Gynae Flashcards
1
Q
HRT types
A
oesetrogen + progesterone or oestrogen only
2
Q
oesetrogen + progesterone or oestrogen only
A
types of HRT
3
Q
risks of oestrogen only HRT
A
endometrial hyperplasia –> endometrial cancer
4
Q
endometrial hyperplasia –> endometrial cancer
A
risk of oestrogen only HRT
5
Q
risks of any HRT
A
increased VTE risk in 1st 6/12, increased breast cancer risk after 5 years of treatment
6
Q
increased VTE risk in 1st 6/12, increased breast cancer risk after 5 years of treatment
A
risks of any HRT
7
Q
premature ovarian failure
A
cessation of mentruation for 1 year before 40 years old
8
Q
cessation of mentruation for 1 year before 40 years old
A
premature ovarian failure
9
Q
menstrual phase occurs becuase
A
no ovum has been fertilised, corpus luteum breaks down, therefore cessaton of progesterone production, vasoconstriction of spiral arteries which supply the functional layer of the endometrium, layer necroses + is shed
10
Q
pulsing of what hormone initiates puberty
A
GnRH
11
Q
GnRH pulsation initiates
A
puberty
12
Q
ovarian hyperstimulation S
A
associated with HCG in maturing follicles during IVF, lower abdo discomfort, N, V, abdo distension
13
Q
associated with HCG in maturing follicles during IVF, lower abdo discomfort, N, V, abdo distension
A
ovarian hyperstimulation S
14
Q
1’ amenorrhoea causes
A
Turner’s S, testicular feminisation, congenital adrenal hyperplasia, congenital malformation of the genital tract
15
Q
Turner’s S, testicular feminisation, congenital adrenal hyperplasia, congenital malformation of the genital tract are causes of
A
1’ amenorrhoea
16
Q
2’ amenorrhoea causes
A
periods stop for >6/12 hypothalamic amenorrhoea (stress, excessive exercise), PCOS, hyperprolactinaemia, premature ovarian failure, thyrotoxicosis, Sheehan S (hypopituitarism), Asherman S (intrauterine adhesions)
17
Q
hypothalamic amenorrhoea (stress, excessive exercise), PCOS, hyperprolactinaemia, premature ovarian failure, thyrotoxicosis, Sheehan S (hypopituitarism), Asherman S (intrauterine adhesions) are causes of
A
2’ amenorrhoea
18
Q
mittelschmerz is
A
mid cycle pain, sharp
19
Q
endometriosis is
A
growth of ectopic endometrial tissue o/s of the uterine cavity, ?initiate by retrograde menstruation spreading endometrical cells w/i the pelvis
20
Q
ovarian torsion is
A
sudden onset, deep colicy pain, V, distress
21
Q
pelvic pain differentials
A
endometriosis, PID, migraine, lower back pain, adenomyosis, adhesions, ectopic, ovarian torsion, appendicitis, IBS, cystitis, depression, sleep disorders, abuse (past + present)
22
Q
amenorrhoea differentials
A
1’: delayed puberty, PCOS, Turner’s S, imperforated hymen, transverse vaginal septum
2’: pregnancy, menopause, lactation, iatrogenic (progestogens, GNRH analogues, some antipsychotics), premature menopause, PCOS, hyperprolactinaemia (pituitary hyperplasia, benign adenoma), hypothalamic hypogonadism (low BMI, excessive exercise, tumour), thyroid dysfunction
23
Q
dysmenorrhoea differentials
A
idiopathic (common), fibroids, adenomyosis, endometriosis, PID, ovarian tumours
24
Q
menorrhagia differentials
A
subjective to PTs beliefs, idiopathic, fibroids, polyps, coagulopathy, adenomyosis, malignancy
25
PCB differentials
cervical ectropion, polyps, CIN, cervicitis, vaginitis
26
infertility differentials
female factors: ovulation (PCOS, hypothalamic hypogonadism, hyperprolactinaemia, premature ovarian faliure), fallopian tube (PID, endometriosis, previous Sx), cervical, implantation
male factors: sperm numbers, motility, morphology (smoking, EtOH, drugs, chemical exposure, genetics, idiopathic)
both: sexual (ED, dyspareunia)
27
PMB differentials
endometrial cancer, cervical cancer, premalignant endometrial hyperplasia, sequential HRT, atrophic vaginitis, polyps, cervicitis, ovarian carcinoma
28
IMB differentials
anovulatory cycles, fibroids, polyps, adenomyosis, ovarian cysts, chronic pelvic infection, STI, miscarriage
29
oligomenorrhoea
infrequent periods -/- 35/7-6/12 between periods
30
PMB is
bleeding 1 year post-menopause
31
menorrhagia history
menstrual calendar, flooding, clots, IMB, PCB, dysmenorrhoea, bleeding from elsewhere (PR), contraception use
32
menorrhagia O/E
anaemia, enlarged uterus - fibroids, tenderness - adenomyosis
