

Question 33

How can we manage PCOS

Answer 33

Depends on the patients symptoms/ needs

Question 34

What are some of the pre treatment options for PCOS

Answer 34

``` weight loss smoking cessation no alcohol folic acid 400mcg rubella immunity check prescribed drugs ```

Question 35

How can we induce ovulation in PCOS

Answer 35

``` Clomifene citrate Gonadotrophin therapy (daily injections) Laparoscopic ovarian diathermy ```

Question 36

What is the first line treatment for inducing ovulation

Answer 36

Clomifene citrate

Question 37

What can we use in patients who have clomifene resistance

Answer 37

Metformin Gonadotrophin therapy Laparoscopic ovarian drilling Assisted conception e.g. IVF

Question 38

What percentage of patients do not ovulate on Clomifene

Answer 38

15-20%

Question 39

What is the advantages of using metformin for inducing ovulation

Answer 39

Improves insulin resistance and therefore an increase in sex hormones should occur reduces androgen production

Question 40

What are the 3 main risks of ovulation induction

Answer 40

Ovarian hyperstimulation multiple pregnancies ?Risk of ovarian cancer

Question 41

How serious sis ovarian hyper stimulation?

Answer 41

You can become critically unwell or die from it

Question 42

What are some of the risks of ovarian hyper stimulation

Answer 42

Age of less than 35 | PCOS

Question 43

What are some of the increased risk of a multiple pregnancy

Answer 43

``` Hyperemesis (morning sickness) Anaemia Hypertension / pre-eclampsia Gestational diabetes Mode of delivery - more likely to be c section Postnatal depression / stress early and late miscarriage low birth weight prematurity disability stillbirth / neonatal death twin-twin transfusion syndrome (TTTS) ```

Question 44

If a US scan is lambda present, what does this mean

Answer 44

The pregnancy is dichorionic

Question 45

What does it mean if there is a T present in the US

Answer 45

Monochorionic

Question 46

What causes twin-twin tranfusion syndrome

Answer 46

Unbalanced vascular communications within placental bed

Question 47

What are the treatment options for TTTS

Answer 47

laser division of placental vessels Amnioreduction Septostomy

Question 48

What could happen if TTTS is left untreated?

Answer 48

Both babies could die

Question 49

What are some short term problems with prematurity

Answer 49

Neonatal ICU Require help with breathing Respiratory distress syndrome

Question 50

What are some long term problems of prematurity

Answer 50

``` Cerebral palsy Impaired sight congenital disease low IQ ADHD SALT required for language development ```

Question 51

What are 3 important aspects of the history in hyperprolactinaemia

Answer 51

Amenorrhoea Galactorrhoea Current medication

Question 52

What should be examined in hyperprolactinaemia

Answer 52

visual fields

Question 53

What investigations should be carried out for hyperprolactinaemia

Answer 53

Normal FSH/LH Low oestrogen Raised serum prolactin MRI to diagnose Micro/macro prolactinoma

Question 54

What is the treatment for hyperprolactinaemia

Answer 54

Dopamine antagonist e.g. cabergoline twice weekly

Question 55

What can be found in ovarian failure

Answer 55

High levels of gonadotrophins (raised FSH) Low oestrogen Amenorrhoea Menopausal

Question 56

What are some genetic causes of premature ovarian failure

Answer 56

Turner Syndrome XX gonadal agenesis Fragile X

Question 57

What is the treatment for premature ovarian failure

Answer 57

HRT Egg or embryo donation Ovary/ egg/ embryo cryopreservation prior to cancer treatment

Question 58

What are some important factors of taking a gynaecological history

Answer 58

``` Details of menstrual cycle amenorrhoea hirsuitism acne galactorrhoea headaches visual symptoms PMHx DHx ```

Question 59

What is a normal response to the progesterone challenge test

Answer 59

Menstrual bleed in response to a five day course of progesterone (indicates oestrogen levels normal)

Question 60

What would we want to look at measuring if the patient is not ovulation

Answer 60

The serum FSH, LH and estradiol levels