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Reproduction > Contraception, STIs and termination > Flashcards

Contraception, STIs and termination Flashcards

1
Q

What is law for people under 16 having sex?

A
  • a young child under 13 cannot consent to any sexual activity
  • if you are told this by a patient, you must inform social services
  • an older child (i.e. 13-15) cannot legally have intercourse or oral sex with anyone, but consensual touching, kissing and sexual conversations between older children are generally considered to be part of growing up
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2
Q

Describe the fraser guidelines

A
  • he/she has a sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
  • he / she cannot be persuaded to tell her parents or to allow the doctor to tell them
  • he / she is very likely to begin or continue having sexual intercourse with or without contraceptive treatment
  • his / her physical or mental health is likely to suffer unless he / she received the advice or treatment
  • the advice or treatment is in the young person best interests
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3
Q

How can contraception prevent ovulation?

A
  • main mechanism of most hormonal methods (except hormone coil and traditional POPs)
  • works by suppressing FSH and LH (negative feedback hypothalamus / pituitary)
  • emergency hormonal contraception only temporarily delays (rather than suppresses) ovulation
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4
Q

How can contraception prevent fertilisation?

A
  • condoms, diaphragm + spermicide, female and male sterilisation, intrauterine devices, hormonal methods (cervical mucous effect)
  • works by creating a mechanical or surgical barrier or by direct toxicity
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5
Q

How can contraception prevent implantation?

A
  • hormonal contraceptive methods
  • intrauterine devices only as secondary mechanism of action but more relevant copper coil when used as emergency contraception
  • works by creating a hostile endometrium or direct toxicity
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6
Q

Name examples of hormonal methods of contraception

A
  • combine pill, ring and patch
  • minipill
  • DMPA injection and contraceptive implant (nexplanon)
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7
Q

Name examples of barrier methods of contraception

A
  • male and female condoms

- diaphragm or cervical cap (plus spermicide)

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8
Q

Name examples of intrauterine methods of contraception

A
  • intrauterine device (copper coil, IUD)

- intrauterine system (hormone coil IUS)

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9
Q

Name examples of permanent methods of contraception

A
  • female sterilisation

- male sterilisation (vasectomy)

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10
Q

Name examples of fertility awareness methods of contraception

A
  • basal temperature
  • calendar
  • cervical secretion monitoring methods
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11
Q

Name examples of emergency contraception

A
  • emergency IUD

- emergency hormonal contraception (ulpristal acetate (ella one) or levonogestrel)

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12
Q

Describe the non contraceptive benefits of hormonal contraception

A

Decreased;

  • period pain
  • heavy menstrual bleeding
  • irregular PV bleeding
  • ovulation pain
  • PMS
  • cyclical breast tenderness
  • ovarian cysts
  • endometriosis
  • ovarian cancer
  • acne or hirsutism
  • perimenopausal symptoms
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13
Q

What might be the only reliable suitable contraception method for women after breast cancer?

A

Intrauterine device (copper)

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14
Q

What is the most effective of all contraceptive methods?

A

Nexplanon

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15
Q

What is the action of combined hormonal contracpetion?

A

Stops ovulation

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16
Q

How can the COC be taken?

A
  • starts in first 5 days of period
  • or at any time in cycle when reasonably sure not pregnant plus condoms 7 days
  • take daily for 21 days followed by a 7 day break
  • tricycling; three months then stop for 7 days
  • continuous use; bleed for 4 days or more stop for 4 days and start again
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17
Q

What factors may affect the effectiveness of CHC?

A
  • impaired absorption; GI conditions
  • increased metabolism; liver enzyme induction, drug interaction
  • forgetting
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18
Q

What are some risks of using CHC?

A
  • venous thrombosis
  • arterial thrombosis
  • adverse effects on some cancers
  • systemic hypertension; BP checked at 3 months then annually
  • migraine with aura increases the risk of ischaemic stroke so CHC use in individuals with migraine with aura is contraindicated
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19
Q

What is aura associated with migraine?

A
  • a change occuring 5-20 minutes before the onset of headache
  • may be visual, typical scotoma
  • altered sensation
  • smell or taste
  • hemiparesis
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20
Q

Name side effects of CHC

A
  • nausea
  • bleeding
  • spots
  • breast tenderness
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21
Q

What is the mode of action of desogestrel POP?

A

Inhibits ovulation

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22
Q

How do you take / start progestogen only methods?

