Gynae Flashcards
Management of menorrhagia if requires contraception?
If doesn’t require contraception?
Requires contraception:
- Mirena
- COCP
- Long-acting progestogen (Depo-provera)
Doesn’t:
- Tranexamic acid or mefanamic acid (NSAID)
If semen analysis abnormal?
Repeat in 3 months
Management of endometriosis?
1st line - NSAIDs and/or paracetamol
2nd line - add in COCP
Secondary care:
- GnRH analogues (lower oestrogen, induce ‘pseudomenopause’)
- Surgery - laparoscopic excision and laser treatment of endometriotic ovarian cysts
(unfortunately drug treatment has very little impact on fertility)
Management of DUB?
Symptoms:
- tranexamic acid - bleeding
- mefanamic acid - pain
Periods: 1st - mirena 2nd - COCP 3rd - IM progestogens 4th - GnRH analogues/Danazol - dampen HPA axis and induce menopause
Surgical:
endometrial ablation
hysterectomy
Menegement PCOS hirsutism?
PCOS infertility?
General: Lifestyle & monitor for diabetes, HTN, hyperlipidaemia
Hirsutism:
- COCP
- topical eflornithine
Infertility:
- weight reduction
- Letrozole or Clomifene (stimulates ovulation)
- Metformin
- gonadotrophins
- IVF
CI and risks of depot?
CI:
- BREAST CANCER
- cardiac disease
- undiagnosed vaginal bleeding
Risks:
- osteoporosis (avoid in young if possible)
- weight gain
- delay in return of fertility (10 months)
- irregular bleeding (settles with time)
CI IUD?
CI:
- peptic ulcer disease
- PID
- Abnormal uterine anatomy
- endometrial/cervical cancer
- Pregnancy - risk of ectopic
IUS same but not peptic ulcer
Implant CI and interactions?
CI:
- Breast cancer
- IHD
- unexplained vaginal bleeding
- liver cirrhosis
Interactions:
Enzyme inducers like rifampicin, phenytoin; and obesity - need to change earlier
Why is injection contraceptive contraindicated 50+ y/o?
Osteoporosis
Unexplained vaginal bleeding is a CI for what contraceptives?
IUD/IUS
What contraceptives are preferred in epilepsy?
Depo, IUD or IUS
Lamotrigine:
- all bar COCP
COCP post-partum?
NOT <6 weeks if breastfeeding
CAN give >6 weeks, even if breastfeeding (UKMEC 2), although it can reduce breast milk production
If not breastfeeding, can start from day 21
If on day 21, immediate contraception
If after day 21, barrier for 7 days
If a POP contains desorgestrel - missed pill?
12 hour window instead of 3 hour
How long after stopping COCP may women be amenorrhoeic?
3 months
CI for EllaOne (ullipristal)?
Asthma
Rx adenomyosis?
GnRH anologues
Hysterectomy
General advice for menopause? Non-HRT symptomatic relief options for: - vasomotor symptoms? - vaginal dryness? - psychological?
Weight loss, smoking cessation, complementary therapies
Vasomotor: fluoxetine, citalopram, velafaxine, clonidine
Vaginal dryness:
- topical oestrogen (can be used alongside HRT)
- vaginal lubricant or moisturiser
Psych: CBT, antidepressants, self-help
CI for HRT?
- current/past breast cancer
- any oestrogen-sensitive cancer
- undiagnosed vaginal bleeding
- untreated endometrial hyperplasia
Bleeding in first trimester if:
- <6 weeks?
- 6+ weeks or uncertain gestation?
If NO PAIN, then manage expectantly and repeat pregnancy test in 7-10 days. Return if pain and if pregnancy test still positive
If negative, miscarriage.
If 6+ weeks or uncertain gestation, refer to EPAU
FSH/LH in turner’s syndrome?
Raised
Primary gonadal dysgenesis
5 female factors which warrant early referral to infertility clinic?
5 male factors?
Female:
- age >35
- amenorrhoea
- previous pelvic surgery
- previous STI
- abnormal genital examination
Male:
- previous surgery on genitalia
- previous STI
- varicocele
- significant systemic illness
- abnormal genital exam
3 components of RMI for ovarian cancer?
Menopausal status
CA125
USS findings
Initial investigations for urinary incontinence?
If they have post-void symptoms (feeling of incomplete emptying)?
If unsure what type of incontinence?
- bladder diary 3 days
- pelvic exam to exclude prolapse and pelvic floor muscle weakness
(remember neuro exam S2-S4!!!) - Urinalysis
Post-void:
- post-void residual
If unsure what type:
- urodynamic studies
Cystoscopy may also be used
If someone has treatment for CIN when should their next smear be?
6 months
Genital herpes Ix?
Rx?
If pregnant/labour?
Swab base of ulcer for PCR (50% HSV1 and HSV2)
Rx: analgesia and aciclovir
Pregnant - risk of 1st trimester miscarriage
Labour - C section
Syphilis tests?
What stays positive and what stays negative?
Cardiolipin tests - RPR or VLDR
Test for non-specific antibody to cardiolipin
(false positive in APS, pregnancy etc)
Treponema specific antibody - TPHA
After treatment:
VLDR/RPR - are negative
TPHA - remain positive
Management of endometrial hyperplasia if simple without nuclear atypic?
If any other type?
High dose progestogens with repeat sampling in 3-4 months, IUS may be used
Any others - Hysterectomy with BSO
