Differential Diagnosis in Gynaecology Flashcards
What are the most common presenting complaints in gynaecology?
- Amenorrhoea
- Irregular menstruation
- Intermenstrual bleeding
- Dysmenorrhoea
- Menorrhagia
- Postcoital Bleeding
- Pelvic Pain
- Vaginal discharge
- Pruritis Vulvae
What is Amenorrhoea?
- amenorrhoea refers to lack of menstrual periods
- can be divided into primary and secondary
What is primary amenorrhoea?
-primary amenorrhoea is when the patient has never developed periods
What is secondary amenorrhoea?
-secondary amenorrhoea is when the patient previously had periods that subsequently stopped
What are causes of primary amenorrhoea?
- abnormal functioning of the hypothalamus/pituitary gland –> hypogonadotropic hypogonadism
- abnormal functioning of gonads –> hyergonadotropic hypogonadism
- imperforate hymen or other structural pathology
What are the causes of secondary amenorrhoea?
- pregnancy (most common)
- menopause
- physiological stress due to exercise/low weight/chronic disease/psychosocial
- polycystic ovarian syndrome
- medications such as hormonal contraceptives
- premature ovarian insufficiency (menopause before 40)
- hyper/hypothyroidsm
- prolactinoma
- cushing’s syndrome
What does irregular menstruation refer to?
- abnormal uterine bleeding –> irregularities in menstrual cycle affecting frequency, duration, cycle length and volume of menses.
- irregular menstruation indicates anovulation (lack of ovulation) or irregular ovulation
- it occurs due to disrupted menstrual hormone levels or ovarian pathology
What are the causes of irregular menstruation?
- extremes of reproductive ages (early periods of perimenopause)
- POS
- physiological stress due to exercise/low weight/chronic disease/psychosocial
- medications, especially progesterone only contraception, antidepressants and antipsychotics
- hormonal imbalances such as thyroid abnormalities, cushings syndrome and high prolactin
What does intermenstrual bleeding refer to?
- IMB refers to any bleeding that occurs between menstrual periods
- is a red flag that makes you consider cervical and other cancers, though other causes more common
What are causes of intermenstrual bleeding?
- hormonal contraception
- cervical ectropion, polyps or cancer
- STI
- endometrial polyps or cancer
- vaginal pathology, including cancers
- pregnancy
- ovulation can cause spotting in some women
- medication such as SSRIs and anticoags
What does dysmenorrhoea refer to?
-dysmenorrhoea describes painful periods
What are causes of dysmenorrhoea?
-primary dysmenorrhoea (no underlying pathology)
-endometriosis or adenomyosis
-fibroids
-pelvic inflammatory disease
-copper coil
cervical or ovarian cancer
What does menorrhagia refer to?
-menorrhagia refers to heavy menstrual bleeding
What can cause menorrhagia?
- Dysfunctional uterine bleeding (no identifiable cause)
- fibroids
- endometriosis and adenomyosis
- PID (infection)
- Contraceptives –> especially copper coil
- anticoags
- bleeding disorders eg VWD
- endocrine disorders (diabetes/hypothyroidsm)
- connective tissue disorders
- endometrial hyperplasia or cance
- polycystic ovarian syndrome
What does postcoital bleeding refer to?
- PCB refers to bleeding after sexual intercourse
- is a red flag so consider cervical and other cancers
- often no cause is found
