Y2S2 P1 Reproductive Pathology
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Questions and Answers

What is the definition of primary amenorrhoea?

  • Failure to menstruate by age 16 with normal secondary sexual characteristics. (correct)
  • Failure to menstruate by age 14 regardless of sexual maturation. (correct)
  • Regular menstrual cycles that stop suddenly after age 40.
  • Absence of menstrual cycles for three months after starting menstruation.

    • Which condition is associated with ovarian level causes of primary amenorrhoea?

  • Breastfeeding
  • Hyperthyroidism
  • Turner’s syndrome (correct)
  • Stress and low body weight

    • What is required for a diagnosis of polycystic ovarian syndrome (PCOS)?

  • Thin body type and regular cycles
  • Two of the listed features including hyperandrogenism or oligo/anovulation (correct)
  • High levels of luteinizing hormone (LH) only
  • Absence of hyperandrogenism

    • What systemic cause can lead to secondary amenorrhoea?

    <p>Cushing’s syndrome</p> Signup and view all the answers

    Which mechanism is primarily involved in the pathophysiology of PCOS?

    <p>Insulin resistance leading to hyperglycemia and obesity</p> Signup and view all the answers

    What is a common cause of low FSH leading to infertility?

    <p>Oligo or anovulation</p> Signup and view all the answers

    Which treatment option is commonly used to manage menstrual cycle irregularities?

    <p>COCP</p> Signup and view all the answers

    What percentage of ectopic pregnancies occur in the fallopian tube?

    <p>97%</p> Signup and view all the answers

    What is one potential consequence of a ruptured ectopic pregnancy?

    <p>Massive internal hemorrhage</p> Signup and view all the answers

    Which of the following is NOT a symptom of ectopic pregnancy?

    <p>Menorrhagia</p> Signup and view all the answers

    What is a characteristic feature of Kallmann syndrome?

    <p>Hyposmia/Anosmia</p> Signup and view all the answers

    Which condition is characterized by low LH and FSH levels?

    <p>Hypogonadotropic hypogonadism</p> Signup and view all the answers

    What treatment is commonly administered for Kallmann syndrome to stimulate testicular growth?

    <p>HCG and FSH</p> Signup and view all the answers

    What symptom is typically associated with androgen deficiency in men?

    <p>Decreased muscle mass</p> Signup and view all the answers

    Which syndrome is characterized by small testes and very high LH and FSH levels?

    <p>Klinefelter syndrome</p> Signup and view all the answers

    Infertility is defined as the absence of conception after how long?

    <p>12 months</p> Signup and view all the answers

    What is NOT a common symptom of androgen deficiency?

    <p>Enhanced muscle strength</p> Signup and view all the answers

    What is the role of androgens in males?

    <p>Establish and maintain virilisation</p> Signup and view all the answers

    What is the average age for the final menstrual period in women?

    <p>51.5 years</p> Signup and view all the answers

    Which symptom is NOT typically associated with menopause?

    <p>Increased energy levels</p> Signup and view all the answers

    What defines premature ovarian insufficiency?

    <p>Cessation of ovarian function before 40</p> Signup and view all the answers

    What is a common psychological symptom experienced during menopause?

    <p>Severe anxiety</p> Signup and view all the answers

    Which is a long-term consequence of menopause related to bone health?

    <p>Osteoporosis</p> Signup and view all the answers

    During menopause, what typically happens to estrogen levels?

    <p>They decline</p> Signup and view all the answers

    What physiological change during menopause can lead to cardiovascular disease?

    <p>Altered energy metabolism</p> Signup and view all the answers

    Which condition is characterized by hyperactivity or autism-like behavior and can be associated with premature ovarian insufficiency?

    <p>Fragile X syndrome</p> Signup and view all the answers

    What is a significant risk for women experiencing menopause that affects overall health?

    <p>Increased risk of CVD and metabolic syndrome</p> Signup and view all the answers

    During what period does perimenopause occur?

    <p>From the onset of cycle irregularity until 12 months after FMP</p> Signup and view all the answers

    Which of the following is not a systemic cause of primary amenorrhoea?

    <p>Iatrogenic factors</p> Signup and view all the answers

    What condition is characterized by the absence of three menstrual cycles if normally regular?

