Questions (Gyne) Flashcards

Question

In patients with urinary incontinence, make sure to rule out [2]

Answer 1

In patients with urinary incontinence, make sure to rule out **a UTI and diabetes mellitus**

Answer 2

**mild symptoms** * can be managed with lifestyle advice * apart from the usual advice on sleep, exercise, smoking and alcohol, specific advice includes regular, frequent (2-3 hourly), small, balanced meals rich in complex carbohydrates **moderate** **symptoms** - may benefit from a **new-generation combined oral contraceptive pill (COCP)** examples include Yasminµ (drospirenone 3 mg and ethinylestradiol 0.030 mg) **severe symptoms** - may benefit from a **selective serotonin reuptake inhibitor (SSRI)** - this may be taken **continuously** or just during the **luteal** **phase** (for example days 15-28 of the menstrual cycle, depending on its length)

Answer 3

**Metoclopramide** is an option for nausea and vomiting in pregnancy, but it should not be used for **more than 5 days** due to the risk of **extrapyramidal** **effects**

Answer 4

**Methotrexate** is the drug of choice for medical management of ectopic pregnancy

Answer 5

**NSAIDs** should be offered as first-line treatment for primary dysmenorrhoea, and **ibuprofen** specifically is recommended due to its favourable side effect profile and over-the-counter availability.

Answer 6

Women who have been admitted with hyperemesis gravidarum are generally given **IV normal saline with added potassium** as hypokalaemia is common

Answer 7

the **patient** **appears** **well** but is **suffering cyclical pain** with no evidence of menstruation: - **imperforate hymen**

Answer 8

**Pregnant women who are < 6 weeks gestation** and present with **vaginal bleeding** and **no pain can be managed expectantly** - *Monitor expectantly and advise to repeat pregnancy test in 7 days. If negative, this confirms miscarriage. If positive, or continued or worsening symptoms, refer to the early pregnancy assessment unit 30%*

Answer 9

Infertility in PCOS - **clomifene** is typically used first-line

Answer 10

**Total abdominal hysterectomy with bilateral salpingo-oophorectomy**

Answer 11

Older woman with labial lump and inguinal lymphadenopathy → **?vulval carcinoma**

Answer 12

**Teratomas (dermoid cysts)**

Answer 13

1) An unruptured embryo 2) < 35mm in size 3) Have no heartbeat 4) Be asymptomatic 5) Have a B-hCG level of < 1,000IU/L and declining

Answer 14

To confirm ovulation: Take the serum progesterone level 7 days prior to the expected next period - This woman has a **35 day cycle so 35 - 7 days** = day **28**. Therefore day 28 is the day that a **serum progesterone should be taken.**

Answer 15

**Dysmenorrhoea** (usually a few days before the onset of menstruation), **dyspareunia and pelvic pain**

Answer 16

**Increased FSH/LH** For FSH & LH * KALLman = FALL (Low FSH & LH) * TURNer = TURNed up (High FSH & LH)

Answer 17

**For FSH & LH** * K**ALL**man = **FALL** (Low FSH & LH) * **TURN**er = **TURNed** up (High FSH & LH)

Answer 18

Patient with menopause. Out of the following options, which is most likely to increase her risk of breast cancer? **Combined hormone replacement therapy (HRT)** - **HRT**: adding a **progestogen** increases the risk of **breast cancer** - **O x P = increased risk of breast cancer** ## Footnote **NB**: increased risk of breast cancer: proBREASTerone <3

Answer 19

Venous congestion as fibroid presses on abdominal veins like IVC

Answer 20

**Nabothian** **cysts** are cysts on the **cervix** that occur when the **squamous-cell epithelium of the cervix** slightly **covers** the **columnar** **epithelium**. As the columnar epithelium secretes mucous, the mucous becomes trapped, and cysts form The cysts **contain yellow/amber mucous** and are usually located **around the os** where the epitheliums transition.

