gynae Flashcards

1
Q

what is a krunkenburg tumour

A

development of mets to the ovary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what to do when having surgery if on the pill

A

stop 4 wks before

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

first line for urge incontinence

A

bladder retraining for a min of 6 wks (gradually increasing the time between voiding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

first line for stress incontinence

A

pelvic floor muscle training
8 contractions 3x/day for at least 3 mths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

first-line in the management of nausea & vomiting in pregnancy/hyperemesis gravidarum

A

antihistamines - oral cyclizine or promethazine

ondansetron is second line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

RFs of Hyperemesis gravidarum

A

increased levels of beta-hCG
- multiple pregnancies
- trophoblastic disease
nulliparity
obesity
family or personal history of NVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Referral criteria for nausea and vomiting in pregnancy

A

Continued nausea and vomiting and is unable to keep down liquids or oral antiemetics

Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics

A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

dx of Hyperemesis gravidarum

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

cervical smear: what to do if the sample is Positive hrHPV

A

samples are examined cytologically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

cervical smear: what to do if the sample is Positive hrHPV and abnormal cytology

A

colposcopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

cervical smear: what to do if the sample is Positive hrHPV and normal cytology

A

repeat test 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

(ie test HPV 3x b4 colposcopy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what to do if cervical smear sample is inadequate

A

repeat the sample within 3 months
if two consecutive inadequate samples then → colposcopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

medical mx of abortion

A

mifepristone (an anti-progestogen)

followed by misoprostol (a prostaglandin) 48 hrs later

take a multi-level preg test after 2 wks to check (Quantitative hCG measurement )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

causes of primary amenorrhoea

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

causes of secondary amenorrhoea (after excluding pregnancy)

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is gonadal dysgenesis + what might be the examination findings

A

congenital condition in which the gonads are atypically developed, and may be functionless
e.g. turners syndrome

Due to the abnormal gonads, androgens are not produced in response to FSH and LH from the anterior pituitary gland. -> absent 2ndary sex characteristics

FSH + LH remain high as no -ve feedback

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

ix for ectopic preg

A

transvaginal ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

when to do expectant mx for ectopic

A

size < 35mm
unruptured
asx
no fetal heartbeat
hCG <1,000IU/L
Compatible if another intrauterine pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what does expectant mx for ectopic involve

A

closely monitoring the px over 48 hours and if B-hCG levels rise again or symptoms manifest intervention is performed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

when to do medical mx for ectopic

A

Size <35mm
unruptured
no signif pain
no fetal heartbeat
hCG <1,500IU/L
Not suitable if intrauterine pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what does medical mx for ectopic involve

A

methotrexate
needs to attend follow up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

when to do surgical mx for ectopic

A

Size >35mm
can be ruptured
pain
visible fetal heartbeat
hCG >5,000IU/L
Compatible with another intrauterine pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what does surgical mx for ectopic involve

A

Salpingectomy is first-line for women with no other risk factors for infertility (full fallopian tube out)

Salpingotomy (tube not acc removed, opening made) should be considered for women with risk factors for infertility such as contralateral tube damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

