204 - Gynae Flashcards
What is menorrhagia?
Heavy menstrual bleeding
during regular cycles
>80mls
What should you comment about the uterus in a vaginal exam?
Size Shape Position Mobility Tenderness
When would you be given an outpatient endometrial biopsy if you have menorrhagia?
If over 40
? endometrial malignancy
What are 4 main differentials of menorrhagia?
DUB - Dysfunctional uterine bleeding
Fibroids
Endometriosis
Adenomyosis
What is DUB?
Heavy bleeding not associalted with any organic disease
Normal sized uterus
What are fibroids?
Benign growths in the uterus that can cause regular, heavy periods
Can enlarge uterus
Confirmed on US
What are the types of fibroid location you get?
Subserous
Intramural
Submucous
What is endometriosis?
Endometiral tissue foudn outside the uterus
Causes - painful periods. Bleeds when period is - anywhere
Can cause subfertility
What is adenomyosis?
Ectopic endometrial tissue found int he myometrium (muscle) of the uterus
Painful periods
There are 6 main types of medical management of menorrhagia - what are they?
1) Tranexamic acid
2) Mefenamic acid
3) COCP - pill
4) Oral progesterones
5) Mirena coil
6) GnRHa or Progestogens
What surgical options are there for menorrhagia?
Endometrial ablation - destruction of endometrium to basalis layer - v effective
Hysterectomy
What is PMB?
Post-menopausal bleeding
Vaginal bleeding >12 months after LMP
Why is investigating PMB important?
10% due to endometrial cancer!
What is the majority of PMB caused by?
80% due to atropic vaginitis - low oestrogen so vagina dries out + bleeds
What investigations would you do in PMB? What would cause you to do more?
TV US
if endometrium is thickened >5mm - send for biopsy or hysteroscopy
What is HRT?
Hormone replacement therapy
For relief of symptoms of ovarian function cessation (menopause)
What are the 3 types of HRT course?
E2 only
Sequential
Continuous combined
Why is sequential recommended if you have a uterus and are going through the menopause?
If you are peri-menopausal, you need progesterone to cause a withdrawal bleed, as oestrogen alone thickens the lining which can increase the risk of developing cancer. Continue until age 54 then go to continuous combined, as uterus will be atrophic by then.
After 24 months, what is your natural chance of falling pregnant?
90%
What are the 3 main categories of causes of sub-fertility?
Ovulatory disorders (25%) Tubal disease (20%) Sperm dysfunction (30%)
What ovulatory causes may cause sub-fertility?
PCOS, Hypo-pit-ovarian axis issue, endocrine issues
What is PCOS?
Excess androgen production (and less oestrogen conversion) - causes anovulation or sometimes olgio-ovulation
- Follicular development arrests causing cyst like appearance
- causes sub-fertility
What treatment is available for PCOS?
Ovulation induction - Oestrogen antagonists (to inhibit negative feedback loop so increase FSH + LH).
eg. Clomifen citrate, tamoxifen
Synthetic Gonadotropins (FSH + LH)
Ovarian drilling
How is the hypo-pit-ovarian axis affected to cause sub-fertility?
Affected by stress, eating disorders, low BMI, Radiotherapy, prolactinomas or idiopathic.