A
  • POP, subdermal implant, DMPA
  • day 1-5 of period
  • or anytime if reasonably certain not pregnant plus condoms for 7 (2 for POP) days
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23
Q

Name side effects of the POP

A
  • nausea
  • irregular bleeding common
  • spots
  • headaches
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24
Q

Describe the guidance for a missed POP

A
  • take roughly at the same time everyday

- more than 12 hours late it wont work for two days

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25
Q

What is the mode of action of the depo provera or syana press injections?

A
  • lowers estradiol

- supresses FSH

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26
Q

Name side effects of depo rprovera and syana press

A
  • nausea
  • bleeding
  • weight gain
  • spots
  • headaches
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27
Q

How are diaphragms used?

A
  • must be held in place for 6 hours after sex

- washed out with soapy water afterwards

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28
Q

What legal documents are important in termination of pregnancy?

A
  • certified on HSA1 form (certificate A), 2 doctors sign
  • two emergency clauses (F and G) one doctor signs (HSA2)
  • all abortions reported to CMO via abortion notification form (HSA4)
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29
Q

Clause C allows termination of pregnancy up to when?

A
  • 23+6 weeks
  • the pregnancy has not exceeded its 24th week and the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated , of injury to the physical or mental health of the pregnant woman
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30
Q

Clause E allows termination of pregnancy up to when?

A
  • no gestational limit
  • there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
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31
Q

What are the two methods of abortion?

A

Medical or surgical

  • depends on;
  • gestation
  • patient preference
  • regional availability
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32
Q

How is gestation assessed before abortion?

A
  • clinically; estimated by LMP +/- date of +ve UPT, palpable uterus (>12 weeks)
  • ultrasound; abdominal or transvaginal (<6 weeks), frequently used for all pre-covid, now via risk assessment (symptoms or risk factors for ectopic, uncertainty about dates)
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33
Q

What two drugs are used as part of a medical abortion?

A
  • mifepristone 200mg PO
  • misoprostol 800mcg PV/SL (24-48 hours later)
  • misoprostol can be taken sublingually or vaginally
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34
Q

Describe how medical abortion is undertaken in <12 weeks gestation

A
  • can self administer mifepristone and misoprostol at home
  • further misoprostol (400mcg) if not bleeding within 4 hours and less than 10 weeks
  • 10-11+6 weeks, 3 further doses of misoprostol (400mcg) provided
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35
Q

Describe how medical abortion is undertaken in >12 weeks gestation

A
  • inpatient procedure

- repeated doses of PV misoprostol; 800mcg PV then 400mcg 3 hourly PV/PO/SL (up to 4)

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36
Q

Medical temination of pregnancy up to 21+6 weeks is undertaken how?

A
  • transabdominal ultrasound to visualise the heart of the foetus
  • injection of potassium chloride to stop foetal heartbeat before proceeding with fetocide
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37
Q

What type of drug is mifepristone?

A

Anti-progesteron

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38
Q

What type of drug is misoprostol?

A
  • prostaglandin

- provokes uterus to expel pregnancy

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39
Q

What is included in a medical abortion at home pack from the pharmacy?

A
  • mifepristone 200mg
  • misoprostol 800mg (PV or SL) + additional dose 400mcg
  • anti-emetic
  • analgesia; dihydrocodeine, paracetamol and ibuprofen
  • antibiotics; 7 days doxycycline
  • contraception (6 months POP)
  • patient information leaflet and contact info
  • low sensitivity pregnancy test
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40
Q

Describe the surgical abortion procedure

A
  • removal of pregnancy via surgical procedure (under anaesthesia)
  • cervical priming via misoprostol or osmotic dilators
  • <14 weeks; electric vacuum aspiration, manual vacuum aspiration (up to 10weeks)
  • > 14 weeks; dilatation and evacuation
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41
Q

Name complications of abortion

A
  • haemorrhage +/- blood transfusion
  • failed / incomplete abortion
  • infection
  • uterine perforation (surgical only)
  • cervical trauma (surgical only)
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42
Q

When would VTE prophylaxis be considered at time of abortion?