PCOS test results

A

raised LH:FSH ratio
testosterone may be normal or mildly elevated
SHBG is normal to low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
rotterdam criteria for PCOS
two out of three of the following: Oligo and/or anovulation Clinical and/or biochemical signs of hyperandrogenism Polycystic ovaries
26
risk factors for endometrial cancer
excess oestrogen - nulliparity - early menarche - late menopause - unopposed oestrogen. The addition of a progestogen to oestrogen reduces this risk (e.g. In HRT). The BNF states that the additional risk is eliminated if a progestogen is given continuously metabolic syndrome - obesity - diabetes mellitus - polycystic ovarian syndrome tamoxifen hereditary non-polyposis colorectal carcinoma
27
protective factors for endometrial cancer
multiparity combined oral contraceptive pill smoking (the reasons for this are unclear)
28
how long should women take HRT for premature menopause
until the age of 50
29
presentation of intraductal papilloma
clear or blood-stained nipple discharge tenderness or pain palpable lump (maybe)
30
what is intraductal papilloma
warty lesion that grows within one of the ducts in the breast - benign tumour
31
what is a fibroadenoma
common benign tumours of stromal/epithelial breast duct tissue
32
features of fibroadenoma
Painless Smooth Round Well circumscribed (well-defined borders) Firm Mobile (moves freely under the skin and above the chest wall) Usually up to 3cm diameter more common ages 20-40
33
what to do in fibroadenomas >3cm
surgical excision
34
what is Mammary duct ectasia
dilation of the breast ducts, often resulting in blockage
35
features of Mammary duct ectasia
Most common in menopausal women Discharge typically thick and green in colour Most common in smokers
36
clinical features of breast cancer
Lumps that are hard, irregular, painless or fixed in place Lumps may be tethered to the skin or the chest wall Nipple retraction Skin dimpling or oedema (peau d’orange)
37
two week wait referral for suspected breast cancer for:
An unexplained breast lump in patients aged 30 or above Unilateral nipple changes in patients aged 50 or above (discharge, retraction or other changes)
38
what forms part of a triple assessment
Clinical assessment (history and examination) Imaging (ultrasound or mammography) Histology (fine needle aspiration or core biopsy)
39
what pill to use in PCOS + why
COCP - co-cyprindrol - reduceS hirsutism, acne and regulates periods
40
what to do in PCOS if wanting preg
weight loss clomifene - induces ovulation - Try metformin with it Laparoscopic ovarian drilling IVF
41
most common ovarian cyst
follicular
42
what is a follicular cyst
type of functional cyst non-rupture of the dominant follicle usually regresses after several menstrual cycles
43
what is a corpus luteum cyst
type of functional cyst when it does not break down in a cycle w no preg and fills with blood/fluid may cause pelvic discomfort, pain or delayed menstruation
44
what is a dermoid cyst
most common benign ovarian tumour mature cystic teratomas (come from germ cells + contain various tissue types) assoc w ovarian torsion
45
what do you see on imaging with a dermoid cyst
rokitansky protuberance
46
what is a serous cystadenoma
most common benign epithelial tumour
47
what is the triad in Meig's syndrome
Ovarian fibroma (a type of benign ovarian tumour) Pleural effusion Ascites Typically occurs in older women. Removal of the tumour results in complete resolution of the effusion and ascites.
48
when do you need post-partum contraception
21 days after birth
49
when can you insert IUD after childbirth
within 48 hrs or after 4 weeks
50
candida pres
cottage cheese discharge vulvitis itch
51
tx candida
oral fluconazole single dose CI in preg - use detrimazole pessary
52
trichomonas vaginalis pres
offensive yellow/green frothy discharge vulvovaginitis strawberry cervix
53
trichomonas vaginalis tx
oral metronidazole
54
bacterial vaginosis pres
offensive thin white/grey fishy discharge
55
bacterial vaginosis tx
oral metronidazole
56
gonorrhoea tx
IM ceftriaxone
57
what increases your risk of breast cancer
