Podcast
Questions and Answers
What is the primary adverse effect of continuous GnRH therapy?
What is the primary adverse effect of continuous GnRH therapy?
GnRH antagonists can be used for over 6 months without any indications or issues.
GnRH antagonists can be used for over 6 months without any indications or issues.
False
What hormone do FSH receptors in males interact with?
What hormone do FSH receptors in males interact with?
Sertoli cells
The gonadotropins LH and FSH are classified as __________.
The gonadotropins LH and FSH are classified as __________.
Signup and view all the answers
Match the following hormones with their target cells:
Match the following hormones with their target cells:
Signup and view all the answers
Which of the following is NOT a feature of an anovulatory cycle?
Which of the following is NOT a feature of an anovulatory cycle?
Signup and view all the answers
Dysmenorrhea is commonly associated with anovulatory cycles.
Dysmenorrhea is commonly associated with anovulatory cycles.
Signup and view all the answers
What hormone is primarily lacking in the granulosa cells that affects estrogen production?
What hormone is primarily lacking in the granulosa cells that affects estrogen production?
Signup and view all the answers
The _____ pathway results in the production of estrogen from cholesterol.
The _____ pathway results in the production of estrogen from cholesterol.
Signup and view all the answers
Match the cell type with their respective functions in steroidogenesis:
Match the cell type with their respective functions in steroidogenesis:
Signup and view all the answers
What is one of the primary functions of LH during the menstrual cycle?
What is one of the primary functions of LH during the menstrual cycle?
Signup and view all the answers
FSH is responsible for the final growth and maturation of follicles.
FSH is responsible for the final growth and maturation of follicles.
Signup and view all the answers
What is the role of LH in the maintenance of the corpus luteum?
What is the role of LH in the maintenance of the corpus luteum?
Signup and view all the answers
LH is responsible for the ________ release of ova.
LH is responsible for the ________ release of ova.
Signup and view all the answers
Match the hormones with their main functions in the menstrual cycle:
Match the hormones with their main functions in the menstrual cycle:
Signup and view all the answers
What is the nature of GnRH?
What is the nature of GnRH?
Signup and view all the answers
Continuous secretion of GnRH leads to the upregulation of GnRH receptors in the anterior pituitary.
Continuous secretion of GnRH leads to the upregulation of GnRH receptors in the anterior pituitary.
Signup and view all the answers
Which gene is involved in Kallmann syndrome?
Which gene is involved in Kallmann syndrome?
Signup and view all the answers
The half-life (T1/2) of GnRH is ______________.
The half-life (T1/2) of GnRH is ______________.
Signup and view all the answers
Match the following descriptions related to GnRH release frequencies:
Match the following descriptions related to GnRH release frequencies:
Signup and view all the answers
Which layer of the endometrium is shed during menstruation?
Which layer of the endometrium is shed during menstruation?
Signup and view all the answers
Which form of estrogen is the most common synthetic estrogen used in oral contraceptives?
Which form of estrogen is the most common synthetic estrogen used in oral contraceptives?
Signup and view all the answers
The Zona Basalis is sensitive to hormonal changes.
The Zona Basalis is sensitive to hormonal changes.
Signup and view all the answers
What is the function of progesterone during the menstrual cycle?
What is the function of progesterone during the menstrual cycle?
Signup and view all the answers
Estrone (E1) is the most specific estrogen for pregnancy.
Estrone (E1) is the most specific estrogen for pregnancy.
Signup and view all the answers
What is the normal ratio of estradiol (E2) to estrone (E1) in reproductive age females?
What is the normal ratio of estradiol (E2) to estrone (E1) in reproductive age females?
Signup and view all the answers
During the secretory phase, the endometrium shows a ______ layered appearance.
During the secretory phase, the endometrium shows a ______ layered appearance.