33
adenomyosis is
endometruim breaks through the myometrium of uterus leading to cramps, menorrhagia, abdominal pressure and bloating
34
endometruim breaks through the myometrium of uterus leading to cramps, menorrhagia, abdominal pressure and bloating
adenomyosis
35
menorrhagia investigations
FBC, clotting, TFT, TVUS, hysteroscopy, biopsy
36
menorrhagia management
mirena coil (IUS), tranexamic acid (just during menstruation), mefanamic acid (NSAID), COCP, progestogens (high does/IM), GNRH agalogues (reduce size of fibroid), surgery: polyp removal, endometrial ablation, rescection (fibroids), myomectomy (fibroids), hysterectomy, uterine artery embolisation
37
TVUS uterus wall thickness "too thick"
>10mm premenopausal, >4mm postmenopausal
38
IMB investigations
if appropriate: FBC, urine dip, STI screen, TVUS, hysteroscopy, biopsy
39
IMB management
IUS, COCP, high dose progestogen, HRT, surgery
40
amenorrhoea management
supportive, COCP, HRT, correcting organic cause
41
PCB investigations
speculum, smear, colposcopy if necessary
42
PCB management
polyp: avulsion, ectropion: frozen, LLETZ if appropriate etc
43
dysmenorrhoea is
painful periods, associated with high prostaglandin levels due to contraction + uterine ischaemia
44
dysmenorrhoea history
where in cycle?, relieved by menstruation?, dyspareunia, menorrhagia, oligomenorrhoea, PCB, IMB, STI Hx
45
dysmenorrhoea management
NSAIDs, COCP, reassurance in idiopathic, treat cause in pathology
46
subfertility definition
failure to conceive after 1y of regular unprotected sex
47
1' vs 2' subfertility/infertility
1' means that the person has never conceived, 2' means that the person had previously conceived (even if resulted in miscarriage)
48
infertililty investigations
serum progesterone (high mid-luteal = ovulation), TVUS, FSH (high in ovarian failure, low in hypothalamic DZ, N in PCOS), prolactin (prolactinoma), TSH, LH (high in PCOS), testosterone, semen analysis (repeat in 3/12), laproscopy + dye test, hysterosalpingogram
49
luteal phase is
14 days prior to menstruation e.g. days 14-28 of a 28d cycle
50
mid luteal phase is
day 21 of a 28 day cycle
51
infertility management
lifestyle changes, treat cause, induction of ovulation, IUI, ICSI as part of IVF cycle, counselling
52
complications of assisted conception
multiple pregnancies, ovarian hyperstimulation S, intraperitoneal haemorrhage, infection, ectopic, ch/genetic abnormalities
53
PMB investigations
bimanual, speculum, smear, TVUS, hysteroscopy, biopsies (Pipelle or during hysteroscopy)
54
gynae history
PC, HPC (menstruation: cycle l, ir/regular, heavy, painful, LMP, IMB, PCB, PMB, urinary: f, nocturia, urgency, accidents, associations, dysuria, haematuria, prolapse: heavy, dragging sensation, palpable mass), ICE, O+GH (smear, pregnancies, mode of delivery), sexual (active, discharge, dysuria, rash, dyspareunia), C, PMH, PSH, DH + A, SH, FH
55
pre-cancerous state in cervix
CIN cervical intraepithelial neoplasm
56
CIN cervical intraepithelial neoplasm
precancerous state in cervix
57
CIN is only diagnosable on
biopsy
58
explaining colposcopy
day case, Dr/nurse specialist, speculum, special misroscope (doesn't enter vagina), stain, swab, biopsy (1/52 turnaround), 15-20 mins, can work same day, some bleeding/discharge 3-5/7, bring pad, avoid sex, tampons, pessaries, creams 24h beforehand + until bleeding stops
59
colposcopy biopsy result may result in
diathermy, laser, excision depending on result
60
complications of cervix treatment
premature labour - contact GP if get pregnant, ?cervical l scan
61
premature labour - contact GP if get pregnant, ?cervical l scan
complication of cervical treatment
62
most common type of primary ovarian cancer
epithelial cell carcinoma
63
grading of ovarian carcinoma
boarderline - high grade
64
most common type of primary ovarian cancer in <30 y.o.
germ cell tumour
65
risk factors for ovarian cancer
early menarche, late menopause, nulliparity, FH, benign cysts (can undergo malignant change), HNPCC, BRCA mutation
66
protective factors for ovarian cancer
pregnancy, lactation, COCP
67
epithelial cell carcinoma is the most common type of
ovarian cancer
68
germ cell tumour is the most common type of
ovarian cancer in >30 y.o.