anything that increases oestrogen exposure - early onset periods - late menopause - combined HRT - COCP - smoking - obesity - more dense breast tissue - FHx
58
risk factors for cervical cancer
COCP multiparity HPV 16, 18, 33 smoking early sex, increased no of sexual partners FHx non attendance to screening
59
risk factors for ovarian cancer
increased amount of ovulations age early onset periods late menopause no pregnancies SO COCP, breastfeeding and pregnancy are protective BRCA 1 + 2 genes smoking obesity clomifene use
60
presentation of PID
pelvic pain abnormal bleeding dyspareunia dysuria fever cervical excitation purulent discharge
61
ix PID
a pregnancy test should be done to exclude an ectopic pregnancy high vaginal swab these are often negative screen for Chlamydia and Gonorrhoea
62
mx PID
or intramuscular ceftriaxone (for ghonorrhoea) + oral doxycycline 100mg 2x daily 14 days (for chlamydia) + oral metronidazole 400mg 2x daily 14 days
63
what is a chronic manifestation of PID
Fitz-Hugh Curtis Syndrome - inflam of liver capsule w adhesion formation RUQ pain
64
chlamydia presentation
asymptomatic in around 70% of women and 50% of men women: cervicitis (discharge - strong odour, bleeding - intermenstrual or post coital), dysuria, pelvic pain men: urethral discharge, dysuria, reactive arthritis
65
chlamydia ix
nuclear acid amplification tests (NAATs) for women: the vulvovaginal swab is first-line for men: first catch urine test is first-line
66
gonorrhoea presentation
90% of men and 50% of women are symptomatic women: odourless purulent discharge (green/yellow), dysuria, pelvic pain men: odourless purulent discharge (green/yellow), dysuria, testicular pain or swelling (epididymo-orchitis) rectal infection pharyngeal infection
67
gonorrhoea bacteria
gram -ve diplococcus
68
chlamydia tx
doxycycline 100mg twice a day for 7 days CI in preg + breastfeeding azithromycin 1g stat
69
order of preference of where to take a NAAT sample
women: endocervical, vulvovaginal, and then first catch urine men: first-catch urine sample/urethral swab Rectal and pharyngeal NAAT swabs can also be taken to diagnose chlamydia in the rectum and throat
70
gonorrhoea ix
NAAT - endocervical, vulvovaginal or urethral swabs, or in a first-catch urine sample. Rectal and pharyngeal swab are recommended in all men who have sex with men (MSM), and in those with risk factors (e.g. anal and oral sex) or symptoms of infection in these areas standard charcoal endocervical swab should be taken for microscopy, culture and antibiotic sensitivities before initiating antibiotics
71
which STIs need a test of cure
gonorrhoea due to high abx resistance 72 hours after treatment for culture 7 days after treatment for RNA NAAT 14 days after treatment for DNA NAAT
72
why do you get overactive bladder/urger incontinence
overactive detrusor muscle causes urger to urinate followed by uncontrollable leakage
73
why do you get stress incontinence
weak pelvic floor muscles and sphincter muscles causes urinary leakage when laughing, coughing or surprised
74
what is overflow incontinence
can occur when there is chronic urinary retention due to an obstruction to the outflow of urine incontinence occurs without the urge to pass urine more common in men
75
what to do in women w overflow incontinence
refer for urodynamic testing and specialist management
76
what to do for all types on incontinence
3 day bladder diary vaginal exam (to exc prolapse + see ability for kegels) urine dipstick + culture - to rule out UTI + DM (do urinalysis is >65)
77
meds to use in overactive bladder/urge incontinence
anticholinergic meds - OXYBUTYNIN, tolterodine, solifenacin Mirabegron as an alt (less anticholinergic burden) - B-3 agonist
78
when is oxybutynin CI
elderly/frail glaucoma
79
when is mirabegron CI
uncontrolled HTN need to monitor BP during tx
80
anticholinergic SEs
dry mouth, dry eyes, urinary retention, constipation and postural hypotension can't see, can't pee can't shit, can't spit they can also lead to a cognitive decline, memory problems and worsening of dementia
81
further mx in stress incontinence
Surgery - Tension-free vaginal tape (TVT) etc DULOXETINE (SNRI) if surgery no approp/declined
82
when to suspect a vesicovagal fistulae
