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Phase 4 Question Knowledge > Gynae > Flashcards

Gynae Flashcards

1
Q

Bartholin’s cyst / abscess

A

Fluid filled sac in one of Bartholin’s glands

Gland blocked - mucus build up - cyst

Infected - abscess - E coli, MRSA, STIs

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2
Q

Bartholin’s cyst / abscess Px

A

Cyst
- soft, fluctuant, non-tender mass
- vulvar pain walking / sitting
- superficial dyspareunia
- sudden relief (rupture)

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3
Q

Bartholin’s cyst / abscess Ix

A

Clinical dx

> 40yo biopsy - r/o cancer

Endocervical + high vagina; swabs - STI

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4
Q

Bartholin’s cyst / abscess Mx

A

Small - warm baths may stimulate rupture

Word catheter - incise, insert catheter, leave for 4-6wks, tract forms (not for deep cysts)

Marsupialisation - cut into, suture up - under GA

Also silver nitrate cautery, needle aspiration, CO2 laser

Abscess - abx

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5
Q

Stress incontinence

A

Involuntary leakage of urine with increased intra-abdo pressure

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6
Q

Stress incontinence Px

A

Urine leakage on exertion

Coughing, sneezing, exercise

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7
Q

Stress incontinence Ix

A

R/o UTI - urine dip + culture

Freq/vol chart

Urodynamic studies - r/o detrusor overactivity

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8
Q

Stress incontinence Mx

A

Wt loss, reduce caffeine, stop smoking

Pelvic floor muscle training

Surgical- Tension free vaginal tape

Duloxetine - enhanced contraction of urethral sphincter- if women decline surgical procedure

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9
Q

Urge incontinence

A

Overactive bladder - freq, urg, nocturia - detrusor overactivity

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10
Q

Urge incontinence Px

A

Urgency, frequency, nocturia

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11
Q

Urge incontinence Ix

A

R/o UTI
Freq/vol chart - shows increased freq
Urodynamic studies

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12
Q

Urge incontinence Mx

A

reduce fluids, caffeine

Bladder retraining

Anticholinergics - oxybutynin / solifenacin / tolterodine

Mirabegron

Botox

Surgical mx (detrusor myomectomy) if debilitating sx

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13
Q

Pelvic organ prolapse

A

Descent of pelvic organs into vagina - from weakness / lengthening of ligaments / muscles

Uterine prolapse - uterus descends

Vault prolapse - post-hysterectomy - top of vagina descends

Rectocele - defect in posterior vaginal wall - rectum prolapses

Cystocele - defect in anterior vaginal wall - bladder prolapses

urethrocele - urethra prolapses

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14
Q

Pelvic organ prolapse Px

A

Dragging sensation, something coming down

Urinary sx - incontinence, urgency, freq, weak stream, retention

Bowel sx - incontinence, constipation, urgency

Sexual dysfunction - pain, altered sensation

Lump / mass in vagina

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15
Q

Pelvic organ prolapse exam

A

Use Sim’s speculum, empty bladder / bowel first

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16
Q

Pelvic organ prolapse Mx

A

Pelvic floor exercises, wt loss…

Pessaries

Surgery

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17
Q

Lichen sclerosus

A

Chronic inflammation (?autoimmune) of genitalia usually

more common in elderly F

Atrophy of epidermis + white plaques

Increased vulvar SCC risk

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18
Q

Lichen sclerosus Px

A

White patches
Scarring
Itch
Dyspareunia, dysuria
Sx worse with friction (Koebner)

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19
Q

Lichen sclerosus Ix

A

Clinical
Biopsy if atypical, ?malignancy, no tx response

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20
Q

Lichen sclerosus Mx

A

Topical steroids - clobetasol

Emollients

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21
Q

Ovarian cysts

A

Fluid filled sac in ovary

Common, benign mostly

Simple - fluid only
Non-neoplastic - no malignant potential
Neoplastic - malignant potential

