Female Reproductive Tract

Question 1

What are common presenting complaints in the FRT?

Answer 1

• Vaginal bleeding (post-sex, inter-menstrual, post-menopausal, heavy/irregular periods) - Pain (pelvic, abdominal, painful sex, painful periods. - Discharge (heavy, bloody, offensive, itchy). - Infertility (primary and secondary)

Question 2

What disorders affect the cervix?

Answer 2

• Human Papilloma Virus (HPV) - Cervical Intra-epithelial Neoplasm (CIN) - Cervical cancer - Cervical carcinoma. - Endocervical Polyps.

Question 3

What is human papilloma virus (HPV)

Answer 3

• Transmitted by sexual contact, increased risk with increased sexual partners. - No symptoms - main cause of cervical cancer. - Many different types: 1) low risk - warts and veruccas 2) high risk - cervical cancer

Question 4

What is cervical intra-epithelial neoplasm? (CIN)

Answer 4

• A microscopic lesion which affects the cervix and could potentially develop into cervical cancer if left untreated.

Question 5

What is cervical cancer?

Answer 5

• second most common female malignancy. - Risk factors - HPV, smoking, non-attendance to smear test. - Symptoms - abnormal discharge and bleeding.

Question 6

What is cervical carcinoma?

Answer 6

• Abnormal cells and invasion. - Can present with intermenstrual and post-sex bleeding. - Treatment - local excision or radical hysterectomy.

Question 7

What are endocervical polyps?

Answer 7

• Usually present with irregular vaginal bleeding/spotting. - Benign lesions - can remove.

Question 8

What disorders can affect the uterus?

Answer 8

• Menorrhagia - Fibroids - Endometritis and Pelvic Inflammatory Disease. - Endometriosis. - Endometrial polyps. - Endometrial Cancer. - Endometrial carcinoma.

Question 9

What is menorrhagia?

Answer 9

• ‘Heavy Periods’ >80ml blood loss. - Very common - 1 in 20 women. - Causes - dysfunctional uterine bleeding (DUB, 50%), fibroids, endometriosis and polyps. - Treatment - minera coil, combined pill, endometrial ablasion.

Question 10

What are fibroids?

Answer 10

• Very common benign tumours. - Arise from myometrium (uterine muscular wall). - Can present with painful or heavy periods, pelvic pain or distension. - Treatment depends on symptoms and wishes for pregnancy.

Question 11

What is endometritis and pelvis inflammatory disease?

Answer 11

• Caused by STI’s - abnormal discharge, pain or bleeding. - Can be asymptomatic - major cause of infertility.

Question 12

What is endometriosis?

Answer 12

• Endometrial tissue in the wrong location (outside). - Very common benign condition. - Heavy/painful periods, pelvic pain, painful sex. - Treatment is difficult.`

Question 13

What are endometrial polyps?

Answer 13

• Benign growth from endometrial cavity. - Can be removed at hysterectomy.

Question 14

What is endometrial cancer?

Answer 14

• Cancer of the lining of the uterus. - Often presents as post-menopausal bleeding. - Risk factors - Nulliparity (never given birth), late menopause, high BMI, hormone-replacement therapy (HRT) - Diagnosed by biopsy. - 20yr survival rate is 80%.

Question 15

What is endometrial carcinoma?

Answer 15

• Usually presents as post-menopausal bleeding. - Risk factors - obesity and oestrogen exposure. - Diagnosed by endometrial biopsy. - Treatment usually hysterectomy.

Question 16

What disorders affect the ovaries?

Answer 16

• Follicular cysts - Cystadenomas - Benign mature teratomas. - Polycystic ovarian syndrome. - Ovarian tumours - Ovarian cancer.

Question 17

What are follicular cysts?

Answer 17

• Benign - very common - usually less than 6cm. - Often asymptomatic, no treatment needed.

Question 18

What are cystadenomas?

Answer 18

• Can be very large fluid filled cysts. - Symptoms caused by pressure effects.

Question 19

What are benign mature teratomas?

Answer 19

• Large cysts filled with solid substance.

Question 20

What is polycystic ovarian syndrome?

Answer 20

• Common condition - multiple cysts on ovaries. - Usually presents as irregular periods, no periods, infertility. - Treatment - combined pill, melformin, clomifene. - Complications - increased CV risk, increased risk of type 2 diabetes, increased risk of pregnancy problems.

Question 21

What are ovarian tumours?

Answer 21

• Ovarian cysts malignant or benign - can be huge. - Can occur in young women (20-45 yrs) - usually benign. - Can occur in older women (>45yrs) - usually malignant.

Question 22

What is ovarian cancer?

Answer 22

• Often asymptomatic - especially if small. - Usually presents late and has already spread. - Poorer prognosis than endometrial cancer.

Question 23

What are examples of pregnancy-related disease?

Answer 23

• Miscarriage. - Ectopic pregnancy.

Question 24

What is a miscarriage?

Answer 24

• Loss of pregnancy before 24 weeks. - Occurs in approximately 15% of pregnancies (usually 1st trimester). - Risk factors - older age, multiple pregnancies, smoking and alcohol use, connective tissue disorders in mother and diabetes. - Presents with bleeding.

Question 25

What is an ectopic pregnancy?

Answer 25

• An extra-uterine pregnancy - usually in fallopian tubes. - Occurs in 1% of pregnancies. - May occur very early before a period has been missed. - Can be a gynaecological emergency as rupture of the pregnancy carries a high mortality.