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Reproduction (Amenorrhoea (Causes (Pregnancy, Menopause, Congenital,…
Reproduction
Amenorrhoea
Oligomenorrhoea
<9 periods/year
Primary
Failure of menarche by 16 years
Secondary
6month absence of periods
Causes
Pregnancy
Menopause
Congenital
Polycystic ovarian syndrome
Premature ovarian failure
Uterine adhesions
Hypothalamic dysfunction
Hypopituitarism
Presentation
No periods
Flushes
Loss of libido
Virilisation
Symptoms of hypopituitarism
Investigation
LH
FSH
Oestradiol
T3/T4
Prolactin
Ovarian ultrasound
Primary hypogonadism
Ovarian origin
High LH
High FSH
Secondary hypogonadism
Hypothalamic/ pituitary origin
Low LH
Low FSH
Premature ovarian failure
Loss of ovarian function
Presents with amenorrhoea and oestrogen deficiency
Occurs <40 years
Causes
Turner's
Addison's
Autoimmune thyroid disease
Iatrogenic
Investigation
Low oestrogen
High FSH/LH
Management
HRT
Egg donation
Physiology
Male
LH
Regulates testosterone secretion
Stimulates testosterone
FSH
Stimulates spermatogenesis
Stimulates inhibin
Testosterone
Stimulates spermatogenesis
Inhibits LH
Inhibits GnRH
Inhibin
Inhibits FSH
Female
Menstrual cycle
Follicular phase
1st half
Maturation of egg
FSH stimulates follicular development
Dominant follicle develops
Follicle produces oestrogen
Oestrogen inhibits FSH
Oestrogen stimulates LH
LH peak stimulates ovulation
Luteal phase
2nd half
Development of corpus luteum
Prepares uterine lining
Progesterone secreted by corpus luteum
Fertilisation = maintenance of endometrium
No fertilisation = regression of corpus luteum
Menstrual phase
Corpus luteum degenerates
Reduced progesterone
Reduced oestrogen
Endometrium degeneration
Low oestrogen = stimulation of FSH
Oestrogen
Thickens endometrium
Matures follicles
Secreted by ovaries and adrenal cortex
High concentration = inhibition of FSH
High concentration = inhibition of prolactin
Low concentration = stimulation of prolactin secretion
High concentration = stimulation of LH
Progesterone
Secreted by corpus luteum
Inhibits secretion of LH
Thermogenesis
Maintenance of pregnancy
Hypothalamus releases GnRH
Pulsatile
GnRH stimulates FSH
Low frequency pulses
GnRH stimulates LH
High frequency pulses
Male hypogonadism
Primary
Low testosterone
High LH
High FSH
Causes
Testicular trauma/torsion
Iatrogenic
Autoimmune
Infiltrative disease
Klinefelter's
Secondary
Low testosterone
Low LH
Low FSH
Causes
Hyperprolactinaemia
Pituitary tumour
Infection
Head trauma
Systemic illness
Eating disorders
Excessive exercise
Presentation
Reduced libido
Loss of erections
Inability to ejaculate
Management
Testosterone
Only in <50 years
Polycystic ovary syndrome
12 2-9mm follicles
Increased ovarian volume
Presentation
Oligomenorrhoea
Amenorrhoea
Hyperandrogenism
Insulin resistance
Management
Weight management
Smoking/ alcohol cessation
Ovulation induction
Clomifene citrate/ tamoxifen
Recombinant FSH
Laparoscopic ovarian diathermy
Metformin
Functional hypothalamic amenorrhoea
Causes
Low weight
Stress
Excessive exercise
Systemic illness
Iatrogenic
Investigation
Low FSH/LH
Low T3
Low oestradiol