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Flashcards in Ovulation disorders yet again Deck (63):
1

What is the average length of a full menstrual cycle?

28 days

2

Name the two phases of the menstrual cycle

Follicular
Luteal

3

What is oligomenorrhea?

Less than 9 cycles in a year (i.e prolonged cycles)

4

What is amenorrhea? How can it be classified?

Absence of menstruation. Primary (no menarche) or secondary

5

Oligomenorrhea and amenorrhea are linked to what?

Anovulation (failure of egg to be released from the ovaries)

6

Describe the hypothalamic pituitary ovarian axis

Hypothalamus - gonadotrophic releasing hormone
Pituitary - follicular stimulating hormone and lutenizing hormone
Ovaries - oestradiol + progesterone

7

Where is gonadotrophic releasing hormone produced?

Neurones in the hypothalamus

8

How is gonadotrophic releasing hormone secreted?

Pulsatile

9

How does secretion of GnRH affect secretion of FSH and LH?

Low frequency secretion - FSH
High frequency secretion - LH

10

What secretes FSH?

Anterior pituitary

11

What does FSH do?

Stimulates follicular development
Thickens endometrium

12

What secretes LH?

Anterior pituitary

13

What does LH do?

Peak secretion stimulates ovulation
Corpus luteum development
Thickens endometrium

14

What hormone triggers ovulation?

LH

15

What does an ovulation detector kit detect?

Surge of LH 1.5 days before ovulation

16

How do the ovarian hormones vary with ovulation?

Oestradiol - high before ovulation
Progesterone - high after ovulation

17

What produces progesterone?

Corpus luteum
Placenta during pregnancy

18

What produces oestrogen?

Ovaries
Adrenal glands
Placenta during pregnancy

19

What does oestrogen do?

Thickens endometrium
Induces production of fertile cervical mucus

20

Describe the effects of high oestrogen

Inhibits FSH and prolactin
Stimulates LH

21

What does progesterone do?

Inhibits LH
Maintains endometrial thickness
Induces production of infertile (thick) cervical mucus
Increases basal body temperature
Relaxes smooth muscle

22

How do you determine whether ovulation is taking place?

Regular cycles suggest ovulation ; irregular cycles suggest anovulation

Confirm via mid luteal (day 21) serum progesterone (raised) in two samples
Further hormone testing may be needed

23

Why is the presence of absence of ovulation a big deal?

Can affect fertility

24

Where is the pathology in hypogonadorophic hypogonadism?

Hypothalamus or pituitary

25

How does hypogonadotrophic hypogonadism present?

Low LH/FSH
Oestrogen deficiency
Normal prolactin
Amenorrhea

26

How is oestrogen deficiency tested for?

Serum oestradiol
Progesterone challenge test

27

What are the hypothalamic/pituitary causes of amenorrhea?

Stress
Inc exercise
Low BMI
Tumour
Kallman's
Drugs (steroids, opiates)
Trauma

28

How is hypogonadotrophic hypogonadism managed?

Weight stabilisation
Pulsatile GnRH (subcutaneous or IV) OR Gonadotrophic daily injections

29

What are the benefits of both pulsatile GnRH and gonadotrophic daily injections? How are these treatments monitored?

Pulsatile GnRH - high conception rate
Gonadotrophic injections - higher multiple pregnancy rates
Ultrasound (follicular tracking)

30

How does hypothalamic pituitary dysfunction (NOT failure) present?

Normal oestrogen
Normal gonadotrophs
Oligo/amenorrhea

Often polycystic ovarian syndrome

31

What is the diagnostic criteria for polycystic ovarian syndrome?

Oligo/amenorrhea
Polycystic ovaries on USS
Clinical/biochemical signs of hyperandrogenism

32

What are signs of hyperandrogenism?

Male pattern baldness
Acne
Hirsutism

33

How do people with polycystic ovaries react to insulin?

Resistant - normal pancreatic reserves but impaired efficacy to hyperinsulinaemia (may nave type 2 diabetes as result)

34

How does hyperandrogenism arise in patients with polycystic ovaries?

Insulin lowers sex hormone binding globulin (SHBG) levels causing increases in free testosterone

35

Insulin acts as a co-gonadotroph to LH. T/F

True

36

How is PCOS managed?