Answer 21

**200 mg oral mifepristone** and **48 hours later, 800 micrograms oral misoprostol**

Answer 22

**Salpingectomy** - the removal of the affected fallopian tube, is the preferred surgical treatment, especially in cases where the patient is haemodynamically unstable or there is a high risk of rupture. ## Footnote **NB**: salpingotomy (removal of the ectopic pregnancy while preserving the fallopian tube) is an option in some cases, it is generally considered when the patient has only one functioning fallopian tube or fertility preservation is a priority

Answer 23

A diagnosis of premature ovarian insufficiency is suspected. Which of the following is most likely to be found? **Raised FSH level**: - The history described above is most consistent with a diagnosis of premature ovarian insufficiency. It is characterised by the onset of menopausal symptoms before the age of 40 years with **raised gonadotrophin levels including FSH and LH.** - A **repeat sample** should be taken **4-6 weeks apart** to confirm the elevated FSH levels

Answer 24

The woman has complete amenorrhoea. The woman must be exclusively breast feeding day and night. It has been six months or less since the birth of the baby

Answer 25

1. **Tolterodine** = muscarinic receptor antagonist [urinary frequency, urinary urgency, urinary incontinence] 2. Teriparatide = parathyroid hormone analogue [osteoporosis] 3. Toremifene = selective oestrogen receptor modulator [hormone-dependent breast cancer] (same drug class as Tamoxifen) 4. Finasteride = 5a-reductase inhibitor [benign prostatic hyperplasia] 5. Tamsulosin = alpha adrenoceptor blocker [benign prostatic hyperplasia]

Answer 26

**Surgical excision of the tumour** - Ovarian cancers which are stage 2-4, are treated primarily by surgical excision of the tumour. This may be accompanied by chemotherapy. NICE CG122

Answer 27

**Day 21 progesterone test** is the most reliable test to confirm ovulation - **In simple terms, measure serum progesterone 7 days prior to expected next period** (for 28-day cycle: 28 - 7 = 21. For 35-day cycle: 35 - 7= 28)

Answer 28

**Transdermal** **HRT** does not appear to increase the risk of VTE (vs. oral)

Answer 29

Sex Strenous exercise

Answer 30

**Vaginal atrophy** is the most common cause of postmenopausal bleeding

Answer 31

**mild symptoms** can be managed with lifestyle advice: - apart from the usual advice on sleep, exercise, smoking and alcohol, specific advice includes regular, frequent (2-3 hourly), small, balanced meals rich in complex carbohydrates **moderate symptoms** - may benefit from a new-generation combined oral contraceptive pill (**COCP**) - examples include Yasminµ (drospirenone 3 mg and ethinylestradiol 0.030 mg) **severe symptoms** - may benefit from a selective serotonin reuptake inhibitor (**SSRI**) - this may be taken continuously or just during the luteal phase (for example days 15-28 of the menstrual cycle, depending on its length)

Answer 32

**Women with stage IA cervical cancer** may be considered for a **cone biopsy with negative margins** if they wish to maintain their fertility - **Hysterectomy without lymph node clearance** is an option to consider for **IA1 tumours,** but this would not preserve her fertility.

Answer 33

Nausea and vomiting in pregnancy: admission should be considered in cases of **ketonuria** and/or **weight loss despite use of oral anitemetics**

Answer 34

Urinary incontinence - first-line treatment: urge incontinence: **bladder retraining** stress incontinence: **pelvic floor muscle training**

Answer 35

**Ovarian torsion** may be associated with a **whirlpool sign** on ultrasound imaging

Answer 36

**12 months after the last period in women > 50 years** **24 months after the last period in women < 50 years**

Answer 37

**Laparoscopy** is the gold-standard investigation for patients with suspected endometriosis

Answer 38

A pregnancy test should be performed at **3 weeks** following medical management of a miscarriage

Answer 39

**cannot** be used if there is **distortion** of the **uterine cavity**

Answer 40

**Releases progesterone locally**, **thinning** the **uterine** **lining** and **reducing bleeding**

Answer 41

**menopausal symptoms** (hot flushes, vaginal dryness) and **loss of bone mineral density**

Answer 42

Stereotypical PCOS results: * raised LH:FSH ratio * testosterone may be normal or mildly elevated * SHBG is normal to low

Answer 43

**Von Willebrand’s disease** is an inherited disorder of coagulation that leads to either a deficiency or a malfunction of von Willebrand factor. It is a recognised cause of menorrhagia (heavy periods). People affected may have a history of easy bruising, bleeding from minor wounds and in females menorrhagia from the onset of menarche such as in this patient. To confirm the diagnosis, blood can be sent for von Willebrand antigen testing and von Willebrand factor function assay. Typically patients with von Willebrand's disease have prolonged activated partial prothrombin time (APTT) as seen in this patient, which is required to stabilise factor 8. Bleeding time is also prolonged because von Willebrand Factor is required for platelet function.

