FEMALE HEALTH Flashcards
chronic pelvic pain, dysmenorrhoea, deep dyspareunia, subfertility and urinary symptoms, dyschezia
endometriosis
Investigation for endometriosis?
Laproscopy
management of endometriosis?
- NSAIDS/paracetamol
2. COCP/progestogens e.g. medroxyprogesterone
dysmenorrhoea, menorrhagia and an enlarged, boggy uterus
adenomyosis
management of adenomyosis?
GnRH analogues + hysterectomy
more common in Afro-Carribean
can be asymptomatic
otherwise, menorrhagia, lower abdo pain usually linked to menstruation, bloating, urinary symptoms, subfertility
uterine fibroids/leimyoma
Investigation for uterine fibroids
TVUS
Management for uterine fibroids
asymptomatic = no Tx
GnRH analogues, myomectomy
control any menorrhagia with LNG-IUS, NSAIDs and COCP
pressure, heaviness and bearing down sensation
and urinary symptoms
Uterine prolapse
management of uterine prolapse
start off with conservative = weight loss pelvic floor muscle exercises
ring pessary
hysterectomy or sacrohysteropexy
often postpartum abdo pain radiated to adanexae fever abnormal PV bleeds dyspareunia/uria malaise and tachycardic
endometritis
investiagtion for endometritis
FBC, Blood cultures, high vaginal swabs and biopsy (diagnostic)
management for endometritis
clindamycin and gentamicin
post-menopausal bleeding
pre-menopausal = Intermenstrual bleeding
pain and discharge unusual
endometrial cancer
Ix for endometrial cancer
first line = TVUS
hysteroscopy with endometrial biopsy
management for endometrial cancer
localised disease = total abdo hysterectomy
bilateral salphingo-oophrectomy with post opertaive radiotherapy
frail/elderly - give progestrogen therapy, not suitable for surgeryv
protective factors in endometrial cancer
COCP and smoking
lower abdo pain fever cervical excitation dysuria/discharge menstrual changes deep dyspareunia
pelvic inflammatory disease (PID)
Ix PID
pregnancy test
high vaginal swab
STI screen
urine dip
management of PID
ofloxacin and metronidazole
OR
oral doxy, oral metronidazole and IM ceftriaxone
usually detected on smear
PMB, IMB, PCB
vaginal discharge
cervical cancer
mainly squamous cell but can also have adenocarcinoma
which HPV are linked to cervical cancer
16, 18 & 33
Cervical screening
25-49yrs = every 3 years 50-64 = every 5 years 64+ = self refer
if pregnant = delay screening 3 months post partum
management of cervical cancer
hysterectomy, radiation and concurrent chemo
excessive pain during menstrual period
suprapibic pain - can radiate down thigh of to the back
usually close to time prior to period or during
dysmenrrhoea
management for dysmenorrhoea
first line = NSAIDs - mefanamic acid/ibuprofen
second line = COCP
bloating breast pain anxiety stress fatigue mood swings
usually in luteal phase of cycle
pre-menstrual syndrome
management of premenstrual syndrome
if mild = lifestyle advice
moderate = COCP
severe = SSRI - fluoxetine
sub/infertility menstrual disturbances hirsutism acne obesity acanthosis nigracans
Polycystic ovarian disease (PCOS)
Ix of PCOS
pelvic US
management for PCOS
general = weight reduction and COCP hirsutism/acne = topical eflornithine infertility = clomiphene (+metformin)
failure to establish menstruation
primary amenorrhoea
15yrs
13yrs without any secondary sexual characteristic
cessation of mestruation
secondary amenorrhoea
3-6months for normal
6-12 months for oligomenorrhoea
management of primary amenorrhoea
investigate and treat cause