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Reproductive Physiology and Endocrinology

9 topics in Reproductive Physiology and Endocrinology for PGET Paper II Obstetrics & Gynaecology. Each one explains the concept simply, then gives exam-focus points and a quick revision list.

Reproductive hormones: hypothalamus, pituitary, thyroid, gonads and prolactinHow the hypothalamus, pituitary, thyroid, parathyroid and gonads talk to each other through feedback loops, and how prolactin and oxytocin control milk production and let-down.

The menstrual cycle, HPO axis, puberty and menarcheThe ovarian and endometrial cycles hour by hour, how the hypothalamic-pituitary-ovarian axis times ovulation, and how puberty starts and progresses to menarche.

Abnormal uterine bleeding: HMB, IMB, PCB and PMBThe modern terms for abnormal bleeding, the PALM-COEIN causes, how to investigate heavy, intermenstrual, post-coital and postmenopausal bleeding, and the step-by-step treatment of heavy periods.

Amenorrhoea, hyperprolactinaemia and polycystic ovary syndromePrimary and secondary amenorrhoea sorted by level (hypothalamus, pituitary, ovary, uterus and outflow), with the work-up, hyperprolactinaemia, premature ovarian insufficiency and polycystic ovary syndrome.

Gonadal steroidogenesis, precocious and delayed puberty, and ambiguous genitaliaHow the gonads and adrenals make sex steroids, which enzyme defects cause ambiguous genitalia, the DSD conditions (Turner, Swyer, androgen insensitivity, 5-alpha-reductase deficiency, CAH) and the work-up of early and late puberty.

Menopause and hormone replacement therapyWhat happens to the hormones at the menopause, how to diagnose it and premature ovarian insufficiency, the short- and long-term effects of oestrogen loss, and how to choose, prescribe and counsel about HRT.

Female and male infertilityDefinitions and chances of natural conception, the female and male causes of subfertility, the investigations for each partner (including semen analysis and tubal tests), and treatment from ovulation induction to IVF and ICSI.

Maternal physiological and hormonal changes in pregnancy, and fetal physiologyThe hormones of pregnancy (hCG, progesterone, oestrogens, human placental lactogen, prolactin) and how they change the mother's heart, blood, lungs, kidneys, gut, thyroid and metabolism, plus the key facts of fetal circulation, haemoglobin and lung maturity.

Insulin, metabolic pathways and steroidogenesis in pregnancyThe biochemistry behind pregnancy: what insulin and glucagon do to each pathway, why pregnancy becomes insulin resistant, how glucose, fat and ketones reach the fetus, why gestational diabetes happens, and how the placenta makes its steroid hormones.

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