in px w continuous dribbling incontinence after prolonged labour + country w poor obstetric services
83
ix vesicovagal fistulae
urinary dye studies
84
when to ix infertility
after 1 yr of trying
85
how to ix infertility
semen analysis measure serum progesterone 7 days prior to expected next period (ie on day 21 on a typical 28 day cycle)
86
serum progesterone results when testing infertility
<16 = repeat, if consistent -> specialist 16-30 = repeat >30 = indicates ovulation
87
key counselling pts when trying to conceive
folic acid BMI 20-25 sex every 2-3 days smoking + drinking advice
88
PMS mx
General healthy lifestyle changes, such as improving diet, exercise, alcohol, smoking, stress and sleep Combined contraceptive pill (COCP) - new gen containing drospirenone eg yasmin SSRI antidepressants Cognitive behavioural therapy (CBT)
89
HRT uterus + post-menopause (12 mths w/o periods)
continuous combined oral / patch
90
HRT uterus + perimenopause
sequential (cyclical progesterone + reg breakthrough bleeds) oral / patch
91
HRT hysterectomy (no uterus) / mirena in situ
estradiol / conjugated equine oestrogens oral / patch the mirena is liscenced for use as the progesterone component of HRT for 4 yrs
92
comps of oestrogen + progesterone HRT
increased risk of breast cancer (increases w duration of use, decreases when stopped) increased risk of VTE (transdermal does not) - if px has increased risk of this anyway refer to haematology 1st
93
comps of oestrogen only HRT
increased risk of endometrial cancer DO NOT GIVE TO WOMEN W UTERUS
94
comps of all HRT
increased risk of stroke increased risk of IHD if 10 + yrs after menopause
95
Non-Hormonal Treatments for Menopausal Symptoms
Lifestyle changes such as improving the diet, exercise, weight loss, smoking cessation, reducing alcohol, reducing caffeine and reducing stress CBT Clonidine, which is an agonist of alpha-adrenergic and imidazoline receptors - lowers BP + reduces HR - helpful for vasomotor symptoms and hot flushes SSRIs (e.g. fluoxetine) Venlafaxine (SNRI) Gabapentin
96
Indications for HRT
Replacing hormones in premature ovarian insufficiency, even without symptoms Reducing vasomotor symptoms such as hot flushes and night sweats Improving symptoms such as low mood, decreased libido, poor sleep and joint pain Reducing risk of osteoporosis in women under 60 years
97
CI ulipristal acetate (ellaone)
severe asthma
98
how soon after unprotected sex for levonorgestrel ulipristal acetate (ellaone)
72 hrs (double dose if BMI > 26, weight > 70) 120 hrs
99
when can you start hormonal contraceptive after emergency one w levonorgestrel ulipristal acetate (ellaone)
immediately 5 days
100
2 types of endometrial hyperplasia
precancerous condition involving thickening of the endometrium (5% go to cancer most return to normal): Hyperplasia without atypia Atypical hyperplasia (higher risk of malignancy)
101
how to tx endometrial hyperplasia
using progestogens, with either: Intrauterine system (e.g. Mirena coil) Continuous oral progestogens (e.g. medroxyprogesterone or levonorgestrel) repeat sampling in 3-4 mths
102
endometrial cancer presentation
POSTMENOPAUSAL BLEEDING Postcoital bleeding Intermenstrual bleeding Unusually heavy menstrual bleeding Abnormal vaginal discharge Haematuria Anaemia Raised platelet count
103
referral criteria for endometrial cancer
The referral criteria for a 2-week-wait urgent cancer referral for endometrial cancer is: Postmenopausal bleeding (more than 12 months after the last menstrual period) Referral for a transvaginal ultrasound in women over 55 years with: Unexplained vaginal discharge Visible haematuria plus raised platelets, anaemia or elevated glucose levels
104
ix endometrial cancer
Transvaginal ultrasound for endometrial thickness (normal is less than 4mm post-menopause) Pipelle biopsy, which is highly sensitive for endometrial cancer making it useful for excluding cancer Hysteroscopy with endometrial biopsy
105
stages of endometrial cancer
International Federation of Gynaecology and Obstetrics (FIGO) staging system Stage 1: Confined to the uterus Stage 2: Invades the cervix Stage 3: Invades the ovaries, fallopian tubes, vagina or lymph nodes Stage 4: Invades bladder, rectum or beyond the pelvis