    <p>Secondary amenorrhoea</p> Signup and view all the answers

    Which of the following is associated with hyperandrogenism in PCOS?

    <p>Oligomenorrhea</p> Signup and view all the answers

    Which factor is primarily responsible for insulin resistance in patients with PCOS?

    <p>Increased adipose tissue</p> Signup and view all the answers

    What is a common pituitary cause of secondary amenorrhoea?

    <p>Pituitary tumor</p> Signup and view all the answers

    What dietary approach can improve cycle regularity in women with low FSH levels?

    <p>Weight loss</p> Signup and view all the answers

    Which of the following is NOT a classification of causes for menorrhagia?

    <p>Vascular</p> Signup and view all the answers

    What are the common symptoms associated with an ectopic pregnancy?

    <p>Constant abdominal pain, known pregnancy, amenorrhoea</p> Signup and view all the answers

    Which type of pelvic pain is specifically caused by inflammation of the upper genital tract?

    <p>Tubal pain</p> Signup and view all the answers

    What serious complication can occur as a result of a ruptured ectopic pregnancy?

    <p>Massive internal haemorrhage</p> Signup and view all the answers

    What is the characteristic hormonal profile of hypergonadotropic hypogonadism?

    <p>High LH and FSH</p> Signup and view all the answers

    Which syndrome is more common in males and involves anosmic hypogonadism?

    <p>Kallmann syndrome</p> Signup and view all the answers

    What treatment is typically administered for establishing fertility in Kallmann syndrome?

    <p>Gonadotropin therapy</p> Signup and view all the answers

    Which of the following symptoms is commonly associated with androgen deficiency in men?

    <p>Decreased ejaculate volume</p> Signup and view all the answers

    In the context of male infertility, how is infertility defined?

    <p>Absence of conception after 1 year of regular intercourse</p> Signup and view all the answers

    What is a potential consequence of testosterone treatment in men with androgen deficiency?

    <p>Prostate enlargement</p> Signup and view all the answers

    Which of the following conditions associated with low LH and FSH is characterized by small testes?

    <p>Klinefelter syndrome</p> Signup and view all the answers

    What is a common psychological symptom associated with androgen deficiency in men?

    <p>Irritability</p> Signup and view all the answers

    What is the average age for a woman's final menstrual period?

    <p>51.5 years</p> Signup and view all the answers

    Which symptom is commonly associated with menopause due to the loss of cyclical estrogen production?

    <p>Hot flushes</p> Signup and view all the answers

    Which consequence of menopause is linked to a reduction in reproductive hormone levels?

    <p>Osteoporosis</p> Signup and view all the answers

    What is a common feature of premature ovarian insufficiency?

    <p>Cessation of ovarian function before the age of 40</p> Signup and view all the answers

    Which symptom is often described as a result of diminished estrogen during menopause?

    <p>Vaginal dryness</p> Signup and view all the answers

    What physiological change occurs with menopause that can affect metabolism?

    <p>Altered energy metabolism</p> Signup and view all the answers

    What type of psychological symptoms are frequently reported by individuals going through menopause?

    <p>Severe anxiety/depression</p> Signup and view all the answers

    Which of the following is a risk factor for developing osteoporosis in postmenopausal women?

    <p>Reduced physical activity</p> Signup and view all the answers

    Which of the following conditions may lead to premature ovarian insufficiency?

    <p>Chemotherapy</p> Signup and view all the answers

    Which metabolic condition is closely associated with menopause?

    <p>Menopausal metabolic syndrome</p> Signup and view all the answers

    Which of the following is a potential cause of menorrhagia that is related to non-structural issues?

    <p>Coagulopathy</p> Signup and view all the answers

    What is the most common site of ectopic pregnancies?

    <p>Fallopian tubes</p> Signup and view all the answers

    What symptom is often experienced by a patient with suspected ectopic pregnancy?

    <p>Constant abdominal pain</p> Signup and view all the answers

    Which condition is considered a serious complication associated with ectopic pregnancies?

    <p>Massive internal hemorrhage</p> Signup and view all the answers

    Which of the following factors contributes to pelvic pain caused by conditions like endometriosis?

    <p>Cyclical hormone fluctuations</p> Signup and view all the answers

    Which of the following conditions is most commonly associated with elevated LH and FSH levels in secondary amenorrhoea?