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22
Q

Ovarian cysts / tumours RFs

A

Nulliparity (more ovulations), early menarche, late menopause, smoking, obesity, HRT with oestrogen only

BRCA 1+2 - breast, ovarian ca
HNPCC - colorectal, endometrial, ovarian ca

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23
Q

Ovarian cysts / tumour protective factors

A

Multiparity, combined contraception, breastfeeding

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24
Q

Ovarian cysts Px

A
  • Asym
  • Chronic pain - frequency, constipation, bloating, dyspareunia
  • Acute pain - bleed / rupture / torsion
  • PV bleed
  • Wt loss - cancer
  • Abdo mass, ascites
  • Adnexal masses, cervical excitation
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25
Ovarian cysts Ix
CA125 USS Calculate risk of malignancy index (RMI) - menopausal status + US findings + CA125 level <40yo - bloods for ?germ cell tumour - LDH, alpha-fetoprotein, hCG
26
Ovarian cyst Mx
Pre-menopause - Monitor with rpt US / CA125 - Persistent / >5cm - laparoscopic cystectomy / oophorectomy Post-menopause - RMI <25, <5cm - 1yr follow up with USS + CA125 - RMI 25-250 - oophorectomy / hysterectomy / omentectomy / lymphadenectomy - RMI >250 - staging laparotomy
27
Meig's syndrome
Benign ovarian fibroma (mass) + pleural effusion + ascites Typically older women Remove tumour - effusion + ascites resolve
28
Ovarian cancer
Malignant tumour of ovary Can be surface derived, germ cell, sex-cord stromal, mets
29
Ovarian cancer Px
Abdo / pelvic pain Abdo distension / bloating Urinary sx - urgency Diarrhoea Early satiety, weight loss, anorexia Abdo mass
30
Ovarian cancer Ix
Bloods, inc CA125, (aFP + hCG if <40yo) Abdo / pelvic USS CT / CXR - staging
31
FIGO staging Ovarian cancer
1 - ovary 2 - spread to pelvis 3 - spread to abdo 4 - spread past abdo
32
Ovarian cancer Mx
Surgery - staging laparotomy Chemo Follow up for 5yrs
33
PCOS
Excess androgens + multiple immature follicles (cysts) in ovaries
34
PCOS Patho
- Multifactorial cause - Excess LH (from ant pit) -> ovaries produce excess androgens - Insulin resistance - high insulin - supresses hepatic production of sex hormone binding globulin (SHBG) - higher levels of free androgens - androgens suppress LH surge + ovulation - follicles develop in ovary, arrested at early stage - remain as cysts
35
PCOS Px
- Oligomenorrhoea, amenorrhoea - Infertility - Hirsutism - Obesity - Chronic pelvic pain - Depression - Acne, acanthosis nigricans, male pattern hair loss, HTN
36
PCOS DDx
Hypothyroid Hyperprolactinaemia Cushing's
37
PCOS Dx - Rotterdam Criteria
Dx if 2/3 of: - Oligo +/-anovulation - clinical / biochemical signs of hyperandrogenism - polycystic ovaries on imaging
38
PCOS Ix
- Testosterone raised, SHBG low, LH raised, FSH normal, progesterone low - LH:FSH raised - TFTs, serum prolactin - Pelvic USS - peripheral ovarian follicles - string of pearls appearance - OGTT
39
PCOS Mx
Oligomenorrhoea - With anovulation - low progesterone -> unopposed oestrogen => endometrial hyperplasia + malignancy risk - need to induce bleeds to prevent this: - cOCP - Dydrogesterone (progesterone analogue) Infertility - Clomifene +/- metformin -> induce ovulation - Laparoscopic ovarian drilling - Gonadotrophins Hirsutism - Cosmetic - Anti-androgens - cyproterone, spironolactone, finasteride - Eflornithine - cream for facial hair Obesity - Diet, exercise - Orlistat
40
Adenomyosis
