Differential Diagnosis in Gynaecology Flashcards
What is primary amenorrhoea?
When patient has never developed periods
What is secondary amenorrhoea?
When patient previously had periods that have subsequently stopped
List 3 causes of primary amenorrhoea.
- Abnormal functioning of the hypothalamus or pituitary gland
- Abnormal functioning of gonads
- Imperforate hymen or other structural pathology
What is hypogonadotropic hypogonadism?
Abnormal functioning of the hypothalamus or pituitary gland
What is hypergonadotropic hypogonadism?
Abnormal functioning of gonads
List 9 causes of secondary amenorrhoea.
- Pregnancy
- Menopause
- Physiological stress due to excessive exercise, low body weight, chronic disease or psychosocial factors
- Polycystic ovarian syndrome
- Medications (e.g. hormonal contraceptives)
- Premature ovarian insufficiency (menopause before 40)
- Thyroid hormone abnormalities (hyper or hypothyroid)
- Excessive prolactin from a prolactinoma
- Cushing’s syndrome
What is the most common cause of secondary amenorrhoea?
Pregnancy
What is anovulation?
A lack of ovulation
What is irregular menstruation/ abnormal uterine bleeding?
Irregularities in the menstrual cycle, affecting frequency, duration, regularity of the cycle length and the volume of menses.
List 5 causes of irregular menstruation.
- Extremes of reproductive age (early periods or perimenopause)
- Polycystic ovarian syndrome
- Physiological stress (excessive exercise, low body weight, chronic disease and psychosocial factors)
- Medications, especially progesterone only contraception, antidepressants, antipsychotics
- Hormonal imbalances such as thyroid abnormalities, Cushing’s syndrome, high prolactin
What is intermenstrual bleeding (IMB)?
Any bleeding that occurs between menstrual periods.
What is more worrying: irregular menstruation or intermenstrual bleeding?
Intermenstrual bleeding - is a red flag for cervical and other cancers.
What can cause intermenstrual bleeding?
- Hormonal contraception
- Cervical ectropion, polyps or cancer
- STIs
- Endometrial polyps or cancer
- Vaginal pathology (incl. cancers)
- Pregnancy
- Ovulation can cause spotting
- Medications e.g. SSRIs and anticoagulants
List 7 causes of dysmenorrhoea.
- Primary dysmenorrhoea (no underlying pathology)
- Endometriosis
- Adenomyosis
- Fibroids
- Pelvic inflammatory disease
- Copper coil
- Cervical or ovarian cancer
List 12 causes of menorrhagia.
- Dysfunctional uterine bleeding (no identifiable cause)
- Extremes of reproductive age
- Fibroids
- Endometriosis and adenomyosis
- Pelvic inflammatory disease
- Contraceptives (esp. 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
What are the key causes of postcoital bleeding?
- Cervical cancer, ectropion or infection
- Trauma
- Atrophic vaginitis
- Polyps
- Endometrial cancer
- Vaginal cancer
What are potential causes of pelvic pain?
- UTI
- Dysmenorrhoea
- IBS
- Ovarian cysts
- Endometriosis
- PID
- Ectopic pregnancy
- Appendicitis
- Mittelschmerz (cyclical pain during ovulation)
- Pelvic adhesions
- Ovarian torsion
- IBD
What are 12 potential causes of vaginal discharge?
- Bacterial vaginosis
- Candidiasis (thrush)
- Chlamydia
- Gonorrhoea
- Trichomonas vaginalis
- Foreign body
- Cervical ectropion
- Polyps
- Malignancy
- Pregnancy
- Ovulation (cyclical)
- Hormonal contraception
What term refers to ‘itching of the vulva and vagina’?
Pruritis vulvae
What can cause pruritis vulvae (8)?
- Irritants (soaps, detergents, barrier contraception)
- Atrophic vaginitis
- Infections (candidiasis + pubic lice)
- Skin conditions e.g. eczema
- Vulval malignancy
- Pregnancy-related vaginal discharge
- Urinary or faecal incontinence
- Stress
