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38 Cards in this Set

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  • Back
Broadly, what are the beginning stages of pregnancy, starting at development?
1. Gamete development and maturation
2. Ovulation
3. Fertilization
4. implantation
5. Clinical evidence of pregnancy
6. Documentation of normal development
In males, when is the initiation of spermatogenesis?
Puberty
When does ovulation normally occur?
14 days after the onset of menses
What's the definition of day 1 of the menstrual cycle?
1st day of real, active bleeding.
How many days after fertilization doe simplantation occur?
6-8 days:

3 days in fallopian tube
3-5 days in uterus before physicla attachment
What is the source of HCG in the body/
Trophoblast
How many days after implantation does it take for beta HCG to be detectible?
2-3 days following implantation
What are we measuring when we do an assay for HCG?
The BETA subunit:

the alpha subunit is shared by LH, FSH, and TSH!
What's the definition of gestaional age?
Weeks from day 1 of the last normal menstrual period
What's the mean gestational length?
40 weeks from the last menstrual period

Conception at 2 weeks
Implantation at 3 weeks
Missed menses at 4 weeks
What are 4 causes of the loss of cyclicity?
process works: Pregnancy
revs up: PCOS
winds down: HA
runs out of eggs: Menopause
What is the effect of progesterone and estradiol on GnRH release?
Slows it down!
What underlies PCOS?
Chornically high GnRH pulses
-Lack of negative feedback from CL
-High LH, low FSH
What hormone is overactive in PCOS?
LH
What is the implication of tonically high LH in PCOS?
Increased androgens
What is the impact of increased androgens in PCOS?
No dominant follicle (no FSH)
No LH surge
No ovulation
No CL

Weight gain
Acne
Hirsutism
What is the effect of increased estrogen in PCOS?
Endrometrial proliferation without differentiation!
What are women with PCOS very likely to get?
Endometrial cancer!
Diabetes (type 2, gestational)
dyslipidemia
What are the characteristics of people with PCOS?
Infertile
Hirsutism
Oligomenorrhea (in all women)
Obesity
What is the official definition of PCOS?
Menstrual dysfunction (>35 days cycles; <10 menses/year)
Hyperandrogenism
Polycystic ovaries

Lack of other causes.
What's the prevalence of PCOS?
10-15%
What's the inheritance of PCOS?
AD with incomplete penetrance.
What are some disease risks for PCOS? (other than the conditions they're definitely goign to get)
Increased risk:
-HTN
-CV disease
-Pregnancy induced HTN
-ovarian cancer
What's the diagnostic approach to PCOS?
1. H and P
2. Rule out DM/IGT
3. If regular cycles/clear skin: pelvic ultrasound
4. If significant skin symptoms: serum free testosterone concentration
What's the goal of treatment with PCOS?
1. Healthy lifestyle!
2. Increase insulin sensitivity
3. Decease hyperanndrogenism
4. Prevent cancer and bleeding
What's the traditional therapy for PCOS?
Oral contraceptirves
What are the effects of oral contraceptievesii n PCOS?
Regulate menstruation
Prevent endometrial hyperplasia
Improve hirsutism/acne
What are side effects of oral contraceptives in PCOS?
Decrease in insulin sensitivity
What can you give people with PCOS to help out with insulin sensitivity?
Metformin
What is the effect of giving metformin to peopel with PCOS?
Decreased abdominal fat
Decreased BMI
Decreased leptin
If people have problems with their skin in PCOS, what can you give them?
Spironolactone.
What underlies hypothalamic amenorrhea?
Decrease in GnRH secretion
What are causes of hypothalamic amenorrhea?
Stress
Anorexia/eating disorders
Intense physical exercise
Developmental abnormality
What is the mediator of amenorrhea due to stress?
Neurotransmitter system:
-Stress axis
-Available energy axis
What are women at increased risk for?
Bone problems

Lack of estrogen causes a lack of bone mass.

Lots of stress fractures
What is the triad of amenorrhea?
Exercise
Diet
Stress
What are some endocrinopathies that you should rule out if someone is amenorrheic?
FSH: premature ovarian insufficiency
Prolactin: pituitary adenoma
TSH: primary hypothyroidism
What's the treatment for amenorrhea?
1. Restore energy balance (diet, cut down on exercise)
2. Restore ovarian hormones (cyclic E/P)
3. Induce cyclic ovulation (pulsatile GnRH, FSH/LH)