Growth of endometrial tissue in myometrium - benign tends to be multiparous, older women
41
Adenomyosis Px
- Dysmenorrhoea - cyclical -> daily - Menorrhagia - Deep dyspareunia - Irregular bleeding - Symmetrically enlarged, boggy uterus
42
Adenomyosis Ix
TVUS MRI Histology after hysterectomy - definitive
43
Adenomyosis Mx
NSAIDs, TXA + mefenamic acid for sx Hormone therapy for cycle control - cOCP, progestogens, GnRH agonist, aromatase inhibitor Hysterectomy - curative Uterine artery embolisation - short term to preserve fertility (block blood supply to adenomyosis)
44
Endometrial cancer
Tumour of endometrium Mostly adenocarcinoma From unopposed oestrogen (no progesterone)
45
Endometrial cancer RFs
Obesity, nulliparity, early menarche, late menopause Unopposed oestrogen (so add progesterone to HRT to prevent) DM, tamoxifen, PCOS HNPCC- hereditary non-polyposis colorectal carcinoma- also known as lynch syndrome cOCP + smoking + multiparity - protective
46
Endometrial cancer Px
PMB - post-menopausal bleeding Intermenstrual bleeding (IMB) (pre-menopause) Pain, discharge Abdo pelvic masses, vaginal atrophy
47
Endometrial cancer Ix
All women >55 with postmenopausal bleeding should be referred TVUS - endometrial thickness should be <4mm Pipelle biopsy Hysteroscopy, endometrial biopsy
48
FIGO endometrial cancer staging
1 - in uterus 2 - spread to cervix 3 - spread to pelvis 4 - bladder/bowel/further
49
Endometrial cancer Mx
Hysterectomy + bl salpingo-oophorectomy Chemo / radio if mets Progesterone therapy - if frail / not fit for surgery
50
Endometrial hyperplasia
Abnormal PV bleed - eg IMB Progestogens (eg Mirena), rpt sample 3-4mo Surgery if atypical hyperplasia - dilatation + curettage
51
Endometriosis
Growth of endometrial tissue outside uterus Tissue is sensitive to oestrogen - cyclical sx
52
Endometriosis Px
- Cyclical pelvic pain - at menstruation - secondary dysmenorrhoea - pain days after bleeding - Deep dyspareunia - Subfertility - Non-gynae sx - dysuria, urgency, haematuria, dyschezia... Pelvic exam - fixed retroverted uterus, tender nodularity in posterior fornix, visible lesions
53
Endometriosis Ix
Laparoscopy US not useful
54
Endometriosis Mx
NSAIDs +/- paracetamol cOCP, progesterones GnRH analogues - reduce oestrogen, induce pseudomenopause Surgical laparoscopic excision, laser tx, hysterectomy
55
Uterine fibroids
Benign smooth muscle tumours of uterus - leiomyomas Intramural, submucosal, subserosal RFs - Afro-Carribean, obesity, early menarche, FHx Develop in response to oestrogen
56
Fibroids Px
- Asym - Heavy menstrual bleeding (HMB), anaemia - Lower abdo pain - Bloating - Urinary frequency - Subfertility - Polycythaemia rarely - Solid mass / enlarged uterus on examination
57
Fibroids Ix
TVUS Hysteroscopy MRI (if ?malignancy)
58
Fibroids Mx
Medical - TXA, mefenamic acid - Hormonal contraception - control HMB - GnRH analogue - suppress ovulation Surgical - Endometrial ablation - Fibroid resection - Myomectomy - Uterine artery embolisation - Hysterectomy
59
Fibroids Cx
Regress after menopause Red degeneration - Ischaemia, infarction, necrosis of fibroid - disrupted blood supply - Abdo pain, fever, tachycardia, vomiting - Supportive mx
60
Heavy menstrual bleeding (HMB)
Excessive menstrual blood loss which interferes with QoL
61
Abnormal uterine bleeding (AUB) causes
