Common gynae diagnoses Flashcards
Primary amenorrhoea?
Causes?
Primary amenorrhoea is when the patient has never developed periods. This can be due to:
Abnormal functioning of the hypothalamus or pituitary gland (hypogonadotropic hypogonadism)
Abnormal functioning of the gonads (hypergonadotropic hypogonadism)
Imperforate hymen or other structural pathology
Secondary amenorrhoea?
Causes?
Secondary amenorrhoea is when the patient previously had periods that subsequently stopped. This can be due to:
Pregnancy (the most common cause)
Menopause
Physiological stress due to excessive exercise, low body weight, chronic disease or psychosocial factors
Polycystic ovarian syndrome
Medications, such as hormonal contraceptives
Premature ovarian insufficiency (menopause before 40 years)
Thyroid hormone abnormalities (hyper or hypothyroid)
Excessive prolactin, from a prolactinoma
Cushing’s syndrome
Irregular menstrual periods indicative of?
Causes?
Irregular menstrual periods indicate anovulation (a lack of ovulation) or irregular ovulation
It can be due to:
Extremes of reproductive age (early periods or perimenopause)
Polycystic ovarian syndrome
Physiological stress (excessive exercise, low body weight, chronic disease and psychosocial factors)
Medications - particularly progesterone only contraception, antidepressants and antipsychotics
Hormonal imbalances - such as thyroid abnormalities, Cushing’s syndrome and high prolactin
What is intermenstrual bleeding (IMB)?
Causes?
Intermenstrual bleeding (IMB) refers to any bleeding that occurs between menstrual periods
This is a RED FLAG that should make you consider cervical and other cancers, although other causes are more common.
The key causes of intermenstrual bleeding are:
Hormonal contraception Cervical ectropion, polyps or cancer Sexually transmitted infection Endometrial polyps or cancer Vaginal pathology, including cancers Pregnancy Ovulation can cause spotting in some women Medications, such as SSRIs and anticoagulants
Dysmenorrhoea?
Causes?
Dysmenorrhoea describes painful periods. The causes are:
Primary dysmenorrhoea (no underlying pathology) Endometriosis or adenomyosis Fibroids Pelvic inflammatory disease Copper coil Cervical or ovarian cancer
Menorrhagia?
Causes?
Menorrhagia refers to heavy menstrual bleeding. This can be caused by:
Dysfunctional uterine bleeding (no identifiable cause)
Extremes of reproductive age
Fibroids
Endometriosis and adenomyosis
Pelvic inflammatory disease (infection)
Contraceptives, particularly the copper coil
Anticoagulant medications
Bleeding disorders (e.g. Von Willebrand disease)
Endocrine disorders (diabetes and hypothyroidism)
Connective tissue disorders
Endometrial hyperplasia or cancer
Polycystic ovarian syndrome
Postcoital bleeding?
Causes?
Postcoital bleeding (PCB) refers to bleeding after sexual intercourse.
This is a RED FLAG that should make you consider cervical and other cancers, although other causes are more common. Often no cause is found. The key causes are:
Cervical cancer, ectropion or infection Trauma Atrophic vaginitis Polyps Endometrial cancer Vaginal cancer
Pelvic pain causes?
Urinary tract infection Dysmenorrhoea (painful periods) Irritable bowel syndrome (IBS) Ovarian cysts Endometriosis Pelvic inflammatory disease (infection) Ectopic pregnancy Appendicitis Mittelschmerz (cyclical pain during ovulation) Pelvic adhesions Ovarian torsion Inflammatory bowel disease (IBD)
Excessive, discoloured or foul-smelling discharge may indicate?
Excessive, discoloured or foul-smelling discharge may indicate:
Bacterial vaginosis Candidiasis (thrush) Chlamydia Gonorrhoea Trichomonas vaginalis Foreign body Cervical ectropion Polyps Malignancy Pregnancy Ovulation (cyclical) Hormonal contraception
What is pruritus vulvae?
causes?
Pruritus vulvae refers to itching of the vulva and vagina. There are a large number of causes:
Irritants such as soaps, detergents and barrier contraception Atrophic vaginitis Infections such as candidiasis (thrush) and pubic lice Skin conditions such as eczema Vulval malignancy Pregnancy-related vaginal discharge Urinary or faecal incontinence Stress