69
early menarche, late menopause, nulliparity, FH, benign cysts (can undergo malignant change), HNPCC, BRCA mutation are risk factors for
ovarian cancer
70
pregnancy, lactation, COCP are protective factors for
ovarian cancer
71
ovariam cancer symptoms
persistent bloating, early satiety, LOA, pelvic/abdo pain, weight loss, fatigue, change in bowel habits, urinary f, urgency
72
persistent bloating, early satiety, LOA, pelvic/abdo pain, weight loss, fatigue, change in bowel habits, urinary f, urgency
ovarian ca
73
ovarian ca investigations
abdo examination, bimanual, CA125 (>50 y.o.), AFP + hCG (<40 y.o. - germ cell markers), TAUS
74
risk calculation in ovarian ca
RMI - risk of malignancy index
75
RMI
US score x menopausal state x CA125
76
US score features
multilobular cysts, solid areas, mets, ascites, bx lesions
77
RMI - risk of malignancy index
used in ovarian ca to decide whether to refer to specialist MDT
78
US score x menopausal state x CA125
RMI
79
multilobular cysts, solid areas, mets, ascites, bx lesions
features on TAUS that contribute 1 point to US score for RMI
80
ovarian ca management
Sx (TAH + BSO + partial omentectomy + LN biopsy/removal), potential for fertility-sparing Sx in boarderline DZ, chemo (carboplatin/cisplatin for high grade), follow up CA125, palliative care
81
ovarian ca staging
1 - ovaries only, 2 - pelvis only, 3 - abdo + pelvis, 4 - distant spread, inc liver
82
PMB must rule out
endometrial ca
83
endometrial ca risk factors
age (60 y.o.), nulliparity, unopposed oestrogen therapy (6x increase), early menarche, late menopause, obesity, DM, tamoxifen, PCOS, ovarian granulosa cell tumour (oestrogen secreting)
84
age, nulliparity, unopposed oestrogen therapy, early menarche, late menopause, obesity, DM, tamoxifen, PCOS are risk factors for
endometrial ca
85
after the menopause submucosal fibroids usually
calcify
86
calcification of which fibroids usually occurs after the menopause
submucosal
87
endometrial ca investigations
TVUS, measure thickness, hysteroscopy, biopsy, Pipelle biopsy, MRI, CXR
88
management of endometrial ca
TAH + BSO, post-op external beam radiotherapy in high risk DZ
89
vaginal atrophy presentation
dyspareunia, dryness, PCB
90
endometrial hyperplasia
abnormal proliferation of endometrium, presents with IMB, PMB, menorrhagia, irregular bleeding
91
rish factors for endometrial hyperplasia
obesity
92
abnormal proliferation of endometrium, presents with IMB, PMB, menorrhagia, irregular bleeding
endometrial hyperplasia
93
fibroids symptoms
asymptomatic, menorrhagia, infertility, abdo mass, pain (if torsion), dysuria, hydronephrosis, constipation, sciatica, bloating, dysmenorrhoea, urinary retention
94
asymptomatic, menorrhagia, infertility, abdo mass, pain, dysuria, hydronephrosis, constipation, sciatica, bloating symptoms of
fibroids
95
fibroids management
IUS, tranexamic acid, COCP, NSAIDs, progesteroenes, Sx (myomectomy, hysteroscopic endometrial ablation, hysterectomy)
96
fibroids associations
most common near the menopause, rare before puberty + after menopause, more common in Afro-Carribeans, FH
97
most common near the menopause, rare before puberty + after menopause, more common in Afro-Carribeans, FH
fibroids
98
fibroids investigations
TVUS, MRI, laparoscopy (differentiate from an ovarian mass/adenomyosis)
99
benign conditions that can raise CA125
endometriosis, menstruation, benign ovarian cysts
100
premature ovarian failure
menopausal symptoms <40 y.o.
