gynae Flashcards
stress incontinence mx
- pelvic floor exercises
- surgery
- duloxetine if surgery declined
urge incontinence mx
- bladder retraining, min of 6 weeks
- oxybutynin or tolterodine (antimuscarinics)
nb avoid oxybutynin in frail elderly patients
adenomyosis imaging
transvaginal USS is gold standard
in preference to transabdo USS or MRI) (NICE
primary dysmenorrhoea mx
- NSAIDs, e.g. Mefenamic acid and Ibuprofen
2. COCP
secondary dysmenorrhoea mx
must refer to gynae for investigations
menorrhagia mx
does not require contraception - Tranexamic acid
requires contraception - IUS, COCP
closed cervical os - what miscarriages?
threatened
missed
complete
open cervical os - what miscarriages?
inevitable
incomplete
‘open your I’s’
medical mx of ectopic
Methotrexate
when is mifepristone used?
termination of uterine pregnancy, used along side misoprostol
when is misoprostol used?
medical management of miscarriage
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
cervical cancer aetiology
HPV 16 & 18
mx of thrush in pregnancy
clotrimazole pessary
oral fluconazole is CI
trichomonas vaginalis features and mx
offensive, yellow/green, frothy discharge
vulvovaginitis
strawberry cervix
metronidazole
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