106
mx endometrial cancer
total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH and BSO (removal of uterus, cervix and adnexa)) for stage 1 + 2 Other treatment options depending on the individual presentation include: A radical hysterectomy involves also removing the pelvic lymph nodes, surrounding tissues and top of the vagina Radiotherapy Chemotherapy Progesterone may be used as a hormonal treatment to slow the progression of the cancer
107
UKMEC4 conditions for COCP (unacceptable risk)
>35 yrs + 15 cigs/day migraines w aura hx of thromboembolic dis/mutation hx of stroke/IHD breastfeeding < 6 wks post partum uncontrolled HTN breast cancer major surgery w prolonged immobilisation +ve antiphospholipid antibodies (eg SLE)
108
UKMEC3 conditions for COCP (risks>advs)
>35 <15 cigs / day BMI > 35 FHx thromboembolism dis controlled HTN immobility (wheelchair) BRCA1/BRCA2 mutation
109
POP + abx
no change **unless the antibiotic alters the P450 enzyme system, for example, rifampicin
110
starting POP
if commenced up to + inc day 5 = immediate protection day 6+ = additional contraceptive for the first 2 days if switching from COCP = immediate protection if continued directly from the end of a pill packet (i.e. Day 21)
111
taking POP
should be taken at the same time every day, without a pill-free break
112
missed pills POP
if < 3 hours* late: continue as normal *for Cerazette (desogestrel) a 12 hour period is allowed if > 3 hours*: take the missed pill as soon as possible, continue with the rest of the pack, extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours
113
vaginal atrophy
the thinning, drying, and inflammation of the walls of the vagina due to a reduction in oestrogen following the menopause can result in vaginal bleeding
114
what is used to rehydrate if admitted w hyperemesis gravidarum
normal saline with added potassium is used to rehydrate
115
limit for abortion
24 wks
116
surgical abortion options
vacuum aspiration (MVA), electric vacuum aspiration (EVA) and dilatation and evacuation (D&E) cervical priming with misoprostol +/- mifepristone b4 an intrauterine contraceptive can be inserted immediately after evacuation of the uterine cavity
117
choice of abortion procedure
women are offered a choice between medical or surgical abortion up to and including 23+6 weeks' gestation likelihood of women seeing products of conception pass and decreased success rate before 10 weeks medical abortions are usually done at home
118
abortion act
2 registered medical practitioners are of the opinion: - the pregnancy has not exceeded its 24th week + the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family - the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman - the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated - substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.
119
electrolyte imbalance w vomiting
hypokalaemia
120
RFs for ectopic preg
(anything slowing the ovum's passage to the uterus) damage to tubes (pelvic inflammatory disease, surgery) previous ectopic endometriosis IUCD progesterone only pill IVF (3% of pregnancies are ectopic)
121
1 missed COCP
take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day no additional contraceptive protection needed
122
2+ missed COCP
take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day the women should use condoms or abstain from sex until she has taken pills for 7 days in a row.
123
2+ missed COCP in week 1 emergency contra?
emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
124
2+ missed COCP in week 2 emergency contra?
after seven consecutive days of taking the COC there is no need for emergency contraception
125
2+ missed COCP in week 3 interval?
she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
126
most common type of ovarian cancer
Epithelial Cell Tumours - eg. serous tumour
127
protective factors ovarian cancer
Factors that stop ovulation or reduce the number of lifetime ovulations Combined contraceptive pill Breastfeeding Pregnancy
128
ovarian cancer presentation
