WHO type 1 anovulation: an update on diagnosis, management and implications for long-term health – TOG 2020

Question 1

What is WHO type 1 anovulation

Answer 1

Women with primary or secondary amenorrhoea, low levels of endogenous gonadotrophins and negligible endogenous estrogen activity.

Question 2

WHO 2 anovulation

Answer 2

Women with anovulation associated with a variety of menstrual disorders (including amenorrhoea) who exhibit distinct endogenous estrogen activity and gonadotrophins in the normal range.

Question 3

WHO 3 an ovulation

Answer 3

Women with primary or secondary amenorrhoea due to primary ovarian failure associated with low endogenous estrogen activity and pathologically high gonadotrophin levels.

Question 4

Graph showing hormone levels throughout the menstrual cycle

Answer 4

Question 5

Diagram showing LH and FSH effect on theca and granulose cell

Answer 5

Question 6

What hormone stimulate GnRH neurone to produce GnRH

Answer 6

Kisspeptin

Question 7

Diagram showing kisspeptin-GnRH steroid pathway

Answer 7

Question 8

Describe Kallmann syndrome

Answer 8

Disruption of embryonic migration of GnRH neurones

Neural hearing loss, cleft palate/other midline craniofacial defects, renal agensis/aplasia, dental defects.

HH

Question 9

Acquired cause of hypothalamic hypogonadism

Answer 9

Infiltrative disorders such as haemochromatosis, sarcoidosis, Wegener’s granulomatosis and histiocytosis
Drugs such as glucocorticoids and narcotics
Infections such as meningitis, encephalitis and tuberculosis
Head trauma or space-occupying lesions such as craniopharyngioma, glioma, germ cell tumours, hamartomas and teratomas, and/or their treatment such as surgery, chemotherapy or radiotherapy

Question 10

Table comparing Hypo Hypo, hypothalamic amenorrhoea, hypooituitarus, PCOS

Answer 10