A
  • if high risk, consider LMWH for 1 week after abortion

- if very high risk, considering starting LMWH before abortion +/- continuing for longer e.g. 6 weeks

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43
Q

Describe what is asked during a pre-abortion consultation

A
  • confirm ID and check alone / safe
  • feelings about pregnancy
  • gynae / obstetric history
  • medical, drug and social history
  • explore safeguarding issue e.g. under 16s
  • discussion of available options
  • risk of procedure and consent
  • STI risk assessment +/- testing
  • contraception
  • further arrangements and follow up
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44
Q

What are the partner notification periods for different infections?

A
  • chlamydia; male urethral = 4 weeks, any other = 6 weeks
  • gonorrhoea; male urethral = 2 weeks, any other infection = 3 weeks
  • non-specific urethritis; 4 weeks
  • trichomonas vaginalis; 4 week
  • epididymitis; 6 months unless chlamydia/ gonorrhoea
  • PID; 6 months unless chlamydia / gonorrhoea
  • HIV; 4 weeks before negative test; or before most likely time of infection
  • primary syphilis = 90 days
  • secondary syphilis = 2 years
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45
Q

What is the eligibility criteria for PrEP in scotland?

A
  • MSM condomless anal sex with 2+ sexual partners in last year and likely in next 3 months
  • rectal bacterial STI in last year
  • partner of someone with HIV who does not have a suppressed viral load
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46
Q

Post exposure prophylaxis following sexual exposure is available for what infectons?

A
  • hepatitis B; HBV vaccine up to 7 days, immunoglobulin for vaccine non-responders
  • HIV; 3 antiretrovirals, start within 72 hours, 28 days total
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47
Q

How can gonorrhoea and chlamydia be sampled?

A
  • vulvovaginal swab (VVS), pre speculum
  • urine; first void
  • throat swab
  • rectal swab
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48
Q

What tests are done with samples from symptomatic vaginal or urethral discharge?

A
  • cervical microscopy (gram stain)
  • vaginal microscopy (gram stain and wet prep) and pH (narrow range)
  • urethral microscopy (gram stain)
  • amies swab (HVS culture and sensitivity) if; recurrent / persistent discharge, vaginitis of unknown cause, pregnant, postpartum, post gynae surgery / instrumentation or has symptoms or signs of PID
49
Q

What is the treatment of chlamydia?

A
  • doxycycline 100mg BD x 1 week
  • azithromycin 1G stat followed by 500mg daily for 2 days
  • for PID; ceftriaxone 1g IM, doxycycline 100mg BD x 2 weeks and metronidazole 400mg BD x 2 weeks
50
Q

What are the 3 different serovars of chlamydia and what do they cause?

A
  • serovars A-B; endemic trachoma, ocular infections, mostly developing countries
  • serovars D-K; urethritis, epidiymo-orchitis, PID, neonatal pneumonia, neonatal conjunctivitis
  • serovars L1-L3; lymphogranuloma venereum, genital ulcerative disease / proctitis
51
Q

Describe the presentation of chlamydia

A
  • urethral discharge (milky)
  • irregular bleeding
  • abdominal pain
  • dysuria
  • urethritis
  • cervicitis
  • epidiymo-orchitis
  • proctitis
52
Q

Name complications of chlamydia

A
  • PID
  • reactive arthritis
  • conjunctivitis
  • fitz hugh curtis
  • ectopic pregnancy
53
Q

What is LGV infection?

A
  • serovars of chlamydia
  • diagnosed mainly in MSM
  • rectal pain, discharge and bleeding
54
Q

What is the treatment of gonorrhoea?

A
  • first line; ceftriaxone 1g IM
  • second line; cefixime 400mg oral plus azithromycin 2g (only if IM injection is contraindicated or refused by patient)
  • test of cure in all patients
55
Q

What is gonorrhoea?

A
  • gram negative intracellular diplococcus

- primary sites of infection are the mucous membranes of the urethra, endocervix, rectum and pharynx

56
Q

Name complications of gonorrhoea

A 
Lower genital tract 
- bartholinitis 
- tysonitis 
- periurethral abscess 
- rectal abscess 
- epidiymitis 
- urethral stricture 
Upper genital tract
- endometritis 
- PID 
- hydrosalpinx 
- infertility 
- ectopic pregnancy 
- prostatitis
57
Q

What is mycoplasma genitalium?