non-spec sx, often dx late Abdominal bloating Early satiety (feeling full after eating) Loss of appetite Pelvic pain Urinary symptoms (frequency / urgency) Weight loss Abdominal or pelvic mass Ascites An ovarian mass may press on the obturator nerve and cause referred hip or groin pain.
129
referral criteria for ovarian cancer
Refer directly on a 2-week-wait referral if a physical examination reveals: Ascites Pelvic mass (unless clearly due to fibroids) Abdominal mass
130
Carry out further investigations before referral in women presenting with symptoms of possible ovarian cancer: which ix who to refer
CA125 uss? women over 50 years presenting with: New symptoms of IBS / change in bowel habit Abdominal bloating Early satiety Pelvic pain Urinary frequency or urgency Weight loss
131
ix ovarian cancer
CA125 blood test (>35 IU/mL is significant) Pelvic ultrasound CT scan to establish the diagnosis and stage the cancer Histology (tissue sample) using a CT guided biopsy, laparoscopy or laparotomy Paracentesis (ascitic tap) can be used to test the ascitic fluid for cancer cells
132
risk of malignancy index (RMI)
estimates the risk of an ovarian mass being malignant, taking account of three things: Menopausal status Ultrasound findings CA125 level
133
Women under 40 years with a complex ovarian mass
require tumour markers for a possible germ cell tumour: Alpha-fetoprotein (α-FP) Human chorionic gonadotropin (HCG)
134
postmenopausal women w cysts
any postmenopausal woman with an ovarian cyst regardless of nature or size should be referred to gynaecology for assessment
135
premenopausal women w cysts
If the cyst is small (e.g. < 5 cm) and reported as 'simple' then it is highly likely to be benign. A repeat ultrasound should be arranged for 8-12 weeks and referral considered if it persists.
136
how many women who undergo a salpingotomy for an ectopic pregnancy require further treatment
20%
137
what is adenomyosis
endometrial tissue within the myometrium more common in later repro yrs + women who are multiparous
138
features of adenomyosis
dysmenorrhoea pain during sex menorrhagia enlarged, boggy uterus
139
ix adenomyosis
1. transvaginal ultrasound MRI
140
mx adenomyosis
symptomatic treatment - tranexamic acid to manage menorrhagia - mefenamic acid to manage menorrhagia + dysmenorrhoea hormone contraception GnRH agonists endo ablation uterine artery embolisation hysterectomy - considered the 'definitive' treatment
141
causes of recurrent miscarriage
antiphospholipid syndrome endocrine disorders: poorly controlled diabetes mellitus/thyroid disorders. Polycystic ovarian syndrome uterine abnormality: e.g. uterine septum parental chromosomal abnormalities smoking
142
most effective emergency contraception
copper intra-uterine device
143
features of fibroids
may be asx menorrhagia may result in iron-deficiency anaemia bulk-related symptoms - lower abdominal pain: cramping pains, often during menstruation - bloating - urinary symptoms, e.g. frequency, may occur with larger fibroids subfertility rare features: - polycythaemia secondary to autonomous production of erythropoietin
144
what are fibroids
benign smooth muscle tumours of the uterus. T hey are thought to occur in around 20% of white and around 50% of black women in the later reproductive years
145
dx fibroids
transvaginal ultrasound
146
mx fibroids
asx = none menorrhagia = levonorgestrel intrauterine system (LNG-IUS) - useful if the woman also requires contraception - cannot be used if there is distortion of the uterine cavity NSAIDs e.g. mefenamic acid tranexamic acid combined oral contraceptive pill oral progestogen injectable progestogen to shrink / remove =
147
Indications for early referral to fertility specialist
>35 Has a menstrual disorder Previous surgery Previous STI/PID
148
mastitis mx normal + if worse
ctu breastfeeding analgesia warm compresses if systemically unwell/nipple fissure present/sx do not improve after 12-24 hours of effective milk removal/culture indicates infection - oral flucloxacillin for 10-14 days
149
most common cause of infective mastitis
s aureus
150
mastitis presentation
typically assoc w breast feeding painful, tender, red hot breast fever, and general malaise may be present
151
tx periductal mastitis
co-amoxiclav
152
characteristics of periductal mastitis
smokers freq infections