Ovulatory Disorders

Question 1

how long are most menstrual cycles?

Answer 1

28-35 days

Question 2

when does ovulation typically occur?

Answer 2

day 14 of the cycle

Question 3

what are the two phases of the menstrual cycle?

Answer 3

follicular phase

luteal phase

Question 4

which phase of the menstrual cycle can vary in length?

Answer 4

follicular phase

luteal phase is ALWAYS 14 days

Question 5

what is the first day of the menstrual cycle?

Answer 5

the first day of menstruation

Question 6

what is oligomenorrhoea?

Answer 6

cycles lasting longer than 42 days

Question 7

what is amenorrhoea?

Answer 7

the complete absence of menstruation

Question 8

what is primary amenorrhoea?

Answer 8

periods never started

Question 9

what is secondary amenorrhoea?

Answer 9

periods started but have stopped

Question 10

what hormone in the HPO axis does the hypothalamus secrete?

Answer 10

GnRH

Question 11

what does GnRH secretion cause?

Answer 11

LH/FSH secretion from the anterior pituitary

Question 12

what does LH/FSH secretion cause?

Answer 12

secretion of progesterone and oestrogen

Question 13

what do low frequency pulses of GnRH stimulate?

Answer 13

FSH release

Question 14

what do high frequency pulses of GnRH stimulate?

Answer 14

LH release

Question 15

what does FSH do?

Answer 15

stimulates follicular development

thickens the endometrium

Question 16

what do peak levels of LH do?

Answer 16

stimulate ovulation

Question 17

what does LH do?

Answer 17

stimulates development of the corpus lute

thickens the endometrium

Question 18

what is basal body temperature?

Answer 18

the bodies temperature in the morning before moving or eating

Question 19

what can cause the basal body temperature to increase?

Answer 19

ovulation

Question 20

what does the LH surge trigger?

Answer 20

ovulation

Question 21

when does oestrogen peak?

Answer 21

before ovulation

Question 22

when does progesterone peak?

Answer 22

following ovulation

Question 23

what produces progesterone?

Answer 23

the corpus luteum

Question 24

how is ovulation confirmed?

Answer 24

measuring a midluteal serum progesterone - >30 suggests normal

Question 25

when should a midluteal serum progesterone be measured?

Answer 25

around day 21

Question 26

what are the three groups of ovulatory disorders?

Answer 26

group I group II group III

Question 27

what causes group I ovulatory disorders?

Answer 27

hypothalamic or pituitary failure

Question 28

what are the clinical features of group I ovulatory disorders?

Answer 28

amenorrhoea low levels of FSH/LH oestrogen deficiency

Question 29

how is an oestrogen deficiency identified?

Answer 29

negative progesterone challenge test

Question 30

what is another name for group I ovulatory disorders?

Answer 30

hypogonadotrophic hypogonadism

Question 31

what should be done before initiating treatment for group I ovulatory disorders?

Answer 31

stabilise weight folic acid 400mcg lifestyle modifications

Question 32

what do management strategies for group I ovulatory disorders require to see if they are working?

Answer 32

ultrasound monitoring - known as follicle tracking

Question 33

what are the two possible management strategies for group I ovulatory disorders?

Answer 33

pulsatile GnRH | gonadotrophin daily injections

Question 34

how does pulsatile GnRH therapy work?

Answer 34

pump worn continuously and a pulse is administered every 90 mins

Question 35

what is there a risk of with gonadotrophin daily injections?

Answer 35

multiple pregnancies

Question 36

what is the normal response in a progesterone challenge test?

Answer 36

withdrawal bleed in 7-10 days of stopping taking progesterone suggests normal oestrogen

Question 37

what causes group II ovulatory disorders?

Answer 37

hypothalamic pituitary dysfunction

Question 38

what are the clinical features of group II ovulatory disorders?

Answer 38

oligomenorrhoea or amenorrhoea normal gonadotrophin normal oestrogen

Question 39

what is the main cause of group II ovulatory disorders?

Answer 39

PCOS

Question 40

what is the first line management of group II ovulatory disorders?

Answer 40

clomiphene citrate

Question 41

what is the diagnostic criteria for PCOS called?

Answer 41

Rotterdam diagnostic criteria

Question 42

when is PCOS diagnosed?

Answer 42

if patients meet 2/3 criteria

Question 43

what are the criteria on the Rotterdam diagnostic criteria for PCOS?

Answer 43

oligomenorrhoea/amenorrhoea polycystic ovaries on USS hyperandrogenism

Question 44

what do many patients with PCOS also suffer from?

Answer 44

insulin resistance

Question 45

what is another name for group III ovulatory disorders?

Answer 45

ovarian failure

Question 46

what are the clinical features of ovarian failure?

Answer 46

amenorrhoea menopause high gonadotrophin low oestrogen

Question 47

how is ovarian failure managed?

Answer 47

HRT | assisted conception