A
  • emerging sexually transmitted pathogen
  • associated with non-gonococcal urethritis
  • asymptomatic carriage
  • NAAT test
  • high levels of macrolide resistance
58
Q

Describe the management of genital ulcers

A
  • give oral antiviral treatment (aciclovir 400mg TDS for 5/7)
  • consider topical lidocaine 5% ointment if very painful
  • saline bathing
  • analgesia
59
Q

Name symptoms of genital herpes (primary infection)

A
  • blistering and ulceration of the external genitalia
  • pain
  • external dysuria
  • vaginal or urethral discharge
  • local lymphadenopathy
  • fever and myalgia (prodrome)
60
Q

How is syphilis transmitted?

A
  • sex (acquired)

- trans-placental / during birth (congenital)

61
Q

What are the different stages of syphilis?

A 
Early infection 
- primary 
- secondary 
- early latent (less than 2 years)  
Late non-infectious 
- late latent (more than 2 years)
- tertiary
62
Q

Describe primary syphilis

A
  • incubation period is from 9-90 days (mean of 21 days)
  • lesion is traditionally known as a primary chancre (painless)
  • lesions appear at the site of inoculation
  • sites are genital (90%) or extra genital (10%)
  • non-tender local lymphadenopathy
63
Q

Describe secondary syphilis

A
  • incubation period is 6 weeks to 6 months
  • skin (macular, follicular or pustular rash on palms + soles)
  • lesions of mucous membranes
  • generalised lymphadenopathy, fever, sore throat
  • malaise
  • anterior uveitis
  • cranial nerve lesions
  • condylomata lata (most highly infectious lesion in syphilis, exudes a serum teeming with treponemes)
64
Q

Describe the diagnosis of syphilis

A
  • demonstration of treponema pallidum; dark field microscopy, PCR
  • serological testing; detects antibody to pathogenic treponemes
65
Q

Describe the treatment of syphilis

A

Early syphilis;
- 2.4 MU benzathine penicillin (stat)
Late syphilis;
- 2.4 MU benzathine penicillin weekly x 3 weeks

66
Q

Describe the follow up of syphilis

A
  • follow up serologically
  • until RPR is negative or serofast
  • titres should decrease fourfold by 3-6 months in early syphilis
  • concern re serological relapse / reinfection if titres increase by fourfold
67
Q

Name differentials of genital lumps

A
  • skin tags
  • molluscum contagiosum
  • spots of fordyce
  • pearly penile papules
68
Q

Name high risk types of HPV

A
  • 16
  • 18
  • 31
  • 33
  • 35
  • 39
  • 45
  • 51
  • 52
  • 56
  • 59
  • 68
69
Q

HPV can be associated with what symptoms?

A
  • latent infection
  • anogenital warts
  • palmar and plantar warts
  • cellular dysplasia / intraepithelial neoplasia
70
Q

Describe HPV treatment

A
  • podophyllotoxin (condyline); cytotoxic, no licensed for extra genital warts but widely used, not licensed in pregnancy
  • imiquimod; immune modifier, can be used on all anogenital warts, not licensed in pregnancy
  • cryotherapy; cytolytic can require repeat treatments
  • electrocautery
71
Q

What is HIV?

A
  • RNA retrovirus
  • HIV-1 and HIV-2
  • HIV-1 group M responsible for global epidemic
  • sub-types show geographical distribution
72
Q

What does retrovirus mean?

A

Uses enzyme reverse transcriptase to make copies of itself

73
Q

How often does HIV replicate?

A
  • rapid replication in very early and very late infection

- new generation every 6-12 hours

74
Q

Describe how HIV replicated

A
  • two strands of single stranded RNA in an envelope of surface antigens (GP 120 and GP41)
  • surface antigens helps to bind to CD4 receptor cells
  • complex forms between GP120 and GP41 and CD4 receptor and co-receptor, these bind and allows the envelope to fuse with the CD4 membrane and enter the cell
  • viral DNA is then incorporated into the hosts genome
  • virus ‘buds’ off and then matures
  • it can then go out and infect other cells
75
Q

HIV usually infects which tissues / cells?

A
  • infection of mucosal CD4+ cell (langerhans and dendritic cells)
  • transport to regional lymph nodes
  • disseminated to gut associated lymphoid tissue which is quickly depleted
  • infection established within 3 days of entry
76
Q

What is CD4?

A

A glycoprotein found on the surface of a range of cells including;

  • t help lymphocytes
  • dendritic cells
  • macrophages
  • microglial cells
77
Q

What do CD4+ Th lymphocytes do?