Answer 44

**Corpus luteal cyst**: - During ovulation, the dominant follicle ruptures to release an egg. This process may itself be accompanied by pain. The follicle then becomes the corpus luteum, which acts to secrete hormones in preparation of pregnancy. If pregnancy does not occur, the corpus luteum involutes and regresses. Failure of the corpus luteum to regress may result in a corpus luteal cyst, which can rupture and cause pain. These are considered physiological and almost always resolve spontaneously. Provided there is no evidence of torsion, and pain is controlled, conservative management is usually first line

Answer 45

19 Jul 2024 — The risks of developing **breast and ovarian cancer** are markedly increased in people who inherit a harmful change in **BRCA1 or BRCA2.**

Answer 46

**Chlaymdia trachomatis**

Answer 47

**Laparoscopy** is the gold standard diagnostic tool for confirming ovarian torsion and facilitating immediate intervention.

Answer 48

**PMS** is **before** the **luteal phase** which is at **least 10 days** **symptoms 4-12 hours** prior to **menstruation** and **no mention of emotional** symptoms **makes primary dysmenorrhia more likely** ## Footnote E.g.: PMS *The week before her period she has noticed a significant change in her mood. She feels incredibly low and anxious, with poor concentration.*

Answer 49

60-year-old obese, nulliparous woman presenting with vaginal bleeding ## Footnote This malignancy is characteristic of women who are older than 60 years old, and obese patients are at particular risk, as increased levels of peripheral fat increase aromatase activity, which leads to the conversion of androgens to oestrogens, which directly promotes endometrial proliferation. Additionally, the fact that the bleeding is worse following sexual intercourse but the intercourse itself is not painful, points away from the other likely diagnosis of vaginal atrophy, making a diagnosis of endometrial cancer the most likely.

Answer 50

**If bleeding** is **worse** following **sexual intercourse** but the **intercourse** itself is **not painful,** points **away** from the diagnosis of **vaginal** **atrophy**, making a diagnosis of endometrial cancer the most likely.

Answer 51

**< 6 weeks gestation**: - women have **bleeding**, but **NO** **pain** or **risk factors** for **ectopic** **pregnancy**, then they can be **managed expectantly** **>= 6 weeks gestation**: - and the woman has bleeding she should be referred to an **early pregnancy assessment service** for a **transvaginal** **ultrasound** **scan** to identify the **location of the pregnancy and whether there is a fetal pole and heartbeat.**

Answer 52

**Regular, frequent (2-3 hourly), small, balanced meals rich in complex carbohydrates**

Answer 53

**Cervical ectropion** is the most common identifiable cause of postcoital bleeding

Answer 54

**urinalysis** should be performed in order to **exclude** **diabetes** or a **urinary tract infection** before diagnosing **stress incontinence** **uroflometry to diagnose stress incontinence** and cystmetrography to diagnose urge incontinence

Answer 55

**Stage 1** Tumour confined to ovary **Stage 2** Tumour outside ovary but within pelvis **Stage 3** Tumour outside pelvic but within abdomen **Stage 4** Distant metastasis ## Footnote NB: Stage 1 (1 word) = ovary Stage 2 (2 words) = ovary + pelvis Stage 3 (3 words) = ovary + pelvis + abdomen

Answer 56

**Anticholinergics** are contraindicated in **myasthaenia gravis** as they can **precipitate a crisis** OR if **elderly** Instead - give **botox**

Answer 57

Which is the most likely cell type if ovarian cancer is diagnosed? **Epithelial-cell tumour** - The most likely diagnosis here is ovarian cancer. Around 90% of ovarian tumours are epithelial-cell tumours. Epithelial-cell tumours are thought to arise from the lining of the fimbriae in the fallopian tubes. - **Serous cystadenocarcinoma** is the most **common** **subtype** of **epithelial ovarian cancer** and is characterised by the presence of Psammoma bodies on histology.

Answer 58

BRCA1 gene mutation in the context of raised **CA125** and pelvic mass is a risk factor for **ovarian** **cancer**.

Answer 59

What is the most common type of uterine fibroid? **Intramural fibroid** - Intramural fibroids are the most common form of fibroid and are located within the myometrium. If they enlarge, they can distort the uterus and can cause issues with intrauterine system insertion and future pregnancies.