PALM - structural - Polyp - endometrial / cervical - Adenomyosis - Leiomyoma (fibroid) - Malignancy, hyperplasia COEIN - non-structural - Coagulopathy - Ovulatory dysfunction - PCOS, hyperthyroid, anorexia, athletes - Endometrial - Iatrogenic - hormonal contraception, HRT, post-surgery - Not yet classified - PID, endometriosis, trauma, FB HMB - miscarriage / ectopic - as above
62
HMB Px
Excessive PV bleed at menstruation Fatigue COB ?pallor, assess for inflamed cervix, pelvic masses....
63
HMB Ix
- Pregnancy test - Bloods - FBC, TFT, hormones (PCOS), coag, vWF... - TVUS - Cervical smear - Swabs - infection - high cervical + endometrial - Pipelle endometrial biopsy - if persistent bleed, >45yo - Hysteroscopy + biopsy
64
HMB Mx
1. Mirena - thin endometrium, shrink fibroids 2. TXA / mefenamic acid / cOCP 3. Progesterone only - POP, depo, implant - oral on d5-26 of cycle, not acting as contraception Surgical - endometrial ablation (if no longer wanting to conceive) - hysterectomy
65
Primary dysmenorrhoea
Painful periods / lower abdo pain, no underlying pathology Prostaglandins -> spiral artery vasospasm, myometrial contractions => pain
66
Secondary dysmenorrhoea
Painful periods associated with pathology Endometriosis, adenomyosis, PID, intrauterine devices, fibroids
67
Primary dysmenorrhoea Px
Lower abdo / pelvic pain - starts just before period Malaise, N+V, diarrhoea, dizzy Examination unremarkable
68
Primary dysmenorrhoea Ix
R/o pathology - eg swabs for infection, TVUS
69
Primary dysmenorrhoea Mx
Stop smoking, analgesia Monophasic cOCP Mirena Water bottles, heat patch TENS - transcutaneous electrical nerve stimulation
70
Post-coital bleeding causes
50% no pathology Cervical ectropion (more common on cOCP) Cervicitis - infections Cancer Polyps Trauma
71
Post-menopausal bleeding (PMB)
PV bleed after >12mo amenorrhoea
72
PMB causes
- Vaginal atrophy - endometrial hyperplasia - endometrial / cervical / ovarian / vaginal / vulval cancer - Trauma
73
PMB Ix
- PMB >55yo -> TVUS <2wks for ?endometrial cancer (<5mm thickness acceptable) - Hysteroscopy + biopsy if uncertain / anything found
74
PMB Mx
Tx cancer Change HRT Tx vaginal atrophy
75
Cervical polyps
Benign growths on inner surface of cervix, malignant potential
76
Cervical polyps Px
Asym PV bleed, discharge Rarely block os - infertility May project through os - see on speculum
77
Cervical polyps Ix
Triple swabs - r/o infection - endocervical + high vaginal Cervical smear - r/o CIN Biopsy - definitive
78
Cervical polyps Mx
Remove - polypectomy forceps / in colposcopy clinic
79
Cervical ectropion
Eversion of endocervix - columnar epithelium (bleeds easily) Commonly seen when taking oestrogen contraceptives
80
Cervical ectropion Px
Asym PV bleed - post-coital, IMB Discharge Speculum - red appearance
81
Cervical ectropion Ix
Clinical dx pregnancy test, triple swabs, cervical smear
82
Cervical ectropion Mx
No tx unless sx Stop cOCP Ablation of tissue
83
Cervical cancer
Cancer of cervix 70% SCC, 15% ACC, 15% mixed Develops from cervical intraepithelial neoplasia (CIN) Majority caused by HPV Mets to lung, liver, bone, bowel
84
Cervical intraepithelial neoplasia (CIN)
Dyskaryosis - cell mutations in transformational zone of cervix, (cells already transforming from squamous -> columnar) Tx - large loop excision of transformational zone (LLETZ)
85
HPV in cervical cancer
HPV 16 + 18 high risk, 6 + 11 low risk Vaccinate to prevent
86
Cervical cancer RFs
HPV Smoking STIs >8yrs cOCP use Immunodeficiency
87
Cervical screening
