Reproductive Disorders: Female

Question 1

High FSH and LH with low estrogen indicates ___________.

Answer 1

primary ovarian insufficiency (such as Turner’s)

Question 2

__________ often gets disrupted in women due to exercise, stress, or malnutrition.

Answer 2

GnRH

Question 3

What gonadotroph levels are typical in the early follicular phase?

Answer 3

Equal LH and FSH

Question 4

In the luteal phase, ___________ stimulates the lowering of FSH in relation to LH.

Answer 4

progesterone

Question 5

Inhibin A is important in the __________ phase and inhibin B is important in the __________ phase.

Answer 5

luteal; follicular

Question 6

How does prolactin affect the HPG axis?

Answer 6

It shuts off GnRH, thereby eliminating LH and FSH.

Question 7

What is premature ovarian insufficiency?

Answer 7

A form of hypergonadotropic hypogonadism caused by early menopause or any other disorder that damages the ovaries (such as radiation or an autoimmune infiltrative process)

Question 8

____________ percent of PCOS patients are overweight, but all are ____________.

Answer 8

Only 60; insulin resistant

Question 9

PCOS presents with a ratio of ________ LH:FSH.

Answer 9

2.5 or greater

Question 10

Why does PCOS raise risk of endometrial cancer?

Answer 10

Because there is elevated estrogen without opposing progesterone

Question 11

New data suggests that ____________ can improve ovulation and suppress androgen levels in women with PCOS.

Answer 11

metformin

Question 12

How can you distinguish ovarian or adrenal tumors that make androgens from PCOS?

Answer 12

Speed of onset and change from baseline

That is, those with PCOS will have symptoms starting before puberty while those with ovarian tumors will develop hyperandrogenism out of the blue.

Also, tumors usually make T greater than 200 or DHEA greater than 800.

Question 13

________________ presents like PCOS but without elevated LH.

Answer 13

Obesity-induced anovulation

This can be treated with weight reduction.

Question 14

How does clomiphene citrate (Clomid) work?

Answer 14

In patients with an intact HPG axis, Clomid stimulates a rise in FSH that induces ovulation.

Question 15

If patients fail Clomid therapy (for fertility), _____________ can be used.

Answer 15

LH and FSH

Though there is an increased risk of multiple gestations.

Question 16

Remember that ___________ can also stimulate prolactin release from the anterior pituitary.

Answer 16

TRH (so primary hypothyroidism can cause prolactin elevations and subsequent inhibition of GnRH)

Question 17

What is the average age of menopause?

Answer 17

51 (in the U.S.)

Question 18

How is androgenism treated in women with PCOS?

Answer 18

Spironolactone

Question 19

Which PCOS drug should be discontinued prior to pregnancy?

Answer 19

Spironolactone (because it can have anti-androgenic effects on the fetus)