Answer 60

High risk HPV and negative cytology - repeat in a year If same result again - refer for colposcopy

Answer 61

**People affected by LS have a higher risk of developing:** * colon cancer * rectal cancer * endometrial cancer * ovarian cancer **And they have a slightly higher risk of developing**: * stomach cancer * pancreatic cancer * small bowel cancer * ureter and renal pelvis cancer.

Answer 62

**Serous cystadenocarcinoma** - Epithelial ovarian cancer is the most common type of ovarian cancer comprising approximately 90% of all ovarian tumours. Serous cystadenocarcinoma is the most common subtype of epithelial ovarian cancer and is characterised by the presence of Psammoma bodies on histology.

Answer 63

**Serous cystadenocarcinoma** (the most common type of epithelial ovarian cancer)

Answer 64

**hypothyroidism**

Answer 65

**E. coli**

Answer 66

**HRT until 51** - prevent **osteoporosis**, as well as to protect against symptoms of **oestrogen deficiency and possible cardiovascular complication**s

Answer 67

Women with repeat high-risk HPV but negative cytology require **repeat cervical screening in 12 months.**

Answer 68

Ectopic pregnancy requiring surgical management: **salpingectomy** is first-line (rather than **salpingotomy**) for women with no other risk factors for infertility - salping**E**ctomy is before salping**O**tomy in alphabet

Answer 69

**Breast cancer** has increased risk from **combined** **HRT** - specifically the **progesterone** component **Unopposed oestrogen** causes in an increased risk of **endometrial cancer** (which is why it's never given in women with a uterus) **Increased risk of VTE** from **systemic HRT** - reduced by giving as **transdermal patch** due to **progesterone** **HRT for 10+ years after menopause** increases the risk of **stroke**

Answer 70

The **whirl pool sign** in this case refers to an **ovarian** **torsion** - its caused by the blood vessels being twisted ## Footnote Whirpool = spinning = torsion

Answer 71

* 5% pre-pregnancy weight loss * dehydration * electrolyte imbalance

Answer 72

**Antihistamines** are first-line in the management of nausea & vomiting in **pregnancy/hyperemesis gravidarum** ## Footnote Anti**H**istamines for **H**G

Answer 73

**Risk malignancy index (RMI)** prognosis in **ovarian cancer** is based on **US findings, menopausal status and CA125 levels**

Answer 74

**Mittelschmerz** is **mid-cycle ovulatory pain and it is common**. * The pain is due to **rupture** of the **Graafian** (dominant) **follicle**, **each month**, which results in the **release of an ovum into the fallopian tube**. * The pain can vary from being right-sided to left-sided depending on which ovary is ovulating that month. * Duration of pain can vary from minutes up to a few days and it can be controlled using **simple analgesics such as paracetamol and NSAIDs**

Answer 75

50-60% of CIN 1 will spontaneously regress within 2 year and the malignant potential is low, **so conservative management with repeat cytology in 6 months is usually recommended** if there are no other risk factors

Answer 76

What is the most common cause of pruritus vulvae? **Contact dermatitis** - This is either a delayed allergic reaction to allergens like medication, contraceptive creams/gel, latex, etc. or an irritant reaction to chemical or physical triggers like humidity, detergents, solvents or friction/scratching etc.

Answer 77

Annual cytology

Answer 78

Which is the most important consideration when prescribing this medication to the patient? **Avoid use for more than 5 days due to risk of acute dystonia** Prolonged use leads to a small increased risk of the baby having a cleft lip Prolonged use may lead to hyperprolactinaemia and associated complications She will require additional IV vitamin supplementation The drug can cause diarrhoea

Answer 79

Cervical cancer screening: if 2nd repeat smear at 24 months is still hrHPV +ve → **colposcopy**

Answer 80

Which of the following ovarian tumours is associated with the development of endometrial hyperplasia? **Granulosa cell tumours** - Atyplical hyperplasia of the endometrium is classified as a premalignant condition - granulosa cells make oestrogen which causes endometrial hyperplasia

Answer 81

Lynch Syndrome is the **CEO** of cancers * **Colon** * **Endometrial** * **Ovarian**

Answer 82

Around 1 in 5 women who undergo a salpingotomy for an ectopic pregnancy require further treatment: **methotrexate and/or a salpingectomy**