Speculum, brush transformational zone, send for HPV screen, liquid based cytology for dyskaryosis 24.5yo - first invitation 25-49yo - 3yrly screening 50-64yo - 5yrly screening >65yo - if recent smear / no screening since 50yo
88
Cervical screening results
HPV -ve - continue as routine HPV +ve, normal smear - rpt smear 12mo - if still HPV +ve + normal smear - rpt again in 12mo - if still HPV +ve normal smear at 24mo - colposcopy - if HPV -ve at 24mo test - back to routine If HPV +ve, abnormal smear - colposcopy If inadequate smear - rpt 3mo - if still inadequate - colposcopy Include transgender men / non-binary individuals in screening Pregnant women - delay screening until 12wks post-partum
89
Cervical cancer Px
- Asym - Abnormal PV bleed - PV discharge - Dyspareunia - Pelvic pain - Wt loss - Local invasion - oedema, loin pain, PR bleed, radiculopathy, haematuria, urinary retention - Pelvic mass on bimanual
90
Cervical cancer Ix
- Colposcopy - magnify cervix, take biopsy - Premenopause - Ix + Tx for chlamydia - if sx ongoing, for colposcopy - Post-menopause - urgent colposcopy + biopsy CT / MRI / PET Examination / biopsy under GA
91
Cervical cancer FIGO staging
0 - in situ 1 - cervix 2 - pelvis 3 - vagina 4 - bladder, rectum, mets
92
Cervical cancer Mx
Surgery - Trachelectomy - remove cervix + upper vagina - preserve fertility - Laparoscopic hysterectomy + pelvic lymphadenectomy - Remove all organs Radiotherapy Chemotherapy
93
Vulval carcinoma
Rare, 90% SCC, rest BCC... RFs - HPV, lichen sclerosis, lichen planus, smoking...
94
Vulval carcinoma Px
Pruritis, burning, soreness, bleed, pain, lump Unifocal lesion on labia majora / clitoris / perineum
95
Vulval carcinoma Ix
Biopsy Staging 1 - vulva 2 - vagina (lower 1/3) / urethra / anus 3 - upper 2/3 vagina / bladder / rectal / lymph nodes 4 - distant mets
96
Vulval carcinoma Mx
Surgical resection +/- lymphadenectomy Small - wide local excision Advanced - radical vulvectomy
97
Ovarian torsion
Ovary twists - compromise blood supply - ischaemia, necrosis Adnexal torsion - involves fallopian tube Often mass present
98
Ovarian torsion Px
Sudden onset colicky abdo / pelvic pain, unilateral N+V, distress Fever (minority) Adnexal tenderness on VE, palpable mass
99
Ovarian torsion Ix
Bloods - bhCG, abdo bloods USS - free fluid / whirlpool sign
100
Ovarian torsion Mx
Laparoscopy - dx and tx Detorsion +/- oophorectomy
101
PID
Infection / inflammation of female pelvic organs - uterus, fallopian tubes, ovaries, peritoneum
102
PID causes
Chlamydia- most common Gonorrhoea Mycoplasma genitalium / hominis
103
PID Px
- Lower abdo / pelvic pain - Fever - Deep dyspareunia - Dysuria - Abnormal PV bleed - Dysmenorrhoea - PV discharge - Cervical motion tenderness
104
PID Ix
Pregnancy test - r/o ectopic High vaginal swab Chlamydia / gonorrhoea screen
105
PID Mx
- IM ceftriaxone stat + oral doxycycline 14d + oral metronidazole 14d OR oral ofloxacin + oral metronidazole Admit if septic, consider removal of coils Drain any abscess
106
PID Cx
Perihepatitis - Fitz-Hugh Curtis syndrome - inflammation of liver capsule from infection spread, adhesions form - RUQ pain Infertility Chronic pelvic pain Ectopic
107
Primary amenorrhoea
Failure to establish menstruation - by 15yo if secondary sexual characteristics - by 13yo if none
108
Secondary amenorrhoea
Cessation of menses where previously normal - 3-6mo if previously normal - 6-12mo if previous oligomenorrhoea
109
Oligomenorrhoea
Irregular periods
110
Primary amenorrhoea causes