| symptoms: hot flushes, night sweats, infertility, 2' amenorrhoea, raised FSH, raised, LH
101
hot flushes, night sweats, infertility, 2' amenorrhoea, raised FSH, raised, LH
premature ovarian failure
102
premature ovarian failure causes
idiopathic, chemo, radiation, AI
103
premenopausal ovarian masses
follicular/lutein cyst, dermoid cyst, endometriomas, benign epithelial tumour
104
follicular/lutein cyst, dermoid cyst, endometriomas, benign epithelial tumour most common massees in
premenopausal
105
post menopausal ovarian masses
benign epithelial tumour, ca
106
benign epithelial tumour, ca most common masses in
postmenopausal
107
types of cyst
physiological/functional cysts, benign germ cell tumours, benign epithelial tumours
108
physiological/functional cyst comprise
follicular cysts + corpus luteum cysts
109
follicular cyst
commonest, due to non-rupture of the dominant follicle/failure of atresia in non-dominant follicle, regress after several menses
110
corpus luteum cyst
instead of corpus luteum breaking down if no pregnancy it fills with blood/fluid, intraperitoneal bleeding
111
benign germ cell tumours comprise
dermoid cysts aka mature cystic teratomas
112
dermoid cysts
lines with epithelial tissue (therefore may contain skin, hair, teeth), > common benign ovarian tumour in >30 y.o., asymptomatic, torsion risk
113
benign epithelial tumours comprise
serous cystadenoma + mucinous cystadenoma
114
serous cystadenoma
bears resemblance to serus carcinoma (most common type of ovarian ca)
115
mucinous cystadenoma
large, may become massive, rupture may cause pseudomyxoma peritonei
116
pseudomyxoma peritonei
cancerous cells producing abundant mucin or gelatinous ascites
117
follicular cysts + corpus luteum cysts are
physiological/functional cysts
118
commonest, due to non-rupture of the dominant follicle/failure of atresia in non-dominant follicle, regress after several menses
follicular cyst
119
instead of corpus luteum breaking down if no pregnancy it fills with blood/fluid, intraperitoneal bleeding
corpus luteum cyst
120
dermoid cysts aka mature cystic teratomas are
benign germ cell tumours
121
lines with epithelial tissue (therefore may contain skin, hair, teeth), > common benign ovarian tumour in >30 y.o., asymptomatic, torsion risk
dermoid cyst
122
serous cystadenoma + mucinous cystadenoma are
benign epithelial tumours
123
bears resemblance to serus carcinoma (most common type of ovarian ca)
serous cystadenoma
124
large, may become massive, rupture may cause pseudomyxoma peritonei
mucinous cystadenoma
125
cancerous cells producing abundant mucin or gelatinous ascites
pseudomyxoma peritonei
126
cysts in early pregnancy
usually physiological, resolve from 2nd trimester, reassurance
127
whirl pool sign on US
ovarian torsion or bowel volvulus
128
endometrial ca is most commonly what type of ca
adenocarcinoma
129
endometrial ca risk factors are "broadly speaking" due to
high oestrogen:progesterone ratio
| endometrial ca develops when there's high oestrogen/when oestrogen therapy = unopposed by progesterone
130
how does obesity increase risk of endometrial ca
peripheral conversion of androgens to oestrogens
131
peripheral conversion of androgens to oestrogens is the mechanism whereby
obesity contributes to endometrial ca risk
132
how does PCOS increase risk of endometrial ca
prolonged periods of amenorrhoea
133
prolonged periods of amenorrhoea is the mechanism whereby
PCOS contributes to endometrial ca risk
134
protective factors for endometrial ca
COCP, pregancy
135
endometrial ca presentation
PMB, in premenopausal women: oligomenorrhagia, IMB, recent onset menorrhagia, abnormal smear
136
stage 1 endometrial ca
confined to uterus
137
stage 2 endometrial ca
uterus + cervix
138
stage 3 endometrial ca
invaded through uterus
139
stage 4 endometrial ca
distant spread
140
Nexplanon/Implanon
forms of implant
141
forms of implant
Nexplanon/Implanon
142
implant mechanism of action
slow release progesterone, prevents ovulation, thickens cervical mucus
143
pros of the implant
highly effective, long lasting (3 yrs), no oestrogen (no VTE, migraine risk)
144
cons of the implant
professional needs to insert/remove, 7/7 until it's effective, irregular/heavy periods, headache, N, breast pain
145
long term complications of PCOS
subfertility, DM, stroke, TIA, CAD, OSA, endometrial ca
146
subfertility, DM, stroke, TIA, CAD, OSA, endometrial ca are long term complications of
PCOS
147
features of PCOS
subfertility/infertility, oligomenorrhoea/amenorrhoea, hirsuitism, acne, obesity, acanthosis nigricans
