Benign Gynaecology Flashcards
What is finesteride
Anti-androgen
Inhibits 5areductase therefore reduces conversion of testosterone to dibydroteatosterone
What is flutamide
Antiandrogen acting directly on the hair follicle
What is Cyproterone acetate
Anti androgen
Synthetic 17-hydroxyprogesterone derivative
Blocks androgen receptors and reduces LH
What is Eornithine
Cream that reduces hair growth
What is Gestrinone
Anti progesterone, anti oestrogen and weak androgen
Can cause masculisation of female Cetus therefore contraception indicated
What is the mechanism of tranexamic acid
Antifibrinolytic
Reduces endometrial tissue plasminogen activator
Reduces menstrual flow by 54%
What is the prevalence of endometriosis
10-20%
What is the threshold size for endometriomas, beyond which histology should be obtained to exclude malignancy
3cm
What is the prevalence of adenomyosis
1%
What is the Rome criteria
IBS: 3 months continuous or recurring abdo pain/irritation
2/+ of the following 25% of time
- Change in frequency - >3 per day or <3 per week
- Change in stool - hard/loose
- Mucous
- Altered sensation - urgency/straining
What are the features of pelvic congestion syndrome on Venography
Ovarian vein diameter >10mm
Uterine venous engorgement
Congestion of the ovarian plexus
Filling of the pelvic veins across the midline &/or filing the vulvovaginal thigh varicosities
What is the prevalence of pelvic congestion syndrome in women of childbearing age
3.8%
When can aromatase inhibitors be considered in the treatment of endometriosis
Rectovaginal endometriosis refractory to other medical or surgical treatment
Can be used in combination with cocp progestogens or GnRH analogues
Anastrazole, letrozole
What surgical interruption of pelvic nerve pathways is useful for treating endometriosis pain and which is not
LUNA laparoscopic uterosacral nerve ablation is NOT useful
PSN pre sacral neurectomy is useful but high risk surgery
What is the only proven method to reduce adhesion formation post surgery for endometriosis
Oxidised regenerated cellulose
Regarding endometriosis
Why and what postoperative treatment is given
After cystectomy for endometrioma - hormonal contraception for secondary prevention of endometrioma
Post op mirena or cocp for at least 18-24 months for secondary prevention of endometriosis associated dysmenorrhea (not non-menstrual pelvic pain or dyspareunia)
Do not use if seeking fertility
What areas are not involved in lichen sclerosis
Vagina or mouth
What is hyalization of the upper dermis pathognomonic of
Lichen sclerosis
What % of women in vulval clinical are seen for lichen sclerosis
25%
How many women undergo FGM worldwide annually according to the WHO
2million
What is the estimated prevalence of endometriosis in women of reproductive age
2-10%
What proportion of female adult population will complain of chronic pelvic pain
1 in 6
What is the incidence of nerve entrapment following pfannensteil incision
3.7%
What % of women presenting with chronic pelvic pain would you expect to find IBS
50%
What’s the most common side effect of bisphosphonates
Oesophageal irritation
What T score on DXA bone scan is diagnostic of osteoporosis
-2.5
> -1 is normal
What neurotransmitters are thought to be involved in PMS
GABA and serotonin
What % of women experience severe PMS
5%
What procedure should be considered to prevent vault prolapse after vaginal hysterectomy
If the vault is above the Introitus
If the vault is at the introitus
Above - McCall cyldoplasty
At - sacrospinous fixation
What is the treatment for patients with overactive bladder, not responding to antichokinergics, who also have faecal incontinence
Sacral neuromodulation
What type of prolapse is most increased due to morbid obesity
Rectocele 75%
Cystocele 57%
Uterine prolapse 40%
What is the incidence of denovo cystocele following sacrocolpopexy
31%
What is the incidence of mesh erosion in sacrocolpopexy
2%
What is a rokitanski nodule pathognomic of on USS
Dermoid - hair through fat
What is the range of testosterone expected with PCOS
2-5
What is the range of testosterone expected with tumour
8-10 tumour possible
>10 tumour likely
Define recurrent UTI
> 3 uti infections in 12 month period
Risk of requiring self catheterisation post Botox for OAB
15%
What is the prevalence of OAB in adult females
13-16%