A
  • essential for induction of adaptive immune response
  • recognition of MHC2 antigen presenting cell
  • activation of B cells
  • activation of cytotoxic T cells (CD8+)
  • cytokine release
  • deficiency in downstream immune reaction if no CD4 cells
78
Q

What effect does HIV infection have on the immune response?

A
  • reduced circulating CD4+ cells
  • reduced proliferation of CD4+ cells
  • reduction CD8+ (cytotoxic) T cell activation; dysregulated expression of cytokines
  • reduction in antibody class switching; reduced affinity of antibdoies produced
  • chronic immune activation
  • susceptibility to; viral infections, fungal infections, mycobacterial infections, infection induced cancers
79
Q

What is the normal CD4+Th cell parameters, and when is risk at its highest of opportunistic infections?

A
  • normal; 500-1600 cell/mm3

- highest risk; <200 cells/mm3

80
Q

When is the average onset of primary HIV infection?

A

Average 2-4 weeks after infection

81
Q

Name symptoms of primary HIV infection

A
  • fever
  • rash (maculopapular) commonly on upper body
  • myalgia
  • pharyngitis
  • headache / aseptic meningitis (if microglial cells are affected)
  • very high risk of transmission
  • these symptoms will resolve and move onto asymptomatic HIV infection
82
Q

What occurs during asymptomatic HIV infection?

A
  • ongoing viral replication
  • ongoing CD4 count depletion
  • ongoing immune activation
  • risk of onward transmission if remains undiagnosed
83
Q

Define opportunistic infection

A

An infection caused by a pathogen that does not normally produce disease in a healthy individual. It uses the ‘opportunity’ afforded by a weakened immune system to cause disease

84
Q

Pneunocystis pneumonia is caused by what organism and what are the signs and symptoms?

A
  • caused by pneumocystis jiroveci
  • insidious onset of SOB and dry cough
  • signs; exercise oxygen desaturation
  • chest may be normal on examination
85
Q

What can be seen on x-ray and how is pneumocystic pneumonia diagnosed?

A
  • CXR: may be normal, interstitial infiltrates, reticulonodular markings
  • diagnosis; BAL and immunofluorescence +/- PCR
86
Q

What is the treatment of pneumocystic pneumonia?

A
  • treatment; high dose co-trimoxazole (+/- steroid)

- prophylaxis; low dose co-trimoxazole for anyone with a reduced CD4 count <200

87
Q

What causes cerebral toxoplasmosis?

A
  • toxoplasma gondii

- CD4 threshold of <150

88
Q

Describe the presentation of cerebral toxoplasmosis

A
  • headache
  • fever
  • focal neurology
  • seizures
  • reduced consciousness
  • raised ICP
  • reactivation of latent infection; multiple cerebral abscess, chorioretinitis
89
Q

What causes cytomegalovirus?

A
  • CMV

- CD4 threshold; <50

90
Q

Describe the presentation of cytomegalovirus

A
  • reduced visual acuity
  • floaters
  • abdominal pain
  • diarrhoea
  • PR bleeding
  • reactivation of latent infection; retinitis, colitis, oesophagitis
91
Q

HIV associated neurocognitive impairment is caused by which strain of HIV and how does it present?

A
  • HIV-1
  • CD4 threshold; increased incidence with decreased CD4
  • reduced short term memory
  • +/- motor dysfunction
92
Q

What causes progressive multifocal leukoencephalopathy (PML) and how does it present?

A
  • JC virus (reactivation
  • CD4 threshold; <100
  • rapidly progressing
  • focal neurology
  • confusion
  • personality change
  • demyelination
93
Q

What organism causes kaposis sarcoma and what is it?

A
  • human herpes virus 8
  • vascular tumour
  • CD4 threshold; any increased incidence with increased immunosuppression
94
Q

Describe the presentation and treatment of kaposis sarcoma

A 
Presentation;
- cutaneous 
- mucosal 
- visceral; pulmonary, GI 
Treatment;
- anti-retrovirals 
- local therapies 
- systemic chemotherapy
95
Q

What organism causes non-hodgkins lymphoma

A
  • EBV

- CD4 threshold; increased incidence with increased immunosuppression

96
Q

What is the presentation and treatment of non-hodgkins lymphoma?

A
  • more advanced
  • B symptoms
  • bone marrow involvement
  • extranodal disease
  • increased CNS involvement
  • diagnosis and treatment is as for HIV-ve individuals
97
Q

Non-AIDS symptomatic HIV can present with what conditions?