Turner's testicular feminisation anatomical abnormality anorexia exercise CAH imperforate hymen AIS Kallman thyroid
111
Secondary amenorrhoea causes
Stress exercise PCOS hyperprolactinaemia premature ovarian failure thyrotoxicosis Sheehan's Ashermann's pregnancy
112
Oligomenorrhoea causes
PCOS, contraception, perimenopause, thyroid disease, DM, anorexia, exercise, meds
113
Amenorrhoea Ix
- Pregnancy test - FBC, U/E, coeliac, TFTs, prolactin, FSH, LH, oestradiol, progesterone, testosterone, 17-hydroxyprogesterone - Low FSH / LH - hypothalamic problem - Raised - ovarian problem (eg Turners) - Karyotype - if ?genetic - USS - ovaries, pelvic anatomy - Progesterone challenge test - elicit withdrawal bleed - if bleed, suggests enough oestrogen, but not ovulating (eg PCOS) - no bleed, low oestrogen / outflow obstruction
114
Amenorrhoea Mx
Tx cause Contraception to regulate periods HRT if ovarian insufficiency
115
Premenstrual syndrome (PMS)
Emotional / physical sx during luteal phase of menstrual cycle
116
PMS Px
Anxiety, stress, fatigue, mood swings, bloating, breast pain, headaches
117
PMS Ix
Sx diary - cyclical
118
PMS Mx
Stop smoking, exercise, sleep well, regular small balanced meals Paracetamol / ibuprofen COCP - Yasmin brand SSRI if severe - continuous / during luteal only CBT
119
Premature ovarian insufficiency (POI)
Menopause onset + elevated gonadotrophins <40yo
120
POI causes
Idiopathic Bl oophorectomy Radio / chemo Infection, eg mumps Autoimmune Resistant ovary syndrome - FSH receptor pathology
121
POI Px
Menopause - hot flushes, night sweats, vaginal dryness, infertility Secondary amenorrhoea / oligomenorrhoea
122
POI Ix
Bloods - Raised FSH, raised LH, low oestradiol Raised FSH levels should be demonstrated on 2 blood samples taken 4-6 weeks apart
123
POI Mx
HRT Offer cOCP until age of menopause
124
Bicornuate uterus
2 horns to uterus - heart shaped Dx on US Risk of miscarriage, premature birth, malpresentation
125
Imperforate hymen
Hymen at vaginal entrance formed, not open Cyclical pelvic pain, no PV bleed Surgical incision to tx
126
Transverse vaginal septae
Septum across vagina - perforate - with hole, difficulty with intercourse - imperforate - sealed + cyclical pelvic pain without blood Dx on US / exam Tx - surgery
127
Vaginal hypoplasia + agenesis
Hypoplasia - abnormally small vagina Agenesis - absent vagina Ovaries usually unaffected Mx - vaginal dilator / surgery
128
Asherman's syndrome
Adhesions in uterus after damage - eg surgery, miscarriage
129
Asherman's syndrome Px
- Recent surgery, endometritis etc - secondary amenorrhoea - lighter periods - dysmenorrhoea - infertility
130
Asherman's syndrome Ix
Hysteroscopy - gold std Hysterosalpingography - contrast injected into uterus, see in XR Sonohysterography - fill uterus with fluid, scan on USS MRI
131
Asherman's syndrome Mx
Dissect adhesions in hsyteroscopy
132
FGM
partial / total removal of external genitalia or injury to female genital organs for non-medical reasons Type 1 Partial / total removal of clitoris +/- prepuce Type 2 as above + labia minora +/- majora Type 3 as above + narrowing of vaginal orifice Type 4 All other harmful procedures - eg scraping, cautery Mx - <18yo - report to police - >18yo - report if F relatives at risk, risk to unborn child - De-infibulation surgery - for type 3
133
Infertility
Start Ix after 12mo unprotected sex trying to conceive (6mo if >35) Causes problems with sperm, ovulation, tubes, uterus.... General advice 400mcg folic acid OD, healthy BMI, avoid smoking / drinking, reduce stress, intercourse every 2-3d, avoid timing sex