    <p>Premature ovarian insufficiency</p> Signup and view all the answers

    Which systemic condition can directly lead to primary amenorrhoea by affecting hypothalamic function?

    <p>Anorexia nervosa</p> Signup and view all the answers

    Which of these conditions involves the presence of polycystic ovaries as one of its diagnostic criteria?

    <p>Polycystic ovarian syndrome</p> Signup and view all the answers

    What condition is characterized by a failure to menstruate by age 16 and could involve abnormalities at the uterine level?

    <p>Androgen insensitivity syndrome</p> Signup and view all the answers

    What is a hallmark of the pathophysiology related to insulin resistance seen in PCOS?

    <p>Enhanced conversion of glucose to adipose tissue</p> Signup and view all the answers

    Which condition is primarily associated with high levels of LH and FSH due to dysfunction in the gonads?

    <p>Klinefelter syndrome</p> Signup and view all the answers

    What is the primary treatment option for individuals diagnosed with Kallmann syndrome to stimulate testicular growth?

    <p>Gonadotropin therapy</p> Signup and view all the answers

    What is a common emotional symptom associated with androgen deficiency in men?

    <p>Irritability</p> Signup and view all the answers

    Which of the following is a symptom indicative of hypogonadotropic hypogonadism?

    <p>Absent puberty</p> Signup and view all the answers

    What condition is characterized by anosmia and hypogonadism chiefly affecting males?

    <p>Kallmann syndrome</p> Signup and view all the answers

    What underlying issue often leads to functional hypogonadotropic hypogonadism?

    <p>Anorexia nervosa</p> Signup and view all the answers

    Which hormonal profile is expected in a case of hypergonadotropic hypogonadism?

    <p>High LH and High FSH</p> Signup and view all the answers

    What physiological change is often associated with testosterone deficiency in men?

    <p>Decreased bone density</p> Signup and view all the answers

    Which symptoms are typically associated with vasomotor instability during menopause?

    <p>Hot flushes and night sweats</p> Signup and view all the answers

    What is the most common cause of premature ovarian insufficiency?

    <p>Idiopathic reasons</p> Signup and view all the answers

    Which hormonal change is primarily responsible for the psychological symptoms experienced during menopause?

    <p>Reduced estrogen production</p> Signup and view all the answers

    Which consequence of menopause is directly linked to decreased bone density?

    <p>Osteoporosis</p> Signup and view all the answers

    What condition is characterized by significant psychological distress in approximately 33% of women during menopause?

    <p>Anxiety and depression</p> Signup and view all the answers

    What is the average age at which a woman experiences her final menstrual period?

    <p>51.5 years</p> Signup and view all the answers

    How does aging directly contribute to the risk of cardiovascular disease during menopause?

    <p>Through weight redistribution and hormonal changes</p> Signup and view all the answers

    Which of the following conditions can present with the characteristic features of Fragile X syndrome in premature ovarian insufficiency?

    <p>Autism spectrum disorders</p> Signup and view all the answers

    What physiological change during the menopause transition can lead to alterations in energy metabolism?

    <p>Altered fat distribution</p> Signup and view all the answers

    What consequence does the decline in estrogen levels have on vaginal health during menopause?

    <p>Vaginal dryness and atrophy</p> Signup and view all the answers

    Study Notes

    Primary Amenorrhea

    • Failure to menstruate by age 16 with normal secondary sexual characteristics or by age 14 with no signs of sexual maturation.

    Causes of Primary Amenorrhea

    • Hypothalamic

      • Low body weight
      • Stress
      • Severe diet restriction (anorexia) or heavy exercise
      • Kallmann’s syndrome

    • Pituitary

      • Tumor

    • Ovarian

      • Polycystic Ovarian Syndrome (PCOS) with normal LH/FSH levels
      • Turner’s syndrome

    • Uterine

      • Gonadal dysgenesis
      • Imperforate hymen
      • Mullerian agenesis
      • Inter - vaginal septum
      • Androgen insensitivity

    • Systemic

      • Constitutional delay
      • Hyper or hypothyroidism

    Secondary Amenorrhea

    • Absence of three menstrual cycles if normally regular or 6 months if normally oligomenorrhea.