Signup and view all the answers
Match the following stages of the menstrual cycle with their characteristics:
Match the following stages of the menstrual cycle with their characteristics:
Signup and view all the answers
The most common estrogen in menopausal females is __________.
The most common estrogen in menopausal females is __________.
Signup and view all the answers
Match each type of estrogen with its description:
Match each type of estrogen with its description:
Signup and view all the answers
Which of the following is a characteristic effect of pulsatile GnRH administration?
Which of the following is a characteristic effect of pulsatile GnRH administration?
Signup and view all the answers
GnRH analogues can be administered via oral routes.
GnRH analogues can be administered via oral routes.
Signup and view all the answers
Name one condition in males that can be treated using GnRH.
Name one condition in males that can be treated using GnRH.
Signup and view all the answers
In continuous GnRH administration, the initial response leads to a/an ______ phase followed by downregulation of the HPO axis.
In continuous GnRH administration, the initial response leads to a/an ______ phase followed by downregulation of the HPO axis.
Signup and view all the answers
Match the following conditions with their respective target demographics:
Match the following conditions with their respective target demographics:
Signup and view all the answers
What is the primary source of estrogen in non-pregnant females?
What is the primary source of estrogen in non-pregnant females?
Signup and view all the answers
Obese females have increased levels of E2 due to higher aromatase activity.
Obese females have increased levels of E2 due to higher aromatase activity.
Signup and view all the answers
What is the end product of progesterone metabolism?
What is the end product of progesterone metabolism?
Signup and view all the answers
Aromatase inhibitors, such as __________, are used in hyperestrogenic conditions.
Aromatase inhibitors, such as __________, are used in hyperestrogenic conditions.
Signup and view all the answers
Match the following hormones with their primary actions:
Match the following hormones with their primary actions:
Signup and view all the answers
What type of tumor is associated with estrogen and progesterone dependence?
What type of tumor is associated with estrogen and progesterone dependence?
Signup and view all the answers
In Turner's Syndrome, there is an increase in estrogen and progesterone levels.
In Turner's Syndrome, there is an increase in estrogen and progesterone levels.
Signup and view all the answers
What are the first signs of ovulation as observed in the early secretory phase during an endometrial biopsy?
What are the first signs of ovulation as observed in the early secretory phase during an endometrial biopsy?
Signup and view all the answers
The appearance of corkscrew or sawtooth glands is associated with the __________ phase.
The appearance of corkscrew or sawtooth glands is associated with the __________ phase.
Signup and view all the answers
Match the following features of endometrial biopsy phases with their corresponding phase:
Match the following features of endometrial biopsy phases with their corresponding phase:
Signup and view all the answers
What effect does high estrogen levels have on cervical mucus?
What effect does high estrogen levels have on cervical mucus?
Signup and view all the answers
Progesterone presence makes cervical mucus thick and not elastic.
Progesterone presence makes cervical mucus thick and not elastic.
Signup and view all the answers
What is the microscopy finding associated with cervical mucus during high progesterone levels?
What is the microscopy finding associated with cervical mucus during high progesterone levels?
Signup and view all the answers
Low estrogen at menopause can result in __________.
Low estrogen at menopause can result in __________.
