1. bladder retraining, min of 6 weeks 2. oxybutynin or tolterodine (antimuscarinics) nb avoid oxybutynin in frail elderly patients

gynae Flashcards by Iona Chisholm

stress incontinence mx

pelvic floor exercises
surgery
duloxetine if surgery declined

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urge incontinence mx

bladder retraining, min of 6 weeks
oxybutynin or tolterodine (antimuscarinics)
nb avoid oxybutynin in frail elderly patients

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adenomyosis imaging

transvaginal USS is gold standard

in preference to transabdo USS or MRI) (NICE

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primary dysmenorrhoea mx

NSAIDs, e.g. Mefenamic acid and Ibuprofen

2. COCP

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secondary dysmenorrhoea mx

must refer to gynae for investigations

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menorrhagia mx

does not require contraception - Tranexamic acid

requires contraception - IUS, COCP

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closed cervical os - what miscarriages?

threatened
missed
complete

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open cervical os - what miscarriages?

inevitable
incomplete
‘open your I’s’

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medical mx of ectopic

Methotrexate

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when is mifepristone used?

termination of uterine pregnancy, used along side misoprostol

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when is misoprostol used?

medical management of miscarriage

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endometriosis mx

analgesia - NSAIDs and/or paracetamol
if analgesia doesn’t help, hormonal treatments - COCP or progestogens, IUS
if neither of the above helps - GnRH analogues

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cervical cancer aetiology

HPV 16 & 18

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mx of thrush in pregnancy

clotrimazole pessary

oral fluconazole is CI

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trichomonas vaginalis features and mx

offensive, yellow/green, frothy discharge
vulvovaginitis
strawberry cervix
metronidazole

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PCOS mx

weight loss
COCP if contraception required (may help hirsutism)
for infertility - Clomifene most effective
Metformin is used for obese patients

what is tranexamic acid used for?

menorrhagia

how often are smears carried out in scotland?

every 5 years from 25-64 years of age

indications for surgical mx of ectopic

>35 mm in size
ruptured
pain
visible foetal heartbeat
b-hCG >1500

investigations for menorrhagia

FBC

transvaginal USS if abnormal examination findings, pelvic pain or postcoital bleeding

when to refer to fertility clinic

no pregnancy after regular sexual intercourse (every 2-3 days) for 12 months

PMS mx

mild symptoms - lifestyle advice
moderate symptoms - new-gen COCP (e.g. Yasmin)
severe symptoms - SSRI (taken either continuously or only during luteal phase)

which ovulation induction agent carries greatest risk of ovarian hyperstimulation syndrome

GnRH therapies

what is invovled in surgical mx of ectopic

salpingectomy

medical mx of fibroids

GnRH agonists, e.g. Leuprolide or Triptorelin, may shrink fibroid prior to surgery

risk factors for ovarian cancer

early menarche, late menopause nulliparity FHx - BRCA1/2

what does raised FSH and LH but low oestradiol suggest

premature ovarian failure

long term complications of PCOS

subfertility diabetes mellitus stroke and TIA endometrial cancer

most common ovarian cyst in asymptomatic patient

follicular cyst

most common ovarian cancer

serous carcinoma

which conditions is cervical excitation a feature of

PID and ectopic pregnancy

what is mefenamic acid used for

mx of primary dysmenorrhoea

diagnostic criteria for PCOS

oligo- or amenorrhoea hyperandrogegism (hirtuism and acne) polycystic ovaries on USS

Asherman's syndrome

intrauterine adhesions can occur following dilation and curettage may prevent the endometrium responding normally to oestrogen causing secondary amenorrhoea

when does HPV test of cure take place

six months after treatment to assess for any residual disease

what is Fitz-Hugh-Curtis syndrome

perihepatitis | seen in PID, Chlamydia and Gonorrhoea