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Womens health- obs&gynae > DUB > Flashcards

DUB Flashcards

1
Q

Medical Conditions that can cause DUB

A
  • PCOS: causes women to produce more sex hormones leading to an imbalance of oestrogen. making periods irregular
  • Endometriosis: Uterine lining growing outside uterus
  • Uterine Polyps: Small growths within uterus, growth of these polyps is heavily influenced by oestrogen.
  • Fibroids: small growths that occur within uterus, uterine lining, or uterine muscles. Oestrogen plays a part in their growth
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2
Q

When to refer patients with DUB

A

1) severe bleeding producing anemia with Hb levels of below 80 (120-180 g/l)
2) irregular bleeding in women in their 40’s and bleeding unresponsive to treatment

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3
Q

What is the main reason for DUB

A

Imbalance of sex hormones (oestrogen is involved)

Therefore it can affect girls during puberty and women during menopause.

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4
Q

Pathophysiology of DUB

A

Unknown - can occur in both ovulation and its absence

Oestrogen withdrawal can cause the symptoms

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5
Q

Treatment for DUB

A

Tranexamic acid + mefenamic acid

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6
Q

Investigations for DUB

A

Ultra sound scan or transvaginal scan

  • these are to exclude uterine fibroids, endometrial polyps and systemic disease
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7
Q

Most common side effect with DUB

A

Iron defficiency anemia

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8
Q

Drugs Causing DUB

A

Birth control pills- Oestrogen

Hormonal agents- oestrogen

warfarin (coumadin)- causes prolonged bleeding

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9
Q

What is Dysfunctional Uterine Bleeding

A

Common condition that affects nearly every woman.

Bleeding outside regular menstrual cycle

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10
Q

Symptoms of DUB

A
  • Most common pc = heavy menstrual bleeding.
  • many or large clots
  • bleeding for more than 7 days
  • spotting & intermenstrual bleeding
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11
Q

What is the most common presenting complaint for DUB

A

Heavy menstrual bleeding

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12
Q

What is cervicitis

A

the inflammation of the uterine cervix. affects over half of all women during their adult life

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13
Q

What symptoms do you get with cervicitis

A

Patients may not have symptoms at all and if they do they might include

  • Abnormal vaginal bleeding (usually after sex)
  • pain during intercouse
  • intermenstrual bleeding (or bloody vaginal discharge)
  • vaginal discharge
  • can get dysuria is urethra is inflamed too
  • can get abnormal yellow/green discharge based on the cause
  • PID (if spread to uterus, fallopian tube or ovaries) causing Abdominal pain & Fever.
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14
Q

What examinations are done when querying cervicitis

A 
Pelvic exam
bimanual and speculum are done to look for:
    - redness of the cervix
    - discharge from the cervix
    - swelling of the vaginal wall
    - swabs are taken for gonorrhea and chlamydia
    - smear test (HSV swab)
Pregnancy test 
biopsy
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15
Q

Treatments for Cervicitis

A

Treatment is dependent on the cause
No treatment if caused by allergies to female products

Gonorrhea- injection of ceftriaxone (500mg IM) + oral azithromycin (1mg)

Chlamydia- Oral antibiotics such as azithromycin, doxycycline, ofloxacin, levofloxacin

Trichomonas Vaginalis- Metronidazole

Genital herpes- antivirals such as acyclovir, valacyclovir, famciclovir (on the first outbreak of genital herpes give 10 days and recurrent outbreaks are treated in 3-5 days)

Cervicitis caused by trauma (from tampons) or an IUD is treated with appropriate antibiotics, associated inflammation will heal within a few days/weeks. It will help to avoid sex until symptoms improve and avoid further irritation to the cervix.

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16
Q

Preventing cervicitis

A
  • reduce the risk of STI’s by using a condom every time
  • ensure foreign objects like tampons are placed properly
  • avoid irritants, like douches and deodorant tampons
17
Q

Causes of cervicitis

A

Sexually transmitted infection (Gonorrhea, Trichomoniasis, Genital Herpes)
Trauma (from tampons)
Exposure to chemical irritants.
Hormonal imbalance (having low oestrogen or high progesterone may interfere with the body’s ability to maintain healthy cervical tissue.

18
Q

What is Premenstrual Syndrome

A

Physical and emotional symptoms that occur in one to two

Weeks before a woman’s period.

19
Q

What symptoms do you get with Premenstrual Syndrome

A
  • Depressed mood
  • Mood swings
  • Anxiety
  • Irritability
  • Loss of confidence
  • Bloating and breast pain
  • Behavioural symptoms
20
Q

How is Premenstrual Syndrome diagnosed

A

Symptoms of PMS recur regularly during the second half of the Menstrual cycle.

Absence of other conditions: depression, hypothyroidism, anaemia and IBS and endometriosis.
Mild: when no symptoms interfere with the women’s personal, social and professional life and possibly daily functioning.
Moderate: symptoms interfere with the women’s life.
Severe: When symptoms cause withdrawal from social and professional

21
Q

How is Premenstrual Syndrome managed

A

Mild PMS: lifestyle advice (advice on diet, regular exercise, smoking cessation, alcohol restriction, regular sleep and stress reduction)
Moderate PMS: Lifestyle & combined oral contraceptive pill
Severe: SSRI can be taken continually or just during the luteal phase of the cycle
NICE guidelines say to also consider CBT in severe cases.