    Causes of Secondary Amenorrhea

    • Hypothalamic

      • Low body weight
      • Stress
      • Severe diet restriction or heavy exercise

    • Pituitary

      • Tumor or infarction (usually during labor)

    • Ovarian

      • PCOS with normal LH/FSH levels
      • Early menopause with high FSH/LH levels

    • Uterine

      • Pregnancy
      • Physical obstruction
      • Iatrogenic

    • Systemic

      • Breastfeeding
      • Hyperthyroidism
      • Cushing’s

    Polycystic Ovarian Syndrome (PCOS)

    • Diagnosis requires two out of three of the following characteristics:
      • Hyperandrogenism features
      • Oligo or Anovulation
      • Polycystic ovaries on ultrasound

    PCOS Pathophysiology

    • Not fully understood but associated with the following:

      • Insulin resistance

      • Hyperglycemia

      • Increased storage of glucose as adipose tissue

      • Truncal obesity

      • High LH

      • Hyperandrogenism

      • Hirsutism

      • Oily skin

      • Acne

      • Low FSH

      • Oligo or anovulation

      • Infertility

    PCOS Management

    • Diet and lifestyle
    • COCP to control the menstrual cycle and hyperandrogenism

    Menorrhagia

    • Uterine

      • Infection
      • Polyps
      • Adenomyosis
      • Leiomyoma/Fibroid
      • Malignancy

    • Systemic

      • Iatrogenic
      • Coagulopathy
      • Endocrine (hypothyroidism)

    Pelvic Pain in Females

    • Ovarian

      • Cyst
      • Malignancy
      • Torsion

    • Tubal

      • Pelvic inflammatory disease
      • Ectopic pregnancy

    • Uterine

      • Fibroid
      • Malignancy
      • Endometriosis
      • Adenomyosis

    • Other

      • Appendicitis
      • Diverticulitis
      • IBD
      • Renal stones
      • UTI/Pyelonephritis

    Ectopic Pregnancy

    • Implantation and maturation of a fertilized embryo outside of the uterine cavity.
    • Occurs in 1% of pregnancies.
    • 97% arise in the fallopian tube.
    • Can rupture and cause massive internal haemorrhage, a medical emergency.

    Ectopic Pregnancy Presentation

    • Classic triad of:
      • Constant abdominal pain
      • Known pregnancy or features of pregnancy:
        • Amenorrhoea
        • Breast tenderness
        • Nausea and vomiting
      • Bleeding

    Ruptured Ectopic Pregnancy

    • Shock
    • Urge to defecate

    Menopause

    • The final menstrual period in a woman who has not had a hysterectomy.
    • Average age is 51.5 years.

    Perimenopause

    • From the onset of cycle irregularity through until 12 months after the FMP.

    Menopause Transition

    • From onset of cycle irregularity to FMP.
    • More anovulatory cycles
    • Irregular menses
    • Lighter or heavier menses
    • Symptoms of estrogen insufficiency or excess (if more follicles are being recruited)

    Premature Ovarian Insufficiency (POI)

    • Cessation of ovarian function before 40 years of age.

    Causes of POI

    • Idiopathic (most common)

    • Physical insults

      • Ionising radiation
      • Chemotherapy
      • Viral infection
      • Smoking
      • Surgery

    • Genetic

      • Fragile X
      • Turner’s

    • Enzyme/gonadotropin defects

    • Immune disturbances

    Consequences of Menopause

    • Loss of cyclical estrogen production leads to:
      • Vasomotor symptoms:
        • Hot flushes
        • Night sweats
      • Formication (crawling sensation on skin)
      • Muscle/joint pains
      • Anxiety/depression/irritability
      • Fatigue
      • Sleep disturbance
      • Lessened memory/concentration
      • Low libido
      • Vaginal dryness and urogenital symptoms

    Long Term Consequences of Menopause

    • Osteoporosis
    • Risk of CVD/Metabolic syndrome

    Delayed or Absent Puberty

    • Absence of secondary sexual characteristics at age 13 in girls and 16 in boys.

