Female reproductive tract

Question 1

Presenting complaints

Answer 1

Vaginal bleeding = post-coital, inter-menstrual, post-menopausal, heavy periods, irregular periods
Pain = pelvic, abdominal, painful sex, painful periods
Discharge = heavy, blood, offensive, itchy
Infertility = primary, secondary

Question 2

Cervical screening smear test

Answer 2

every 3 years from 35-49
every 5 years from 49-64
aims to detect early stages before it becomes invasive

Question 3

Human Papilloma virus

Answer 3

transmitted by sexual contact
risk increases with increased number of sexual partners
no symptoms
main cause of Cervical Intra-epithelial Neoplasia (CIN) and therefore cervical cancer
many different types - low risk = warts/verruca’s, high risk = cervical cancer
girls aged 12-13 offered HPV vaccine

Question 4

Cervical intra-epithelial neoplasia (CIN)

Answer 4

microscopic lesion that affects the cervix

could potentially develop into cancer if left untreated

Question 5

Cervical cancer

Answer 5

2nd most common female malignancy
risk factors: HPV, smoking, non attendance to SCP
symptoms: abnormal discharge and bleeding
on examination, cervix appears normal
> cervical carcinoma
- abnormal cells and invasion
- presents with inter-menstrual or post-coital bleeding
- treatment is either local excision or radical hysterectomy +/-chemo/radiotherapy

Question 6

Endocervial polyps

Answer 6

irregular vaginal bleeding

benign, removed by hysteroscopy

Question 7

Menorrhagia (uterus)

Answer 7

heavy periods - >80ml blood loss
causes: fibroids, endometriosis, polyps
treatment = mirena coil, Mefanamic and tranexamic acid, depo provera, endometrial ablation, hysterectomy, combined pill

Question 8

Fibroids (leiomyoma’s)

Answer 8

very common being tumour
arise from myometrium
presents with heavy periods, pelvic pain or distension

Question 9

End metritis and pelvic inflammatory disease

Answer 9

caused by infections, usually sexually transmitted
presents with abnormal discharge, pain or bleeding (can be asymptomatic)
major cause of infertility

Question 10

Endometriosis

Answer 10

endometrial tissue in the wrong location eg. outside the endometrium
very common benign condition
heavy/painful periods, pelvic pain, painful sex
treatment can be difficult = COCP, mirena coil, Zoladex, surgery

Question 11

Endometrial polyps

Answer 11

benign growths from the endometrial cavity

removed by hysteroscopy

Question 12

Endometrial cancer

Answer 12

cancer of the lining of the uterus
presents as post-menopausal bleeding = detected early
risk factors: nulliparity (woman who has never carried a pregnancy), high BMI, HRT, late menopause
diagnosed on biopsy - pipelle or hysteroscopy
usually undergo TAH and BSO = removal of entire uterus, ovaries, fallopian tubes and cervix
20 year survival rate is 80%
> endometrial carcinoma
- presents as post-menopausal bleeding = early detection
- risk factors: obesity and oestrogen exposure

Question 13

Ovarian cysts

Answer 13

Follicular cysts = benign, common, less than 6cm, asymptomatic, no treatment
Cystadenomas = large fluid filled cysts, symptoms can be affects of pressure
Benign mature teratomas = large cysts filled with a solid substance

Question 14

Polycystic ovarian syndrome

Answer 14

multiple cysts on ovaries
presents as irregular periods, infertility
treatment = COCP, Metformin, Clomifine
complications: increased CV risk, increased type 2 DM, increased problems in pregnancy

Question 15

Ovarian cancer

Answer 15

often asymptomatic if small tumour

usually presents late when already spread

Question 16

What is a miscarriage?

- risk factors

Answer 16

loss of pregnancy before 24 weeks (15% of all pregnancies, usually 1st trimester)
classification: threatened, inevitable, incomplete, missed
often no cause found
risk factors: old age, multiple pregnancies, smoking, alcohol, connective tissue disorder, diabetes
treatment = conservation, medical with Misoprostol, surgical with Vacuum suction under GA

Question 17

Ectopic pregnancy

Answer 17

extra uterine pregnancy usually occurring in the Fallopian tubes
can occur very early, before a period is missed
can be a gynaecological emergency!!! as pregnancy carries a high risk of mortality due to rupture
risk factors: fertility treatments, pelvic inflammatory disease, previous ectopic, smokers
indicators include raised beta HCG levels on blood testing
treatment always surgical