Answer 83

**Follicle stimulating hormone level**

Answer 84

**Endometrial cancer**

Answer 85

**There is a small increased risk of cleft lip/palate in the newborn if used in the first trimester** ## Footnote Ondansetron - Orofacial malformation - Trimester One

Answer 86

Polycystic ovarian syndrome (PCOS) increases the long-term risk of which of the following conditions? **Endometrial cancer** - The polycystic ovaries develop and secrete oestrogen (like any developing follicle), but as there's no corpus luteum (because the follicles don't fully mature, and rupture), theres no progesterone to protect against the high oestrogen

Answer 87

**functional incontinence** - physical disability prevent from urinate (eg.wheelchair/bedridden) **overflow incontinence** - poor stream/incomplete emptying

Answer 88

**Androgen insensitivity syndrome (AIS)** - This patient has presented with **primary** **amenorrhoea** as she has failed to establish menstruation by 15 years of age. - The blood tests show **increased testosterone** and her **examination** shows **little to no axillary or pubic hair and bilateral lower pelvic masses**. - These findings all point in the direction of AIS, which is an X-linked recessive condition characterised by end-organ resistance to testosterone, causing genetically male children (46XY) to have a female phenotype. - The **bilateral lower pelvic swellings are likely to be undescended testes and testosterone is elevated due to tissues being unresponsive to it.** **Congenital adrenal hyperplasia (CAH)** - Although this can also cause **primary amenorrhoea,** this is associated with the **development of male secondary sexual characteristics in females** (such as deep voice and hirsutism) - This is because of impaired cortisol synthesis leading to surplus progesterone which is converted to **extra** **testosterone** to **reduce** the **levels of progesterone**. - Unlike AIS, the **body is still responsive to testosterone,** therefore, this would mean that this patient would have **hirsutism** and **excess male-pattern hair growth, including axillary and pubic hair.**

Answer 89

Endometrial hyperplasia **MOONTA Street** **M**enarchy extremes **O**besity **O**estrogen **N**ulliparity **T**amoxifen **A**ge35+ **S**moking

Answer 90

**Raised FSH/LH** in primary amenorrhoea - consider gonadal dysgenesis (e.g. Turner's syndrome)

Answer 91

**Ergometrine** can cause **uncontrolled hypertension due to its smooth muscle constriction** and **cerebral vasospasm properties**. It is also contraindicated in people with **peripheral vascular disease or heart disease.**

Answer 92

surgically using a dilatation and curettage

Answer 93

**Bimonthly serum** and **urine hCG testing** until levels are normal. * In the case of a **partial mole**, a **repeat hCG test is done 4 weeks later** - if normal, the patient is discharged from surveillance. * In a **complete mole**, **monthly** repeat **hCG** samples are sent for at **least 6 months.**

Answer 94

The calculation is to add **one year and seven days to the first day of the LMP** and **subtract three months.**

Answer 95

1. Commonst type of ovarian cyst due to non rupture of follicle? **follicular cysts** 2. Can present with intraperitoneal bleed? **corpus luteum cyst** 3. Most common benign ovarian tumour in women under 30 that is associated with ovarian torsion? **dermoid cyst** 4. Ectopic tissue in ovary aka chocolate cyst **endometrioma** 5. Become massive and cause pseudomyxoma peritonei **mucinous cystadenoma** 6. Resembles most common ovarian cancer: **serous cystadenoma**

Answer 96

**pseudoMyxoma** - Mucinous **SErous** - Seriously common Epithelial

Answer 97

In the case of pregnancy of unknown location, **serum bHCG levels >1,500** points toward a diagnosis of an ectopic pregnancy

Answer 98

As **thiamine deficiency** is common in patients with hyperemesis gravidarum; fluids containing **dextrose** should not be given as **dextrose increases the body's need for thiamine** which might **precipitate Wernicke encephalopathy**.

Answer 99

**adenomyosis**

Answer 100

**Vesicovaginal fistulae** should be suspected in patients with continuous dribbling incontinence after prolonged labour and from an area with limited obstetric services.