Signup and view all the answers
Match the types of vaginal cells with their descriptions:
Match the types of vaginal cells with their descriptions:
Signup and view all the answers
Study Notes
GnRH
- GnRH is a natural decapetide hormone released by the arcuate nucleus of the hypothalamus in a pulsatile manner
- Continuous secretion of GnRH downregulates GnRH receptors in the anterior pituitary
- GnRH acts on gonadotropins in the anterior pituitary
- GnRH has a half life of 2-4 minutes
- GnRH neurons migrate from the olfactory epithelium to the hypothalamus along olfactory nerve in intrauterine life
Kallmann Syndrome
- Kallmann syndrome is an X-linked recessive disorder
- The KAL-1 gene is involved in Kallmann syndrome
- Males are more affected by Kallmann syndrome than females
GnRH Analogues
- GnRH analogues are orally inactive
- GnRH analogues are administrated via subcutaneous injections
- Examples of GnRH analogues include Leuprolide, Goserelin, and Buserelin
GnRH Agonists
- GnRH agonists induce an initial flare of hormone production, followed by downregulation of the HPO axis
GnRH Antagonists
- GnRH antagonists are used for ≥6 months of GnRH analogue use
- Examples of GnRH antagonists include Elagolix and Cetrorelix
- GnRH antagonists are orally active
- GnRH antagonists are more expensive
Gonadotropins - LH & FSH
- FSH and LH are glycoproteins composed of α and β subunits
- The α subunit is similar to LH, FSH, TSH and hCG
- Gonadotropins are released by the anterior pituitary
- Gonadotropins bind to membrane bound receptors
FSH Receptors
- FSH receptors are found on Sertoli cells in males
- FSH receptors are found on granulosa cells in females
LH Receptors
- LH receptors are found on Leydig cells in males
- LH receptors are found on theca cells in females
- FSH induces LH receptors on granulosa cells of dominant follicles in females
Functions of FSH & LH
- FSH selects a group of follicles every month
- FSH is essential for the growth of pre-antral and graafian follicles
- LH triggers ovulation and the breakdown of collagen
- LH is involved in the growth and maintenance of the corpus luteum
- LH is crucial for the final growth and maturation of follicles
Levels of LH & FSH
- Normal FSH levels are
- Normal LH levels are
Endometrium in Menstruation
- The superficial layer of the endometrium sheds during menstruation
- The deep layer of the endometrium does not shed and is responsible for regenerating the superficial layer
- The endometrium appears as a white line on ultrasound
- The endometrium changes appearance throughout the menstrual cycle
- During the early proliferative phase, the endometrium is thin
- During the late proliferative and ovulatory phase, the endometrium is thick with posterior acoustic enhancement
- During the secretory phase, the endometrium has a trilaminar appearance
Progesterone
- Progesterone is synthesized from LDL cholesterol via the following pathway: LDL cholesterol → Pregnenolone → 3βHSD → Progesterone
- Progesterone is produced by the corpus luteum in non-pregnant females
- Progesterone is produced by the corpus luteum in early pregnancy and the placenta in later pregnancy
- Progesterone is mainly bound to albumin and corticosteroid-binding globulin (CBG)
- Progesterone is mainly found in the bound form
- Progesterone has a free form of 1%
- Progesterone is metabolized to pregnanediol
Actions of Progesterone
- Progesterone supports the endometrium and has secretory and autoproliferative actions
- Continuous progesterone administration leads to endometrial hypertrophy
- Progesterone is used to treat endometrial hyperplasia
Estrogen
- Estrogen is synthesized in the body via the following pathway: Cholesterol → 17-hydroxylase → Androgens → Aromatase → Estrogen
- Estradiol (E2) is the main estrogen found in reproductive age females
- Estrone (E1) is the main estrogen found in menopausal and obese females
- Estriol (E3) is specifically found in pregnancy
- The ratio of E2:E1 is normally 2:1, but is 1:2 in obese females
- Synthetic forms of estrogens include Ethinyl Estradiol, Conjugated Equine Estrogen, and 17-B Estradiol
- The potency of synthetic estrogens is as follows: EE > CEE > E2 > E1 >E3 > E4
- Ethinyl estradiol is the most common synthetic estrogen used in oral contraceptives
