Reproductive Endocrinology Flashcards

Flashcards covering puberty, menstrual cycles, amenorrhea, PCOS, infertility, and assisted conception.

When does menarche typically occur, and what are the initial features of menstrual cycles?

Menarche = first menstruation, around 12.5 years. 95% occur between ages 11–15. Early cycles are irregular and often anovulatory (no ovulation)

What defines precocious puberty in girls?

Secondary sexual characteristics (SSC) before age 8, or menarche before age 10

What causes and consequences are linked to precocious puberty?

Often constitutional, but may be neurological or tumour-related. Leads to early growth spurt, followed by early epiphyseal fusion, resulting in short adult height

What treatments are available for precocious puberty?

GnRH agonists (suppress early puberty), Progestins (hormone regulation), Growth hormone (promotes height if growth is compromised)

What defines delayed puberty in girls?

No menstruation by age 16 with normal SSC, or no pubertal signs (e.g. breast development) by age 14

What are potential causes of delayed puberty?

Haematocolpos: blood trapped behind imperforate hymen, Resistant ovary syndrome: ovary doesn't respond to hormones, H-P axis issues: hypothalamic or pituitary dysfunction, Constitutional delay: benign, familial delayed development

Define the following: Amenorrhea, Primary amenorrhea, Secondary amenorrhea

Amenorrhea: Absence of menstruation, Primary: Menstruation never began, Secondary: Periods stopped for ≥6 months

What is oligomenorrhea?

Infrequent menstruation, Fewer than 9 cycles per year

What is the typical range for a normal menstrual cycle?

26–32 days (commonly cited as 28 days). Day 1 = first day of menstruation

What are common presentations of ovarian dysfunction?

Oligomenorrhea / Amenorrhea, Infertility, Oestrogen deficiency symptoms: Hot flushes, low libido, painful intercourse (dyspareunia), Hyperandrogenism: hirsutism, acne, male-pattern baldness, Weight changes, Galactorrhoea: inappropriate breast milk production

What tests are used to investigate menstrual irregularities?

Pregnancy test (to rule out pregnancy), FSH/LH on days 2–3: evaluate ovarian reserve and HPG axis, Day 21 progesterone: assess ovulation (should be high if ovulation occurred)

What is the progesterone withdrawal bleed test?

Medroxyprogesterone taken for 5 days. If bleeding occurs within 2–7 days after stopping: Endometrium is functional, Oestrogen levels are sufficient, Outflow tract is patent (not blocked)

What are primary ovarian causes of amenorrhea?

Ovarian insensitivity/damage, High FSH/LH, low oestrogen. Causes: Turner’s Syndrome (XO), Premature ovarian failure, Chemotherapy/radiotherapy damage

What are central causes of amenorrhea?

Hyperprolactinaemia (high prolactin inhibits FSH/LH), Prolactin-secreting tumours, Tumours affecting pituitary stalk (reduce dopamine, increase prolactin), Kallmann syndrome, Lifestyle: anorexia, excessive exercise, obesity, stress

What is PCOS, and how common is it?

Most common endocrine disorder in women. Affects ~10% of premenopausal women

What are common symptoms of PCOS?

Oligo/amenorrhea (80%), Hirsutism (30%), Obesity (40%), Infertility due to anovulation (30%)

What hormonal features are seen in PCOS?

Hyperandrogenism: high testosterone, androstenedione, Increased LH:FSH ratio, Possible link to insulin resistance

What are the Rotterdam criteria for diagnosing PCOS?

Two of the following three: 1. Oligo-/Amenorrhea 2. Clinical/biochemical hyperandrogenism 3. Polycystic ovaries on ultrasound

What are the ultrasound features of polycystic ovaries?

≥12 follicles sized 2–9 mm, Ovarian volume >10 mL

What is premature ovarian failure (POF)?

Also called primary ovarian insufficiency, Occurs before age 40, Features: amenorrhea, low oestrogen, high FSH/LH, Affects ~1% of women

What are causes of premature ovarian failure?

Often unknown, Genetic: Turner’s syndrome (45,XO), Autoimmune, Iatrogenic: chemotherapy, radiotherapy, surgery

What are the key steps required for fertility?

1. Normal sperm and egg production 2. Sperm must travel through the female tract 3. Fertilisation (usually in ampulla of uterine tube) 4. Embryo implantation in uterus

How long are sperm and oocytes viable inside the female body?

Sperm: ~5 days, Oocyte: ~24 hours

What is the clinical definition of infertility (NICE)?

Failure to conceive after 2 years of regular unprotected sex, Investigations start after 1 year of trying

What are the causes of infertility in women?

Ovulatory disorders (60%), Tubal damage, Endometriosis, Uterine abnormalities, 15% = unexplained infertility

What is assisted conception, and what are some methods?

Techniques that help conception without correcting underlying cause: Ovulation induction (e.g. Clomiphene), Intrauterine insemination (IUI), In vitro fertilisation (IVF), Intracytoplasmic sperm injection (ICSI)

What is Clomiphene, and how does it work?

Anti-oestrogen taken early in the cycle, Increases FSH release by blocking oestrogen’s negative feedback, Stimulates follicle development

What is IUI, and when is it used?

Injection of prepared sperm into uterus, Bypasses cervical mucus, improves timing. Indications: male factor issues, same-sex couples, unexplained infertility

What is the process of IVF?

1. Pituitary suppression (GnRH agonist or antagonist) 2. Ovarian stimulation (rFSH) 3. hCG trigger to mature eggs 4. Egg retrieval, fertilisation, embryo culture 5. Embryo transfer (day 3 or day 5 blastocyst)

What is ICSI, and when is it indicated?

Single sperm injected directly into an egg, Used in: Severe male infertility, Failed IVF attempts, Sperm from testis or epididymis

What are the risks of IVF/ICSI?

Multiple pregnancies, Ovarian Hyperstimulation Syndrome (OHSS), Invasive for women, Possible long-term risks (e.g. congenital abnormalities, imprinting disorders)