134
Infertility Ix
- BMI - STI screen - Semen analysis - Rubella immunity in mum Female hormone testing - On d2-5 of cycle - LH (high - PCOS), FSH (high - low no. of follicles) - Serum progesterone d21 (7d before cycle end) - should rise (ovulation) - Anti-mullerian hormone (high - good ovarian reserve) - TFTs - Prolactin - if galactorrhoea / amenorrhoea Secondary care - US pelvis - hysterosalpingogram - laparoscopy / dye test
135
Infertility Mx
Anovulation - Wt loss - Clomifene - Letrozole - Gonadotrophins - Ovarian drilling - PCOS - Metformin - PCOS Tubal - Tubal cannulation - laparoscopy to remove adhesions... - IVF Uterine - Surgery - correct abnormalities
136
Male factor infertility causes
Pre-testicular - Pituitary / hypothalamus issues - Stress - increased prolactin - Kallman - Low LH / FSH Testicular - Mumps - undescended - trauma - radio / chemo - cancer - Klinefelter Post-testicular - Damage - ejaculatory duct obstruction - retrograde ejaculation - scarring - no vas deferens (CF) - young's syndrome
137
Semen analysis sample
Avoid ejaculation for 3-7d, avoid hot baths, deliver to lab <1hr, keep warm Rpt in 3mo if abnormal Look at sperm count etc
138
Male factor infertility Ix
- Abnormal semen - urology referral - hormone testing - LH, FSH, testosterone - genetic testing - transrectal US / MRI - vasography - inject contrast into vas deferens, XR - testicular biopsy
139
Male factor infertility Mx
- surgical sperm retrieval - surgical correction of vas deferens - intrauterine insemination - intracytoplasmic sperm injection - donor insemination
140
Ovarian hyperstimulation syndrome (OHSS)
Seen with gonadotrophin / hCG tx Multiple luteinised cysts in ovaries -> high oestrogen, progesterone, VEGF -> fluid loss -> oedema, ascites, hypovolaemia, RAAS Px Low BP, diarrhoea, N+V, pleural effusion, renal failure, ascites, VTEs Mx Oral fluids, UO monitoring, paracentesis, IV human albumin solution, ICU tx Prevention monitor serum oestrogen during tx, US monitor follicles, lower hCG / gonadotrophin dose
141
Menopause
Permanent cessation of menstruation - no periods for 12mo - avg age 51yo Take contraception for 12mo after LMP if >50yo, 24mo if <50yo
142
Menopause Px
- menstrual cycle length changes - PV bleeds - hot flushes, night sweats - vaginal dryness + atrophy - urinary frequency - anxiety / depression - brain fog - reduced libido, fatigue Sx can last 7yrs long term - osteoporosis, IHD
143
Menopause Ix
Clinical dx Consider serum FSH (raised) if atypical sx >45yo, 40-45yo with sx, or ?POI <40yo
144
Menopause Mx
- Exercise, wt loss - HRT - vasomotor sx - fluoxetine, citalopram, venlafaxine, clonidine - vaginal lubrication - vaginal oestrogen for atrophy (atrophic vaginitis - dry, pain, spotting) - vit D supplements post-menopause - 2-5yrs tx, gradually reduce HRT when stopping
145
HRT
- Oral / transdermal patch - If uterus present - give combined HRT (oestrogen + progesterone) - unopposed oestrogens cause endometrial cancer - If still having periods - give cyclical HRT - If no periods for >12mo - give continuous HRT S/Es - Nausea, breast tenderness, fluid retention, wt gain CI's - current / past breast CA - oestrogen-sensitive CA - endometrial hyperplasia Risks - VTE, stroke, coronary heart disease, breast CA, ovarian CA

Phase 4 Question Knowledge (36 decks)

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