Answer 101

Which nerve is the most likely to be damaged during childbirth? **Obturator** Femoral Sciatic Lumbrosacral

Answer 102

* Weakness in hip adduction, numbness over the medial thigh due to **obturator nerve damage**

Answer 103

SSRIs, either **continuously** or during the **luteal phase**, may help premenstrual syndrome

Answer 104

HRT: adding a progestogen increases the risk of **breast** cancer

Answer 105

**Fibroid degeneration** may develop during pregnancy, presenting with low-grade fever, pain and vomiting.

Answer 106

The **progesterone** **injection** is the contraceptive of choice amongst the epileptic population. The injection does not interact with liver enzymes

Answer 107

**epithelial ovarian cancers** are the most common overall, they occur much more commonly in post-menopausal women **Germ cell tumours** are around 10% of ovarian cancers, and mainly affect younger women.

Answer 108

**Referred pain** to the hip from an **ovarian mass** occurs due to the **shared innervation of the ovary and the hip region by the obturator nerve (L2-L4).** The ovary is located near the pelvic sidewall, and when an ovarian mass enlarges or irritates surrounding tissues, **it can stimulate the obturator nerve**, leading to pain referred to the medial thigh, groin, and hip. This reflects the phenomenon of viscerosomatic convergence, where visceral organ pain is perceived as musculoskeletal pain.

Answer 109

A 55-year-old postmenopausal woman presents with abdominal bloating, early satiety, and weight loss. On examination, there is a palpable pelvic mass. CA-125 is elevated. What is the most likely type of ovarian tumor? A) Germ cell tumor B) Granulosa cell tumor **C) Serous epithelial tumor** D) Dysgerminoma E) Sertoli-Leydig cell tumor

Answer 110

The most likely diagnosis is a **Krukenberg tumor**, which is a metastatic ovarian tumor, typically originating from a gastrointestinal primary, most commonly gastric adenocarcinoma. Key Features: Krukenberg tumors are characterized histologically by signet-ring cells. They often present bilaterally and can cause abdominal or pelvic pain, bloating, or ascites.

Answer 111

**C) Clear cell carcinoma**

Answer 112

A woman with ovarian cancer presents with pelvic pain and bloating. Imaging reveals spread of the tumor to the fallopian tubes and the peritoneum within the pelvis. There is no involvement of lymph nodes or distant metastasis. What is the most likely stage of her ovarian cancer? A) Stage I **B) Stage II** C) Stage III D) Stage IV

Answer 113

**C) Stage III**

Answer 114

**Endometrial** - This is primarily due to the hormonal imbalances associated with PCOS, particularly the prolonged exposure to unopposed estrogen. - In PCOS, women often have irregular ovulation or anovulation (lack of ovulation), leading to infrequent or absent menstrual cycles.

Answer 115

**Liquid in posterior vaginal vault**

Answer 116

Both have increased risk of prolonged oestrogen exposure - so both increased by early menarche and late menopause!

Answer 117

This patient's clinical presentation suggests the possibility of Von Willebrand's disease. This is the most common inherited bleeding disorder that affects platelet function and coagulation. The disease is characterised by excessive menstrual bleeding and prolonged bleeding after minor trauma. **Desmopressin** is the first line treatment of Von Willebrand's disease. The medication works by temporarily increasing FVIII and Von Willebrand factor levels by releasing endothelial stores.

Answer 118

The main risk factor for endometrial cancer is exposure to **unopposed oestrogen**. This includes: * **Nulliparity** * **Obesity** * **DM** * **Early menarche** * **Late menopause** * **Polycystic ovary syndrome** * **Oestrogen-only hormone replacement therapy**

Answer 119

**bicuspid aortic valve.**

Answer 120

**Sciatic**

Answer 121

**Lichen sclerosus:** * Diagnosis is typically clinical, with first-line treatment being high-potency steroids like clobetasol propionate. **A non-responsive patient may benefit from topical calcineurin inhibitors like tacrolimus**

Answer 122

Simple vulvectomy and bilateral inguinal lymphadenectomy

Answer 123

The differential diagnosis of right iliac fossa pain in a young woman includes * appendicitis * urinary tract infection (UTI) * ovarian or tubal pathology * pelvic inflammatory disease (PID) * ruptured ectopic pregnancy * mesenteric adenitis * and other less common pathologies such as Crohn’s disease.

Answer 124

A 36-year-old female is a candidate for artificial insemination. Which blood hormone can be used as a reliable marker of imminent ovulation? **Luteinising hormone (LH)** - An LH surge, which occurs prior to ovulation, triggers ovulation. There is also a smaller surge in FSH that occurs at the same time. Ovulation occurs about 12 h after the peak in LH.