A
  • mucosal candidiasis
  • seborrhoeic dermatitis
  • diarrhoea
  • fatigue
  • worsening psoriasis
  • lymphadenopathy
  • parotitis
  • epidemiologically linked conditions; STIs, hepatitis B, hepatitis C
98
Q

How can HIV be transmitted?

A
  • sexual transmission (79% of new infection in UK)
  • parenteral transmission; injection drug use, infected blood products, iatrogenic
  • mother to child; in utero/transplacental, delivery, breast feeding
99
Q

High risk countries for HIV include where?

A
  • sub saharan Africa
  • Carribean
  • South East Asia
100
Q

Who should be tested for HIV?

A
  • universal testing in high prevalence areas
  • opt-out testing in certain clinical settings
  • screening of high risk groups
  • testing in the presence of ‘clinical indicators’
101
Q

In what services is opt-out HIV testing offered?

A
  • termination of pregnancy services
  • sexual health services
  • addiction and substance misuse services
  • antenatal services
  • assisted conception services
102
Q

Which groups of people are at high risk of HIV infection so are offered screening?

A
  • MSM
  • female partners of MSM
  • Black Africans
  • prisoners
  • trans women
  • people who or have injected drugs
  • partners of people living with HIV
  • adults from endemic areas
  • children from endemic areas
  • sexual partners from endemic areas
103
Q

Which markers of HIV are used by labs to detect infection?

A
  • RNA (viral genome)

- capsule protein (p24)

104
Q

What is the first marker of HIV to become positive?

A
  • viral RNA
  • then P24
  • then antibody (this can take three months before detectable in blood)
105
Q

For how long may an HIV test be negative even if infection is present?

A

Up to 45 days if 4th generation testing used

106
Q

Name different targets for anti-retroviral drugs

A
  • reverse transcriptase
  • integrase
  • protease
  • entry; fusion, CCR5 receptor
  • capsid
  • monoclonal antibodies
  • maturation
107
Q

What is the purpose of highly active anti-retroviral therapy?

A
  • reduce viral load to undetectable levels
  • restore immunocompetence
  • reduce morbidity and mortality
  • prevent onward transmission
108
Q

How is drug resistance prevented?

A

Adherence

109
Q

Describe the HAART toxicity side effects

A
  • GI side effects (protease inhibitors)
  • skin; rash, hypersensitivity, stevens johnson (abacavir, nevirapine)
  • CNS side effects; mood, psychosis (efavirenc, dolutegravir)
  • renal toxicity; proximal renal tubulopathies, nephrolithiasis (tenofovir, disoproxil, atazanavir)
  • bone; osteomalacia (tenofovir, dispoproxil)
  • CVS; increased MI risk (abacavir, lopinavir, maraviroc)
  • haematology; anaemia (zidovudine)
110
Q

What drugs are used for PrEP?

A
  • tenofovir

- emtricitabine

111
Q

What dosing schedules are used in PrEP?

A
  • daily

- on-demand

112
Q

When is post-exposure prophylaxis taken and what drugs are used?

A
  • start within 72 hours of high risk exposure; sexual or occupational
  • combination ART taken for 4 weeks; tenofovir / emtricitabine, raltegravir
113
Q

How is HIV prevented from mother to child transmission?

A
  • HAART during pregnancy
  • vaginal delivery undetected viral load
  • caesarean section if detected viral load
  • 2-4/52 PEP for neonate
  • exclusive formula feeding
114
Q

What is PMS?

A
  • premenstrual syndrome

- any complex of symptoms experienced by some women in the days immediately before menstruation

115
Q

When must symptoms be present for a diagnosis of PMS?

A

Must be present in luteal phase, abate during menstruation followed by a symptom free week

116
Q

What is the most common oestrogen?

A

Estradiol e2

117
Q

PMS is thought to be due to what?

A
  • Sensitivity to progesterone
  • serotonin receptors
  • GABA levels
  • not well understood
118
Q

Describe diagnosis of PMS

A
  • record symptoms prospectively using a symptom diary

- can use GnRH analogues to help if diagnosis from diary not conclusive

119
Q

Describe management of PMS

A
  • primary care generally until failure of treatment
  • simple measures e.g. COCs, vitamin B6, SSRIs
  • GnRH inhibitor / analogue; e.g. danazol
  • spironolactone
  • surgical managment

Reproduction (10 decks)

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