What is oligomenorrhoea?
Menstrual cycles lasting longer than 35 days
What is amenorrhoea?
Absent menstruation
Amenorrhoea can be either ___ or ___.
primary
secondary
Which abnormal event of the menstrual cycle can cause oligomenorrhoea or amenorrhoea?
Anovulation
GnRH is released from the hypothalamus in a pulsatile manner.
Which types of pulses cause the secretion of
a) FSH
b) LH?
a) FSH is secreted by low frequency GnRH pulses
b) LH is secreted by high frequency GnRH pulses
Which hormones cause thickening of the endometrium during the menstrual cycle?
Oestradiol
FSH
LH
Progesterone
hCG
basically all of them
Which organs secrete oestrogens?
Ovaries
Adrenal cortex
Placenta
Oestrogens cause the (thickening / thinning) of the cervical mucus.
thinning
Which process does high concentrations of oestrogen cause?
Which hormones are affected?
Negative feedback AND Positive feedback
FSH, Prolactin secretion inhibited
LH secretion stimulated
Secretion of which hormone is inhibited by progesterone?
LH
seeing as LH surges to cause ovulation, and progesterone secretion marks the luteal phase and menstruation
What effect does progesterone have on body temperature?
Increases body temperature
Progesterone is a smooth muscle (relaxant / contractor).
smooth muscle relaxant
presumably to make menstruation easier
Regular menstrual cycles suggests that ___ is occuring as normal.
ovulation
Irregular menstrual cycles indicate that which abnormal event is occuring?
Anovulation
___ disorders are a common cause of presumed infertility.
Ovulatory disorders
What are three causes of anovulation according to the World Health Organisation?
I - Hypothalamic-pituitary failure - hypogonadotrophic hypogonadism
II - Hypothalamic-pituitary dysfunction - PCOS, hyperprolactinaemia
III - Ovarian failure - menopause, premature
What is hypothalamic-pituitary failure, causing anovulation, also known as?
Hypogonadotrophic hypogonadism
What are four important causes of hypogonadotrophic hypogonadism?
Stress
Low BMI (e.g anorexia nervosa)
Excessive exercise (often goes with the above, or eating disorders)
Kallmann syndrome (associated with anosmia)
What hormone abnormalities are seen in hypogonadotrophic hypogonadism?
Low GnRH
Low FSH and LH
so low oestrogen
What is the main symptom of hypogonadotrophic hypogonadism?
Amenorrhoea
How can hypogonadotrophic hypogonadism be diagnosed?
Progesterone challenge test
How is hypogonadotrophic hypogonadism treated?
Treat underlying causes (stress, sort BMI, hormone tests/USS for tumours)
GnRH pump
IV FSH/LH injections
What are two ovulatory disorders which come under WHO II: Hypothalamic-pituitary dysfunction?
Polycystic ovary syndrome (PCOS)
Hyperprolactinaemia
What is PCOS?
Polycystic ovary syndrome
Causes hyperandrogenism (acne, hirsutism) and oligo- or amenorrhoea
What are the three diagnostic criteria for PCOS?
1. Oligo- or amenorrhoea
2. Evidence of polycystic ovaries on USS
3. Hyperandrogenism symptoms (acne, hirsutism)
What is an endocrine complication of PCOS?
Insulin resistance
What two effects does hyperinsulinaemia have on the HPO axis?
Elevates LH
Reduces SHBG levels, leading to increased levels of free testosterone > hyperandrogenism
What BMI must patients be under before they are considered for any sort of infertility treatment?
< 35, <30 depending on some places
What supplement are all pregnant women given?
Why?
Folic acid
Helps to prevent birth defects
What general type of treatment is used for patients with PCOS?
Ovulation induction
What is the first line type of ovulation induction in patients with PCOS?
Clomiphene citrate therapy
If clomifene citrate isn’t effective in women with PCOS, what other types of ovulation induction can be attempted?
Gonadotrophin injections
As hyperandrogenism arrests follicular growth, FSH injections are used to restimulate it
What is an uncommon type of ovulation induction?
Laparoscopic ovarian drilling
somehow causes ovulation
What are three complications of ovulation induction therapy?
Ovarian hyperstimulation (which can be lethal)
Multiple pregnancy (woo twins)
Possibly ovarian cancer
What are the two types of twins?
Monozygotic (identical) twins - the one egg splits into two zygotes
Dizygotic (fraternal) twins - two sperm cells fertilise two eggs
What complication of multiple pregnancy involves transfusion of blood from one twin to another (& actually happened to me and scott lol)?
Twin-twin transfusion syndrome
Apart from PCOS, what is another hypothalamic-pituitary disorder which can cause anovulation?
Hyperprolactinaemia
Why does hyperprolactinaemia cause anovulation?
Prolactin inhibits the secretion of GnRH
What should be assessed on examination of anyone with suspected pituitary gland swelling or tumours?
Visual fields
for bitemporal hemianopia
How is hyperprolactinaemia treated?
Dopamine agonists
e.g CABERGOLINE
In women with hyperprolactinaemia who are trying to conceive, when should the use of dopamine agonists be stopped?
Once they become pregnant
What is the third cause of anovulation according to the WHO?
Ovarian failure
What level of
a) gonadotrophins
b) oestrogen
is seen in ovarian failure?
a) High gonadotrophins (in an attempt to compensate)
b) Low oestrogen (because the ovaries can’t produce any)
When does ovarian failure occur normally?
Menopause
When is ovarian failure premature?
When it occurs before the age of 40
Ovarian failure causes (oligomenorrhoea / amenorrhoea).
amenorrhoea
What are the “menopausal” symptoms of ovarian failure?
Hot flushes
Night sweats
Vaginal dryness
Irritability
Reduced libido
What is a genetic cause of premature ovarian failure?
Turner’s syndrome
What is the karyotype of Turner’s syndrome?
45 XO
What is the presentation of someone with Turner’s syndrome?
Girl of short stature and undeveloped sexual characteristics
Amenorrhoea
Apart from Turner’s, what are some other causes of premature ovarian failure?
Iatrogenic - radio/chemotherapy, surgery
Autoimmune
How can women with premature ovarian failure raise their own family?
Egg donation
What may women with premature ovarian failure be put on to control their symptoms?
HRT
i.e oestrogen/progesterone via combined contraceptive pill