    Causes of Delayed or Absent Puberty

    • Nonpathologic/Transient (“late bloomer”)

    • Hypogonadotropic hypogonadism/Secondary failure

      • Low LH and FSH.
      • Deficiency in pulsatile GnRH, FSH or LH secretion.
      • Due to issues with the hypothalamus or pituitary stalk.
        • Congenital: Kallmann syndrome
        • Acquired: CNS tumors or congenital malformations
        • Functional: Anorexia nervosa, intense exercise, IBD, coeliac

    • Hypergonadotropic hypogonadism/Primary failure

      • High LH and FSH
      • Direct gonadal dysfunction.
        • Klinefelter syndrome
        • Turner’s syndrome

    Kallmann's Syndrome

    • Congenital GnRH deficiency due to failure of GnRH neurons to migrate into the hypothalamus.
    • Triad of:
      • GnRH deficiency
      • Absent puberty
      • Small testes
      • Hyposmia/Anosmia
      • Hypoplasia of the olfactory lobes
    • 4x more common in males than females.

    Kallmann's Syndrome Treatment

    • Gonadotropin therapy
      • HCG
      • FSH
    • Testosterone replacement for virilisation after 5 years.

    Androgen Deficiency in Men

    • Androgens support virilisation.

    Symptoms of Androgen Deficiency

    • General

      • Decreased sense of wellbeing
      • Tiredness
      • Poor stamina
      • Poor concentration
      • Depression
      • Irritability

    • Sexual

      • Decreased libido
      • Decreased ejaculate volume
      • Erectile failure

    • Organ Specific

      • Decreased muscle mass and strength
      • Osteoporosis and fracture
      • Increased fat mass
      • CVD and metabolic

    Treatment of Androgen Deficiency

    • Testosterone

    Male Infertility

    • Defined as the absence of conception after 1 year of regular, unprotected intercourse around the time of ovulation.

    Primary Amenorrhea

    • Failure to menstruate by age 16 with normal secondary sexual characteristics or age 14 with no signs of sexual maturation
    • Causes can be classified based on location of the issue
      • Hypothalamic Level: Low body weight, stress, severe diet restriction, heavy exercise, Kallmann's Syndrome
      • Pituitary Level: Tumor
      • Ovarian Level: PCOS, Turner's Syndrome
      • Uterine Level: Gonadal Dysgenesis (Imperforate hymen, Mullerian agenesis, Inter-vaginal septum), Androgen Insensitivity
      • Systemic: Constitutional delay, hyper or hypothyroidism

    Secondary Amenorrhea

    • Absence of three menstrual cycles (if normally regular) or six months (if normally oligomenorrhea)
    • Causes can be classified based on location of the issue
      • Hypothalamic Level: Low body weight, stress, severe diet restriction, heavy exercise
      • Pituitary Level: Tumor or infarction
      • Ovarian Level: PCOS or early menopause
      • Uterine Level: Pregnancy, physical obstruction, iatrogenic
      • Systemic: Breastfeeding, hyperthyroidism, Cushing's

    Polycystic Ovarian Syndrome (PCOS)

    • Diagnostic criteria: two out of three
      • Features of hyperandrogenism
      • Oligo or Anovulation
      • Polycystic ovaries on ultrasound
    • Associated with: Insulin resistance, high LH, low FSH
    • Management: Lifestyle changes, COCP

    Menorrhagia

    • Excessive menstrual bleeding
    • Causes can be classified as:
      • Uterine: Infection, polyps, adenomyosis, leiomyoma/fibroids, malignancy
      • Systemic: Iatrogenic, coagulopathy, endocrine (hypothyroidism)

    Pelvic Pain in Females

    • Classified by location:
      • Ovarian: Cyst, malignancy, torsion
      • Tubal: Pelvic inflammatory disease, ectopic pregnancy
      • Uterine: Fibroid, malignancy, endometriosis, adenomyosis
      • Other: Appendicitis, diverticulitis, IBD, renal stones, UTI/pyelonephritis

    Ectopic Pregnancy

    • Implantation and maturation of a fertilized embryo outside of the uterine cavity
    • Occurs in 1% of pregnancies
    • 97% occur in the fallopian tube
    • Can cause massive internal haemorrhage
    • Classic Triad of Symptoms:
      • Constant abdominal pain
      • Known pregnancy (but not always) or features of pregnancy
      • Bleeding (but not always)
    • If the ectopic has ruptured: Shock, urge to defecate
    • ANY FEMALE OF REPRODUCTIVE AGE WITH ABDO PAIN SHOULD GET A PREGNANCY TEST

