Common Gynae Presentations - Abnormal Bleeds Flashcards
Presenting complaint
-key questions
WHEN?
- menstrual?
- intermenstrual?
- post coital
- post menopausal
Volume?
- how many pads/tampons do you get through
- spotting?
Gynecological systemic review
Pelvic pain
-SOCRATES
Discharge
- volume
- colour
- consistency
- smell
Vulva
- rashes
- itching
Other relevant systemic reviews
Systemic
-fever, fatigue, weight loss
GI
- change in bowel habit
- pain on defecation
GU
- urinary frequency
- urgency
- dysuria
Past medical history
- menstrual
- obstetric
- sexual
- contraceptive, cervical smear
- other medical history, medication
Menstrual
- length of cycle, menstruation
- regularity, frequency
- volume
- pain
- LMP
Obstetric
-past pregnancies
Sexual
- sexually active?
- how many sexual partners
- use of protection
- STIs in the past?
Contraceptive, cervical smear
Gynecological conditions, surgery, procedures?
- STIs, endometriosis, malignancy?
- abdo/pelvic surgery, Csection, hysterectomy
Migraine aura, VTE, breast cancer => estrogen medications CI
Family history
Hx of
- ovarian, endometrial, breast cancer?
- blood clots
Social history
Living
- other people
- dependents, carers
- ADLs
Occupation and impacts
Smoking, alcohol, recdrugs
Current BMI and diet
Possible differentials for amenorrhea/oligomenorrhea
- primary
- secondary
Primary amenorrhea
- Kallman syndrome
- Turner syndrome
- Androgen insensitivity syndrome
Secondary amenorrhea
- eating disorder
- stress
- PCOS
- POI
- hyperthyroid
- Cushing
Possible differentials for dysmenorrhea
PID
Endometriosis
Ovarian torsion
Hypothyroid
Kallman syndrome
- core features
- investigations
- management
Core features
ANOSMIA
-lack of breast dev, amenorrhea
Tanner staging - abdo, pelvic exam
Low GnRH, FSH, LH
Head MRI
HRT
Turner syndrome
- core features
- investigations
- management
Core features
- short stature, no growth spurt
- reduced sexual characteristics
- wide neck, broad chest
Height chart, compare to parents
FSH, LH, O, P, T - hypergonadotrophic hypogonadism
Bone scan - bone age
Karyotyping - XO
GH, HRT - increase height, bone growth, puberty
MDT support for other associated conditions
Androgen insensitivity syndrome
- core features
- investigations
- management
Core features
- female/ambiguous ext genitalia
- primary amenorrhea
- reduced secondary sexual characteristics
Abdo, pelvic exam
High T
US - confirm absence of womb, ovaries
Karyotyping, genetic testing
Hormone therapy
CBT, counselling
Surgery
Eating disorder
- risk factors
- core features
- investigations
- management
Risk factors
-Hx anxiety, depression
Core features
- preoccupation with weight, body image, exercise, food
- BED, purging, use of medications
- fatigue, weakness, poor concentration
Investigations
BMI, vital signs
ECG
FBC, U&E, LFT
FSH, LH, O, P
Thyroid function - hyperthyroid
Referral to mental health team
Dietician and psychiatry support
PCOS
- risk factors
- core features
- investigations
- management
Risk factors
- FHx
- DM
Core features
- heavy, painful, irregular periods
- weight gain
- acne, hirsutism
- infertillity
Abdo, pelvic exam
Cap glucose, urinedip, pregnancy test
Vital signs - CVD
FSH, LH, O, P, T - high T
Thyroid, AntiTPO, TSH - rule out hypothyroid
Cushing - urine cortisol
HbA1c, lipids
US
Weight loss advice
CVD optimisation
COCP
POI/menopause
- risk factors
- core features
- investigations
- management
Risk factors
-age, FHx
Core features
- hot flushes, night sweats
- mood swings
- vaginal dryness, low libido
- joint pain
- irregular, heavy bleeds
Investigations
Abdo, pelvic exam
FSH, LH, O, P - high FSH, LH, low O, P
Thyroid screen - rule out hypo
Management
- HRT (no P if no uterus)
- vaginal lubes
- CBT, SSRI
- weight bearing exercise
- cool clothes, bedroom
Hyperthyroid
- risk factors
- core features
- investigations
- management
Risk factors
-FHx of Ai cond
Core features
- irregular/no periods
- hot, anxious, tremor, weight loss, diarrhea
Investigations
Abdo, pelvic, thyroid exam
Pregnancy test
FBC
TSH, T3,4, TSH AB
Carbimazole+propanolol
Surgical/radioiodine removal
Levothyroxine
