Gynae Flashcards
What is adenomyosis? What are some features and mx?
Presence of endometrial tissue within the myometrium . Dysmenorrhoea, menorrhgia, enlarged boggy uterus
Tx: GnRH agonist hysterectony
What is primary amenorrhoea?
primary: defined as the failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (such as breast development), or by 13 years of age in girls with no secondary sexual characteristics
What is secondary amenorrhoea?
secondary: cessation of menstruation for 3-6 months in women with previously normal and regular menses, or 6-12 months in women with previous oligomenorrhoea
Causes of primary amenorrhoea
gonadal dysgenesis (e.g. Turner’s syndrome) - the most common causes
Testicular feminisation
Congenital malformations of the genital tract
Functional hypothalamic amenorrhoea (e.g. secondary to anorexia)
Congenital adrenal hyperplasia
Imperforate hymen
Causes of secondary amenorrhoea?
hypothalamic amenorrhoea (e.g. secondary stress, excessive exercise)
polycystic ovarian syndrome (PCOS)
hyperprolactinaemia
premature ovarian failure
thyrotoxicosis*
Sheehan’s syndrome
Asherman’s syndrome (intrauterine adhesions)
What Ix would you carry out for amenorrhoea?
Urinary HcG - exclude preg
All bloods
Gonadotrophins (FSH, LH)
Prolactin
androgen levels - high in PCOS
Oestradiol
What can gonadotrophin levels tell you about amenorrhoea?
gonadotrophins
low levels indicate a hypothalamic cause where as raised levels suggest an ovarian problem (e.g. Premature ovarian failure)
raised if gonadal dysgenesis (e.g. Turner’s syndrome)
How would you manage primary amenorrhoea?
investigate and treat any underlying cause
with primary ovarian insufficiency due to gonadal dysgenesis (e.g. Turner’s syndrome) are likely to benefit from hormone replacement therapy (e.g. to prevent osteoporosis etC)
What is atrophic vaginitis?
Atrophic vaginitis often occurs in women who are post-menopausal women. It presents with vaginal dryness, dyspareunia and occasional spotting. On examination, the vagina may appear pale and dry.
What is the tx for atrophic vaginitis?
Treatment is with vaginal lubricants and moisturisers - if these do not help then topical oestrogen cream can be used.
What are some worsening reasons that suggest an ectopic pregnancy?
If a woman has a positive pregnancy test and any of the following she should be referred immediately to an early pregnancy assessment service:
pain and abdominal tenderness
pelvic tenderness
cervical motion tenderness
What are the main differentials for bleeding in the first trimester?
- Misscarriage/ ectopic
- Implantation bleeding
- Cervical ectropion, vaginitis, trauma and polyps
Bleeding if greater than 6 weeks gestation in preg women?
refer
Less than 6 weeks gestation and bleeding?
If the pregnancy is < 6 weeks gestation and women have bleeding, but NO pain or risk factors for ectopic pregnancy, then they can be managed expectantly. These women should be advised:
to return if bleeding continues or pain develops
to repeat a urine pregnancy test after 7–10 days and to return if it is positive
a negative pregnancy test means that the pregnancy has miscarried
What are the common types of cervical cancer?
squamous cell cancer (80%)
adenocarcinoma (20%)
What are the features of a cervical cancer?
may be detected during routine Cervical cancer screening
abnormal vaginal bleeding: postcoital, intermenstrual or postmenopausal bleeding
vaginal discharge
What are the main rfs for cervical cancer?
HPV!!!!!!!!!!!!!!!!!!
smoking , HIV, early sex, multiple partners, high parity, Lower ses, COCP
How often do you test for cervical cancer?
A smear test is offered to all women between the ages of 25-64 years
25-49 years: 3-yearly screening
50-64 years: 5-yearly screening
In pregnancy delay 3 months post partum,
What is the HPV first system?
The NHS has now moved to an HPV first system, i.e. a sample is tested for high-risk strains of human papillomavirus (hrHPV) first and cytological examination is only performed if this is positive.
Positive hrHPV (high risk HPV) cytology abnormal?
if the cytology is abnormal → colposcopy
this includes the following results:
borderline changes in squamous or endocervical cells.
low-grade dyskaryosis.
high-grade dyskaryosis (moderate).
high-grade dyskaryosis (severe).
invasive squamous cell carcinoma.
glandular neoplasia
Positive hrHPV and cytology is normal?
if the cytology is normal (i.e. hrHPV +ve but cytologically normal) the test is repeated at 12 months
if the repeat test is now hrHPV -ve → return to normal recall
if the repeat test is still hrHPV +ve and cytology still normal → further repeat test 12 months later:
If hrHPV -ve at 24 months → return to normal recall
if hrHPV +ve at 24 months → colposcopy
What if the cytology or cervical cancer sample is inadequete?
If the sample is ‘inadequate’
repeat the sample within 3 months
if two consecutive inadequate samples then → colposcopy
What is the staging used in cervical cancer?
FIGO staging- do we have to learn it?
Stage 1 - confined to cervix
2- tumor beyond the cervix but not into pelvic wall
3- beyond cervix and into the vaginal wall
4- Extension beyond the pelvis involvement of bladder or rectum and beyond for extreme stages
Mx of cervical cancer?
Gold standard for 1a is hysterectomy +- lymph node clearance
If wishing to maintain fertility - cone biopsy with negative margins
for advanced tumors radiotherapy with concurrent chemo is advised
What is a cervical ectropion?
This means cervical ectropion often presents with postcoital bleeding.
Cervical ectropion is associated with higher oestrogen levels, and therefore, is more common in younger women, the combined contraceptive pill and pregnancy.
Mx od cervical ectropion
Ectropion will typically resolve as the patient gets older, stops the pill or is no longer pregnant. Having a cervical ectropion is not a contraindication to the combined contraceptive pill.
Problematic bleeding is an indication for the treatment of cervical ectropion. Treatment involves cauterisation of the ectropion using silver nitrate or cold coagulation during colposcopy.
Causes of delayed puberty with a short stature?
Delayed puberty with short stature
Turner’s syndrome
Prader-Willi syndrome
Noonan’s syndrome
Delayed puberty with a normal stature?
Delayed puberty with normal stature
polycystic ovarian syndrome
androgen insensitivity
Kallman’s syndrome
Klinefelter’s syndrome
What do you know about primary dysmenorrhoea?
affects 50% of women and no cause- usually appears 1-2 years after menarche
pain typically starts just before or within a few hours of the period starting
suprapubic cramping pains which may radiate to the back or down the thigh
Management
NSAIDs such as mefenamic acid and ibuprofen are effective in up to 80% of women. They work by inhibiting prostaglandin production
combined oral contraceptive pills are used second line