Patient dependent
Sub fertility managed by ovulation induction

37

What should be done pre ovulation induction for fertility treatment?

Weight loss (BMI

38

How is ovulation induction carried out?

Clomefine citrate/tamoxifen/letrozole OR (if resistant)
Gonadotrophin (recombinant FSH) daily injection OR
Laproscopic ovarian diathermy

39

What risks are associated with gonadotrophin daily injection?

Multiple pregnancies
Overstimulation

40

What risks are associated with laproscopic ovarian

Ovarian destuction

41

What can be used as an alternative to clomefine citrate? Why?

Metformin
Increases insulin sensitivity, decreases androgens (& thus hyperandrogenism) and raises SHBG
Restores menstruation and ovulation

42

What does metformin not do?

Help with weight loss

43

What is ovarian hyperstimulation? What are the risk factors?

Follicles produce increased growth factors --> fluid shift --> dehydration and thick blood

44

What are the symptoms of ovarian hyperstimulation?

Depends on severity:

Abdo pain
Ascites
Nausea & vomiting
Oliguria
Hypoproteinaemia
Thromboembolism
Large ovaries

45

Are single or multiple pregnancies higher risk? Higher risk of what?

Multiple

Hyperemesis
Pre/eclampsia
Gestational diabetes
Stillbirth
Intra-uterine death
Anaemia
Post-natal depression
Post partum haemorrhage
Prematurity
Low birth weight
Twin to twin transfusion syndrome

46

Are monochronic or dichronic twins at most risk of perinatal mortality?

Monochronic

47

What ultrasound sign indicates dichronicity? Which ultrasound sign indicates monochronicity?

Lambda
T sign

48

What is twin to twin transfusion syndrome? Which type of twins are at risk?

Unbalanced vascular communications within placental bed results in recipient of increased blood developing polyhydraminos and donor developing oliguria, oligohydraminos and growth restriction

Monochronic diamniotic

49

How can twin to twin transfusion syndrome be managed? What happens if its not treated?

Laser division of placental vessels
Amnioreduction
Septostomy

Death

50

What are the early and long term problems of prematurity?

Early
- Intensive care admission
- Respiratory distress syndrome
Late
- Cerebral palsy
- Sight impairment
- Congenital heart disease
- Lower IQ
- ADHD
- Language development problems

51

How does hyperprolactinemia present?

Amenorrhoea
Galactorrhea

52

What medications are linked with hyperprolactinaemia?

Anti-emetic
Anti-psychotic

53

What must be clinically tested when a patient presents with hyperprolactinemia?

Visual fields

54

How should hyperprolactinaemia be investigated?

FSH/LH (should be normal)
Low oestrogen
Raised serum prolactin over 1000 (>2 occasions)
Thyroid function tests (normal)
MRI

55

How is hyperprolactinaemia treated? What is it important to remember?

Dopamine antagonist
- Cabergoline twice weekly
- Bromocriptine

STOP treatment during pregnancy

56

How does ovarian failure present?

High gonadotrophins (raised FSH in two samples)
Low oestrogen
Amenorrhea
Menopause

57

How is premature ovarian failure defined?

Menopause before the age of forty

58

List the causes of premature ovarian failure

Genetic (turner's, fragile X, XX gonadal agenesis)
Radiotherapy
Chemotherapy
Oophrectomy (bilateral)
Autoimmune

59

How is premature ovarian failure managed?

Hormone replacement therapy
Assisted conception
Cryopreservation of gametes prior to cancer therapy
Counselling

60

What are the key features of a gynaecological history?

Details of menstrual cycle
Amenorrhea (pregnancy test)
Acne
Galactorrhea
Headaches
Visual symptoms
Past medical history
Drug history

61

What biochemical investigations should be performed with ovarian irregularities?

Mid luteal progesterone (day 21)
Early follicular tests (day 2-5)
- FSH, LH, oestradiol
- serum testosterone / SHBG (free androgens)
- prolactin
- TSH (hypothyroid)
Progesterone challenge test (bleeding indicates normal oestrogen)

62

Which type of ultrasound is used in infertility testing/monitoring treatment response?

Transvaginal

63

What tests may be indicated in infertility testing?

Autoantibodies
Karyotype
MRI
Bone density (oestrogen)

Decks in Year 2 Class (72):