Adolescent Gynaecology Flashcards
What is Gillick competency?
Child <16y can give/withhold consent if doctor feels she fully understands what is involved in an intervention without parental permission/knowledge
In certain situations, parents can overrule
What is Fraser competence?
Child under 16yo who is considered to be sufficiently mature & has understanding to be competent to receive contraceptive advice without parental knowledge/consent
What key things are encompassed by fraser competence?
Must be mature enough to understand advice/implications of Rx
Dr tried to persuade girl to tell parents/let her tell the parents
Girl’s health would suffer without Rx/advice
Is in girl’s best interest to give Rx/advice
When do you investigate primary amenorrhoea
Primary amenorrhoea + normal secondary sexual characteristics - 16y
Primary amenorrhoea + absent secondary sexual characteristics - 14y
What investigations should you do for primary amenorrhoea?
FSH, LH, prolactin, TSH, testosterone, oestrogen
Why do you want to test prolactin in amenorrhoea?
Prolactinoma could grow into the pituitary and prevent FSH/LH production
Why do you want to test TSH levels?
Hypothyroidism can cause amenorrhoea
What tests/imaging should you do after the initial FSH etc. blood levels?
Pelvic USS
Progesterone withdrawal bleeding
ASK ABOUT CYCLICAL ABDOMINAL PAIN
Rule out pregnancy!!
How does the progesterone withdrawal bleed work?
Give progesterone and if no withdraw bleeding occurs –> patient has v. low oestrogen/problem with outflow tract (e.g. adhesions/scarring)
If bleeds - oestrogen there but no ovulation is occurring
If lack oestrogen - investigate FSH/LH/TSH/prolactin
NB - low FSH/LH v. common in this age group (esp if v. thin)
Why do you need to ask about cyclical pain in primary amenorrhoea?
May be imperforate hymen/septum - USS will show mass of blood collecting in uterus
Must make excision to let blood out
What is puberty induction?
Mimicking normal puberty by gradually building up oestrogen (until they stop growing)
Add on progesterone once maximal height potential is reached (at go on low oestrogen pill at this point (at least 20mg)
Do if girl hasn’t gone through puberty at 16/18
Why can’t you give high dose oestrogen straight away when inducing puberty?
Alters breast shape
What is secondary amenorrhoea?
Absence of menses for more than 3 months in woman with previously regular cycles (or 6m in irreg. cycles)
What can cause secondary amenorrhoea?
Weight
PCOS
Pregnancy
Fluctuating LH/oestrogens (e.g. fluctuating weight –> hypogonadoatrophic hypogonadism)
What is PCOS?
Disorder characterised byb hyperandrogenism (xs androgen which leads to virulisation) oligoovulation/anovulation +/- polycystic ovaries
What causes PCOS?
Individuals may be genetically predisposed, lifestyle, hyperinsulinaemia disrupts the HPO axis