-> Suggested SSRI doses are fluoxetine 20 mg a day, sertraline 50 mg to 100 mg a day, citalopram 20 mg a day, escitalopram 20 mg a day, or paroxetine 20 mg a day. for initial 3 months trial. which can be taken either continuously or just during the luteal phase of the menstrual cycle.

22
Q

Differential diagnosis for PMS

A 
Depression
anxiety and panic disorders
hypothyroidism 
anemia 
dysmenorrhoea (painful period- occurring just before period actually starts).
23
Q

what is Dysmenorrhoea

A

Excessive pain during the menstrual period.

24
Q

How many types of Dysmenorrhoea are there

A

2, primary and secondary
primary- No underlying pathology
secondary-Starts several years after painless periods due to underlying pathology

25
Q

Causes of primary Dysmenorrhoea

A

No underlying pathology
Starts 6-12 months after the first period (menarche).
Cause: excessive endometrial prostaglandin production is thought to be partially responsible.

26
Q

Treatment for primary Dysmenorrhoea

A

1st line: NSAID (ibuprofen, naproxen or mefenamic acid or paracetamol)
2nd line: Combined oral contraceptive.
Heat application

27
Q

Causes of secondary Dysmenorrhoea

A

Starts several years after painless periods due to underlying pathology
Pain starts 3-4 days before onset of period.
Causes: Endometriosis, adenymyosis (endometrium breaks through the muscle wall of the uterus), PID, IUD (Copper coils), Fibroids.

28
Q

Treatment for secondary Dysmenorrhoea

A

Refer to secondary care

29
Q

Red flags in Dysmenorrhoea

A

The following indicate a serious underlying pathology
Abnormal cervix on examination
Persistent intermenstrual bleeding
Palpable abdominal or pelvic mass on examination (that’s not uterine fibroids)

30
Q

What is Vaginitis

A

Vaginitis is an inflammation of the vagina that can result in discharge, itching and pain

31
Q

What causes Vaginitis

A

The cause is usually a change in the normal balance of vaginal bacteria or an infection. Reduced estrogen levels after menopause and some skin disorders can also cause vaginitis.
vaginitis is commonly caused by:
Bacterial vaginosis, which results from a change of the normal bacteria found in your vagina to overgrowth of other organisms
Thrush (yeast infections) which are usually caused by a naturally occurring fungus called Candida albicans
Trichomoniasis, which is caused by a parasite and is commonly transmitted by sexual intercourse
chlamydia
gonorrhoea
genital herpes

32
Q

How can you help improve vaginitis

A
  • keep your genital area clean and dry – take a warm bath rather than a hot one and use unperfumed soap to clean your genital area (the vagina cleans itself with natural secretions); dry yourself thoroughly.
  • avoid douching (spraying water inside your vagina) – it may make your vaginitis symptoms worse by removing the healthy bacteria that line the vagina and help keep it free from infection
  • don’t use feminine hygiene products – such as sprays, deodorants or powders pads instead of tampons
33
Q

Symptoms of vaginitis

A 
Change in color, odor or amount of discharge from your vagina
Vaginal itching or irritation
Pain during intercourse
Painful urination
Light vaginal bleeding or spotting
34
Q

Prenatal diagnosis/care - what is it

A

Patients will be offered screening tests during pregnancy that could affect the mother or her baby such as infectious diseases, downs syndrome or physical abnormalities.
The tests allow patients to make choices about further tests and care or treatment during the pregnancy or after the baby is born

35
Q

Limitations of Prenatal screening tests

A

some people will be told that they or their baby have a higher chance of having a health problem when they dont have the problem
others will be told their risk is low when they have the problem.
Basically theyre not accurate.

36
Q

What do Prenatal screening tests involve

A

Ultrasound scans may detect physical abnormalities, such as spina bifida.

Blood tests can show whether you have a higher chance of inherited disorders such as sickle cell anaemia and thalassaemia, and whether you have infections like HIV, hepatitis B or syphilis.

Blood tests combined with scans can help find the chance of chromosomal abnormalities such as Down’s, Edwards’ or Patau’s syndromes.

37
Q

Will a prenatal screening test give a definitive answer

A

Yes- for HIV, hepatitis B and syphilis are very accurate, and will tell for certain whether you have these infections.

No- Screening for Down’s, Edwards’ and Patau’s syndromes doesn’t say for certain whether your baby has the condition. It tells you if your baby has a lower or higher chance of having the condition.

38
Q

What screening tests are offered by the NHS

A

screening for infectious diseases (hepatitis B, HIV and syphilis)-as early as possible in pregnancy

screening for inherited conditions (sickle cell, thalassaemia and other haemoglobin disorders)-before 10 weeks

screening for Down’s, Edwards’ and Patau’s syndrome-11 to 14 weeks pregnant

screening for abnormalities (18 to 21 week scan)

39
Q

What is Menopause

A

Menopause is a biological stage when menstruation stops permanently due to the loss of ovarian follicular activity.

It occurs with the final menstrual period and is usually diagnosed clinically after 12 months of amenorrhoea.

In the UK, the mean age of menopause is 51 although this can vary between different ethnic groups.

Womens health- obs&gynae (1 decks)

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