Gynae Flashcards
First line tx for subfertility in PCOS
Clomifene
First line tx for hirsutism and acne (PCOS)
COCP
Pathophysiology of PCOS
- Elevated LH - causes ovarian growth, cyst formation, incr androgen production
- Hyperinsulinaemia
Criteria for diagnosis of PCOS
Two of:
- anovulation
- hirsutism (or biochemical raised FAI/testosterone)
- Ultrasound scan shows polycystic ovaries
Most common ovarian Ca type
(epithelial origin)
serous carcinomas
Clinical fts ovarian Ca
vague :(
- abdominal distension and bloating
- abdominal pelvic pain
- urinary urgency
- early satiety
- diarrhoea
Conditions which may raise Ca125
- ovarian ca
- endometriosis
- benign ovarian cysts
What is a high Ca125 (for 2WW)
> 35IU/mL
ref for urgent USS
Contraceptives that inhibit ovulation
- implant (etonogestrel)
- emergency contraception: levonorgestrel; ulipristal
- depot (medroxyprogesterone acetate)
- POP - desogestrel only
- COCP
Contraceptives that thicken cervical mucus
Protesterone-based
For POP excluding desogestrel this is the only MOA
For IUS (lebonestrel) also prevents endometrial proliferation
all others also inhibit ovulation
MOA IUD
1. as routine
2. as emergency
= copper
- decr sperm motility and survival
- toxic to sperm/ovum + inhibits implanatation
IUS (levonorgestrel) MOA
mainly = prevents endometrial proliferation
also = thickens cervical mucus
POP contraceptive time till effective
1-5st days of cycle = immediate
> 5 days from cycle or >3hrs missed pill: 2 days
Risk factors for Ovarian Ca
- FHx - BRCA1 or BRCA 2 gene
- manu ovulations = early menarch, late menopause, nulliparity
Clinical fts of ovarian Ca
notoriously vague:
- abdo distention/bloating
- abdo/pelvic pain
- urinary - i.e urgency
- early satiety
- diarrhoea
