Benign Gynecological Conditions Flashcards
Menorrhagia Causes
Dysfunctional uterine bleeding
Uterine fibroid (Leiomyoma)
Hypothyroidism
IUD
PID
Bleeding disorders (von willebrand disease)
Menorrhagia Diagnosis
FBC
Routine transvaginal US scan
Menorrhagia Treatment
Without contraception:
> Mefenamic acid 509mg TDS (good for dysmenorrhea)
> Transexamic acid 1g TDS
With Contraception
> Levonorgestrel Intrauterine System (Mirena)
>COCP (combined oral contraceptive pill)
Dysmenorrhea Types
Primary (no underlying pathology)
Secondary (years after menarche w/ underlying pathology)
Dysmenorrhea Types
Primary (no underlying pathology)
Secondary (years after menarche w/ underlying pathology)
Dysmenorrhea Causes
IUD
Endometriosis
Adenomyosis
PID
Fibroids
Dysmenorrhea Treatment
1st line
Mefenamic acid + Ibuprofen
2nd line
COCP
Amenorrhea types
Primary (failure to start menstruating by 16)
Secondary (cessation of menstruation after previously regular periods)
Primary Amenorrhea Causes
Turner syndrome
Congenital adrenal hyperplasia
Congenital malformation of Genitourinary tract
Testicular feminisation
Secondary Amenorrhea Causes
Hypothalamic amenorrhea
(Stress and excessive exercise)
PCOS
Premature ovarian follicles
Thyrotoxicosis
Hyperprolactinemia
Sheehan syndrome (period of ischemia in pituitary gland caused by blood loss)
PCOS symptoms
Hirsutism
Overweight
Acne
Hair loss
Pelvic pain
Infertility
Irregular period
Fatigue
High testosterone
PCOS diagnosis
Pelvis ultrasound (to look for cysts)
LH : FSH (normal 1:1 PCOS 2:1 3:1)
Prolactin
TSH
Testosterone
Rotterdam criteria
Rotterdam criteria
For PCOS
Need two or more of three:
1. Ovulatory problems (irregular periods)
2. Excessive androgens
3. Polycystic ovary (seen on US)
PCOS Management
General Management
1. Weight reduction
2. COCP (for those that also need contraception)
For hirsutism and acne
1. COCP
2. Topical eflornithine
For infertility
1. See a specialist
2. Met forming (combined w/ clomifene)
3. GnRH
Uterine fibroid (leiyomyoma) Symptoms
May be asymptomatic
Firm, irregular mass on palpation
Heavy menstrual bleeding
Menstrual periods lasting >1 week
Pelvic pressure or pain
Frequent urination
Difficulty emptying bladder
Constipation
Backache or leg pains
Uterine fibroid (leiyomyoma) Localization
Submucosal
Intramural
Subserosal
Pedunculated
Uterine fibroid (leiyomyoma) diagnosis
Transvaginal ultrasound
Uterine fibroid (leiyomyoma) Management
- 1st line - Mirena
- Transexamic acid
- COCP
SURGERY
1. Myomectomy (in women still trying to conceive)
2. Hysteroscopic endometrial ablation
3. Hysterectomy (if pation isn’t trying to conceive in the future)
Endometriosis Definition
A condition where tissue similar to the lining of the uterus grows outside of the uterus
Endometriosis Symptoms
Pelvic pain
Dyspareunia
Bloating
Infertility
Pain during bowel movement / urination
Endometriosis investigation
Laparoscopy
Endometriosis Management
Primary management
1. NSAIDs
2. COCP
Secondary management
GnRH
Surgery -
laparoscopic excision
Laser treatment of endometriotic ovarian cyst
(May improve fertility)
Ovarian cyst types
- Physiological (functional) cysts
Follicular cysts (when follicle doesn’t ruptue)
Corpus luteum cysts (when corpus luteum doesn’t degrade in the absence of fertilisation so it fills with blood or fluid) - Benign germ cell tumours
Dermoid cyst - mature cystic teratoma - Benign epithelial tumours
Serous cystadenoma
Mucinous cystadenoma
Ovarian cyst Symptoms
Pelvic pain
Bloating. Abdominal swelling
Changes in menstrual cycle
Urinary symptoms
Digestive symptoms
Dyspareunia (uncommon)
Ovarian cyst Diagnosis
Pelvic examination
Transvaginal ultrasound
Blood test - CA 125
MRI / CT scan
Ovarian cyst treatment
- Watchful waiting
- Pain management
- Hormonal birth control (COCP)
SURGERY
1. Cystectomy (preserving the ovary)
2. Oopherectomy
- Aspirate the cyst : transvaginal aspiration
