Disorder of Pelvis & Ovaries; Menopause Flashcards
Episodic Chronic Pelvic Pain DDx
Dyspareunia
Midcycle pelvic pain - Mittelschmerz
Dysmenorrhea
Continuous Chronic Pelvic Pain DDx
Endometriosis (cyclic)
Adenomyosis
Chronic salpingitis (PD)
Adhesions
Loss of pelvic support
Fever or vomiting w/ abdominal pain indicate
Indicate an acute process
Also rebound tenderness, palpation, straight-leg raise
Straight-leg raise indicate
If it decreases pain = pelvic origin
If it increases pain = abdominal wall/myofascial origin
Pelvic Inflammatory Disease (PID)
Most cases PID are polymicrobial - Neisseria, Chlamydia or normal flora overgrowth
Single episode increased risk of ectopic pregnancy, infertility, tubo-ovarian abscess, chronic pelvic pain, perihepatitis
3 episodes PID - 50% have tubal infertility
PID Dx and Tx
Dx: Minimum criteria - uterine/adnexal tenderness or cervical motion tenderness
->38.8, mucopurulent discharge, ESR/CRP, positive gonorrhea/chlamydia
Tx: 1st line: Ceftriaxone + Azithro/Doxy; Cefoxitin + Probenecid + Doxy
-Consider adding Flagyl
Pt should improve in 72 hours, rescreen STI 4-6 wks to ensure resolve
Polycystic Ovarian Syndrome (PCOS)
Most common hormonal disorder of reproductive age
Often cause androgen excess & hirsutism in women
Dx: Rotterdam Criteria (2/3)- oligomenorrhea/anovulation, hyperandrogenism (acne & hirsutism), polycystic ovaries on US
Tx: Metformin, Clomiphene for pregnancy; lifestyle changes
-Decreases risk endometrial hyperplasia, cancer, breast cancer, DM sequella
Ovarian Cysts
Follicular cysts
Corpus luteum
Arise as a result of normal ovarian physiology
Follicular cyst: follicle fails to rupture, asx unless large or persists
-rupture results in acute, transient pelvic pain
Corpus Luteum: enlarged corpus luteum - produces progesterone
-dull LQ pain, hemorrhage of rupture causes pain
Benign Ovarian Tumors
More common than malignant in all ages
Chance of benign transformation into malignancy increases with age and therefore warrants surgical treatment
Malignant Neoplasm
Risk increases w/ age - commonly 5th-6th decade
BCRA1/2 gene has link
OCP use >5 yrs half the risk of ovarian cancer
Annual exam only proven effective screen - catch it late
Ovarian Torsion
Typically rotates around both infundibulopelvic & Utero ovarian ligaments w/ impedance of blood supply
Adnexal torsion = fallopian tube also twists
Often secondary to ovarian mass, R more common
Sx: acute, severe, unilateral pain w/ N/V - often comes on w/ change in position
Natural Menopause
Permanent cessation of menses
12 months w/ no menses w/o other cause
Don’t need FSH for Dx if they’re >45 yo
Represents depletion of ovarian follicles w/ low estrogen production, elevated FSH
Testosterone is still made
Premature Ovarian Insufficiency
Occurs <40 years old
Menopause Treatments for Hot Flashes
SSRI/SNRI - Venlafaxine, Paroxetine, Fluoxetine
Gabapentin - great for night sx
Zyrtec
Clonidine
Micronized Progesterone
Preferred to medroxyprogesterone
Lower risk of thromboembolism, stroke, elevated triglycerides
No increased risk of breast cancer or CHD
