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Gynaecology > 1: Post-menopausal disorders > Flashcards

1: Post-menopausal disorders Flashcards

1
Q

Define post menopausal bleeding

A

Bleeding after 12 months amenorrhoea in women where menopause can be expected

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2
Q

What is the most severe cause of post-menopausal bleeding

A

Endometrial cancer

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3
Q

How should all post menopausal bleeding be treated

A

As endometrial cancer until proved otherwise

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4
Q

What % of post-menopausal bleeding is endometrial cancer

A

10

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5
Q

What is the most common cause of post-menopausal bleeding

A

Vaginal atrophy

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6
Q

What else are causes of post-menopausal bleeding

A
  • Bleeding disorder
  • Endometrial hyperplasia
  • Cervical cancer
  • Vaginal cancer
  • Vulval cancer
  • HRT = causes spotting
  • Trauma
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7
Q

How should all women >55-years with post-menopausal bleeding be investigated

A

TV-US in 2W referral

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8
Q

What is the cut-off for biopsy on TV-US

A

> 5mm

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9
Q

What is used after TV-US to exclude endometrial cancer

A

Pipette biopsy or hysteroscopy and biopsy

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10
Q

What tumour marker may be ordered and what for

A

CA-125

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11
Q

Define urogenital prolapse

A

Prolapse of pelvic organs in the vagina

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12
Q

What prolapses in urethrocystocele

A

Bladder and urethra

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13
Q

Where does a urethrocystocele prolapse

A

Lower anterior vaginal wall

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14
Q

What prolapses in cystocele

A

Bladder

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15
Q

Where does a cystocele prolapse

A

Upper anterior vaginal wall

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16
Q

What is a rectocele

A

Rectum prolapses

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17
Q

Where does a rectocele prolapse

A

Lower posterior vaginal wall

18
Q

What is a enterocoele

A

Bowel prolapses in pouch of Douglas

19
Q

Where does an enterocoele prolapse

A

Upper posterior vaginal wall

20
Q

What is a uterine prolapse

A

Uterus prolapses into cervix taking vagina

21
Q

What is found anterior upper wall

A

Cystocele

22
Q

What is found anterior lower wall

A

Urethrocystocele

23
Q

What is found posterior upper wall

A

Enterocoele

24
Q

What is found posterior lower wall

A

Rectocele

25
Q

What causes a prolapse

A

Weakening of supportive structures

26
Q

What can cause prolapse

A
  • Weak pelvic floor
  • Prolonged labour
  • Traumatic delivery
  • Obesity, Chronic cough, Constipation
27
Q

What are 4 risk factors for prolapse

A
  • Multiparous
  • Menopause
  • Age
  • Obesity
28
Q

How may a prolapse present clinically

A

Dragging sensation

May feel a lump ‘pop’ out

29
Q

What are symptoms of urocoele

A

Frequency
Urgency
Urinary retention

30
Q

What are symptoms of rectocele

A

Constipation

Difficulty defecating

31
Q

How is prolapse examined for

A

Using a SIMS SPECULUM in the left-lateral position

32
Q

Explain conservative approach to prolapse

A

Factors that reduce intra-abdominal pressure

Or, increase pelvic tone

33
Q

What are conservative measures for prolapse

A

Weight loss
Smoking cessation
Stop straining
Kegel exercises to improve tone

34
Q

What is medical management of prolapse

A

Ring pessary

35
Q

Where are ring pessaries placed

A

Pubic symphysis and posterior fornix

36
Q

How long are ring pessaries kept in for

A

6 months

37
Q

When are pessaries indicated

A
  • Unfit for surgery
38
Q

What is the problem with pessaries

A

Fall out during sexual intercourse - hence not recommended if still sexually active

39
Q

What is indicated for surgical cystocele repair

A

Anterior colporrhhaphy with colposyspension

40
Q

What is indicated for uterine prolapse

A

Hysterectomy and sacrospinous fixation

41
Q

What is indicated for rectocele

A

Posterior colporrhaphy

Gynaecology (22 decks)

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