    Menopause

    • The final menstrual period in a woman who has not had a hysterectomy (average age 51.5 years)
    • Perimenopause: From onset of cycle irregularity through until 12 months after the FMP
    • Menopause transition: From onset of cycle irregularity to FMP
    • Consequences: Vasomotor symptoms, formication, muscle/joint pains, anxiety/depression/irritability, fatigue, sleep disturbance, lowered memory/concentration, low libido, vaginal dryness and urogenital symptoms

    Premature Ovarian Insufficiency

    • Cessation of ovarian function before 40 years of age
    • Idiopathic: Most common
    • Physical insults: Ionizing radiation, chemotherapy, viral infection, smoking, surgery
    • Genetic: Fragile X or Turner's Syndrome
    • Other: Enzyme/gonadotropin defects, immune disturbances

    Consequences of Menopause

    • Loss of cyclical oestrogen production leads to: Vasomotor symptoms, formication, muscle/joint pains, anxiety/depression/irritability, fatigue, sleep disturbance, lessened memory/concentration, low libido, vaginal dryness and urogenital symptoms
    • Overall diminished wellbeing

    Long Term Consequences of Menopause

    • Osteoporosis: Ageing, Vitamin D deficiency, menopausal oestrogen decline
    • Risk of CVD/Metabolic syndrome: Altered energy metabolism, "Menopausal Metabolic Syndrome"

    Delayed or Absent Puberty

    • Absence of secondary sexual characteristics at age 13 in girls and 16 in boys
    • Nonpathologic/Transient: “Late bloomer”
    • Hypogonadotropic hypogonadism/Secondary Failure: Low LH and FSH, deficiency in pulsatile GnRH, FSH or LH secretion (congenital, acquired, functional)
    • Hypergonadotropic hypogonadism/Primary failure: High LH and FSH, direct gonadal dysfunction (Klinefelter syndrome, Turner's syndrome)

    Kallmann's Syndrome

    • Congenital GnRH deficiency
    • Triad of: GnRH deficiency, Hyposmia/Anosmia , Hypoplasia of the olfactory lobes
    • 4x more common in males than females
    • Treatment: Gonadotropin therapy (HCG, FSH), testosterone after 5 years

    Androgen Deficiency in Men

    • Androgens are responsible for establishing and maintaining virilisation
    • Symptoms: Decreased sense of wellbeing, tiredness, poor stamina, poor concentration, depression, irritability, decreased libido, decreased ejaculate volume, erectile failure, decreased muscle mass and strength, osteoporosis, increased fat mass
    • Treatment: Testosterone

    Male Infertility

    • Infertility is defined as the absence of conception after 1 year of regular, unprotected intercourse around the time of ovulation.

    Primary Amenorrhoea

    • Failure to menstruate: by age 16 with normal secondary sexual characteristics OR by age 14 with no signs of puberty
    • Hypothalamic Level: Low body weight, stress, severe diet restriction (anorexia)/heavy exercise, Kallmann’s syndrome
    • Pituitary Level: Tumour
    • Ovarian Level: PCOS (with normal LH/FSH levels), Turner’s syndrome
    • Uterine Level: Gonadal Dysgenesis (Imperforate hymen, Mullerian agenesis, Inter-vaginal septum), Androgen insensitivity
    • Systemic: Constitutional delay (late bloomer), hyper or hypothyroidism

    Secondary Amenorrhoea

    • Absence of three menstrual cycles (if normally regular) OR 6 months (if normally irregular)
    • Hypothalamic Level: Low body weight, stress, severe diet restriction/heavy exercise
    • Pituitary Level: Tumour or infarction (usually during labour)
    • Ovarian Level: PCOS (normal LH/FSH levels) or early menopause (high FSH/LH)
    • Uterine Level: Pregnancy, physical obstruction, iatrogenic
    • Systemic: Breastfeeding, hyperthyroidism, Cushing’s

    Polycystic Ovarian Syndrome (PCOS)