- 17-B Estradiol is the most common synthetic estrogen used in Hormone Replacement Therapy
- High dose oral contraceptives contain ≥ 50 mcg of estrogen
- Low dose oral contraceptives contain ≤ 30 mcg of estrogen
- Oral contraceptives are classified based on their estrogen content
Actions of Estrogen
- Estrogen proliferates the uterine endometrium
- Estrogen promotes the growth of the non-pregnant uterus
- Estrogen is involved in the growth of the non-pregnant and pregnant uterus
Cervical Mucus
- Cervical mucus is thin, profuse, watery, and elastic in the presence of estrogen
- Cervical mucus is thick, scanty, viscous, and non-elastic in the presence of progesterone
- Cervical mucus microscopy shows ferning from day 17 onwards
- High estrogen levels lead to cervical mucus that facilitates sperm penetration
- Low estrogen levels can lead to senile vaginitis (vaginal dryness)
- Progesterone containing contraceptives lead to thick cervical mucus
- Mirena, a LNG (Progesterone) containing IUD, causes thick cervical mucus
- Cu IUDs increase the risk of pelvic inflammatory disease
- Superficial cells in vaginal cytology are favorable for sperm penetration
- Intermediate cells in vaginal cytology are unfavorable for sperm penetration and increase the risk of PID
Clinical Features of Kallman Syndrome
- Decreased estrogen levels in females can lead to:
- Delayed puberty
- Primary amenorrhea
- Infertility
- Hyposmia/anosmia
- Normal Height
- Decreased androgen levels in males can lead to delayed puberty and infertility
Management of Kallman Syndrome
- Pulsatile GnRH administration is a common method of managing Kallmann Syndrome
Uses of GnRH Analogues
- GnRH analogues are used to treat:
- Delayed puberty in both males and females
- Kallmann syndrome
- Anovulation
- Precocious puberty
- Endometriosis
- Fibroids
- ER+ve breast cancer
- Hyperestrogenic conditions
- Hirsutism
- Prostate cancer
Estrogen: Synthesis, Source, Receptors, and Metabolism
- Estrogen is synthesized in the body via the following pathway: Cholesterol → 17-hydroxylase → Androgens → Aromatase → Estrogen
- E2 is synthesized in the granulosa cells through the two-cell, two gonadotropin theory
- E1 is synthesized in adipose tissue from androstenedione
- Obese females have increased E1 levels
- Aromatase inhibitors, such as Letrozole, are used to treat hyperestrogenic conditions
- Estrogen receptors are intranuclear
- Most estrogen is bound, mostly to SHBG and then albumin
- Free estrogen accounts for 2% of estrogen in the body
- The end product of estrogen metabolism is glucuronide
Progesterone: Synthesis, Source, Actions, and Metabolism
- Progesterone is synthesized from LDL cholesterol via the following pathway: LDL cholesterol → Pregnenolone → 3βHSD → Progesterone
- Progesterone is produced by the corpus luteum in non-pregnant females and in early pregnancy
- Progesterone is produced by the placenta in late pregnancy
- Progesterone is located in the cytoplasm and nucleus
- Progesterone is primarily found in the bound form, primarily to albumin and CBG
- Progesterone has a free form of 1%
- Progesterone is metabolized to pregnanediol
- Progesterone is essential for maintaining the endometrium
- Progesterone has secretory and autoproliferative actions
- Continuous administration of progesterone leads to endometrial hypertrophy
General Gynecology
- Cervical mucus studies can be used to assess ovulation
- The Billings method is a natural method of contraception that involves monitoring cervical mucus
- Progesterone-containing contraceptives can thicken cervical mucus to prevent pregnancy
- Cu IUDs increase the risk of pelvic inflammatory disease
- Cervical mucus studies can help diagnose infections
- The predominant cell types in vaginal cytology are superficial and intermediate cells
- Superficial cells are favorable for sperm penetration
- Intermediate cells are unfavorable for sperm penetration and increase the risk of pelvic inflammatory disease
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz covers critical aspects of GnRH, its role in the hypothalamic-pituitary axis, and its association with Kallmann syndrome. Explore the mechanisms of GnRH analogues, agonists, and antagonists, their administration routes, and implications in disorders. Perfect for students aiming to deepen their understanding of reproductive endocrinology.