    • Requires 2 of the following for diagnosis: Features of hyperandrogenism, Oligo or Anovulation, Polycystic ovaries on ultrasound
    • Pathophysiology: Insulin resistance → hyperglycemia → increased glucose storage as adipose tissue → truncal obesity
    • Pathophysiology: High LH → Hyperandrogenism → hirsutism, oily skin, acne
    • Pathophysiology: Low FSH → oligo or anovulation → infertility
    • Management: Diet and lifestyle changes (weight loss improves menstrual cycle regularity and lowers diabetes risk), COCP to control menstrual cycle and hyperandrogenism

    Menorrhagia

    • Uterine Causes: Infection, Polyps, Adenomyosis, Leiomyoma/Fibroid, Malignancy
    • Systemic Causes: Iatrogenic, Coagulopathy, Endocrine (hypothyroidism)

    Pelvic Pain in Females

    • Ovarian: Cyst, Malignancy, Torsion
    • Tubal: Pelvic inflammatory disease, Ectopic pregnancy
    • Uterine: Fibroid, Malignancy, Endometriosis, Adenomyosis
    • Other: Appendicitis, Diverticulitis, IBD, Renal stones, UTI/Pyelonephritis

    Ectopic Pregnancy

    • Implantation of a fertilised embryo outside the uterine cavity
    • Occurs in 1% of pregnancies, 97% in fallopian tube, can rupture and cause massive internal haemorrhage
    • Classic Triad: Constant abdominal pain, known pregnancy or pregnancy features (amenorrhoea, breast tenderness, nausea/vomiting), bleeding
    • Ruptured Ectopic: Shock (pale, cold, lightheadedness), urge to defecate
    • Any female of reproductive age with abdominal pain should get a pregnancy test

    Menopause

    • Final menstrual period (FMP) in woman without a hysterectomy (average age 51.5 years)
    • Perimenopause: Onset of cycle irregularity through 12 months after FMP
    • Menopause transition: Onset of cycle irregularity until FMP
    • Menopause Symptoms: More anovulatory cycles, Irregular menses, Lighter/heavier menses, Symptoms of oestrogen insufficiency/excess
    • Vasomotor Symptoms: Hot flushes, night sweats
    • Other Symptoms: Formication, Muscle/joint pains, Anxiety/depression/irritability, Fatigue, Sleep disturbance, Lessened memory/concentration, Low libido, Vaginal dryness and urogenital symptoms

    Premature Ovarian Insufficiency (before 40 years old)

    • Idiopathic: Most common
    • Physical Insults: Ionising radiation, Chemotherapy, Viral infection, Smoking, Surgery
    • Genetic: Fragile X, Turner’s Syndrome
    • Enzyme/Gonadotropin Defects:
    • Immune Disturbances:

    Consequences of Menopause

    • Vasomotor Symptoms: Reduced thermoneutral zone, Hot flushes caused by warming, stress, food
    • Osteoporosis: Ageing, Vitamin D deficiency/reduced calcium absorption, Menopausal oestrogen decline
    • Increased Risk of CVD: Altered energy metabolism, Increased abdominal/intra-abdominal adiposity, “Menopausal Metabolic Syndrome”
    • "Menopausal Metabolic Syndrome": Dyslipidemia, Insulin resistance, Increased blood pressure, Chronic inflammation

    Delayed or Absent Puberty

    • Late Bloomer: Nonpathologic/Transient
    • Hypogonadotropic Hypogonadism: Low LH and FSH, Deficient GnRH, FSH, or LH secretion
    • Hypergonadotropic Hypogonadism: High LH and FSH, direct gonadal dysfunction (usually due to dysgenesis)

    Kallmann’s Syndrome

    • Congenital GnRH deficiency due to failure of GnRH neurons to migrate into the hypothalamus
    • Triad: GnRH deficiency → absent puberty → small testes, Hyposmia/Anosmia, Hypoplasia of the olfactory lobes
    • Treatment: Gonadotropin therapy (HCG, FSH), Testosterone after 5 years for virilisation

    Androgen Deficiency In Men

    • Symptoms: Decreased sense of wellbeing, Tiredness, poor stamina, poor concentration, Depression, irritability, Decreased libido, Decreased ejaculate volume, Erectile failure, Decreased muscle mass and strength, Osteoporosis and fracture, Increased fat mass, CVD and metabolic
    • Treatment: Testosterone replacement therapy

    Male Infertility

    • The absence of conception after 1 year of regular, unprotected intercourse around the time of ovulation.

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