148
PCOS investigations
US, FSH, LH, prolactin, TSH, testosterone, OGTT
149
PCOS results
raised LH:FSH, prolactin N/mildly raised, testosterone N/mildly raised
150
cervical ectropion symptoms
PCB, vaginal discharge
151
cervical ectropion causes
elevated oestrogen: COCP, ovulatory phase, pregnancy
152
cervical ectropion management
ablation for troublesome symptoms
153
fibroids aka
leiomyomata
154
leiomyomata aka
fibroids
155
fibroids are
benign tumours of the myometrium
156
benign tumours of the myometrium
fibroids
157
fibroids are rare in
parous women, COCP use, injectable progestogens
158
parous women, COCP use, injectable progestogens rarely get
fibroids
159
types of fibroid
intramural, subserosal (+ subserosal polyps), submucosal (occasionally for intracavity), cervical
160
growth of fibroids is probably dependent on
oestrogen + probably progesterone
161
fibroid complicaitons
torsion of pedunculated fibroid, red degeneration, enlargement in mid-pregnancy, calcification(postmenopausal + asymptomatic), leiomyosarcoma
162
red degeneration of a fibroid
normally due to inadequate blood supply, pain, uterine tenderness, haemorrhage, necrosis
163
pregnancy complications of fibroids
premature labour, malpresentation, transverse lie, obstructed labour, PPH, red degeneration, postpartum torsion of pedunculated fibroids
164
myomectomy + fertility
will preserve fertility, may require c/s at delivery (risk of uterine rupture), risk of adhesions
165
medication used to reduce size of fibroid whilst awaiting Sx
GNRH analogue
166
medical Rx for fibroids parameters (i.e. IUS, transaxamic acid, COCP)
fibroid <3cm, not distorting the uterine cavity
167
fibroid <3cm, not distorting the uterine cavity is the criteria for
medical fibroid management e.g. IUS, transaxamic acid, COCP
168
degeneration of fibroid during pregnancy presentation
low grade fever, pain, V
169
degeneration of fibroid during pregnancy management
rest, analgesia
170
endocervix is lined by
columnar, glandular epithelium
171
ectocervix is lined with
squamous epithelium
172
CIN is the
presence of atypical cells w/i the squamous epithelium, dyskaryotic cells with enlarged nuclei + f mitoses
173
CIN I
mild dysplasia, abnormal cells found in the lower 1/3 of epithelium
174
CIN II
moderate dysplasia, cells found in lower 2/3 of epithelium
175
CIN III
severe dysplasia, atypical cells found throughout the epithelium
176
CIN III aka
carcinoma in situ
177
cervical ca risk factors
HPV infection, promiscuity, early first intercourse, smoking, COCP, immunocompromise
178
cervical ca screening programme
25-49 3 yearly, 50-64 5 yearly, >65 for those not screened since 50/abnormal smears
179
dysplasia vs dyskaryosis
dyskaryosis = smear test result, loosely linked to severity of CIN, dysplasia = from biopsy
180
mild/borderline smear result
HPV test, if +ve to colposcopy, if -ve return to routine screening
181
HPV test, if +ve to colposcopy, if -ve return to routine screening
mild/boarderline smear result
182
moderate smear
colposcopy
183
severe smear
urgent colposcopy
184
colposcopy for
moderate smear/HPV +ve in mild/borderline
185
urgent colposcopy
severe smear
186
CIN I/II management
LLETZ/diathermy loop excision
187
LLETZ complications
bleeding, infection, preterm delivery
188
stage 1 cervical carcinoma
confined to cervix
189
stage 2 cervical carcinoma
invasion to vagina
190
stage 3 cervical carcinoma
invasion to lower vagina, pelvic wall, ureteric obstruciton
191
stage 4 cervical carcinoma
further spread
192
stage 1 cervical carcinoma management
cone biopsy/simple hysterectomy
193
stage 2 cervical cancer management
laparoscopic LN resection, radical trachelectomy, removal of cervix (+/- uterus) + upper part of vagina, chemo-radiotherapy
194
stage 3 + 4 cervical carcinoma management
chemoradiotherapy
195
COCP pros
effective (99%), doesn't interfere with sex, reversible, periods regular, lighter, less painful, relieves PMT, reduces ovarian, endometrial + CRC risk, ?protective against PID, ?reduces ovarian cysts, benign breast DZ, acne vulgaris
196
COCP cons
forget to take it, no STI protection, increased VTE risk, increased breast + cervical ca risk, increased stroke + IHD risk, SE: headache, N, breast tenderness, tiredness, change in libido, breakthrough bleeding, skin changes, mood changes, rise in BP
197
VIN
vulval intraepithelial neoplasm, presence of atypical cells in the vulval epithelium. Usual type vs differentiate type
198
usual type VIN presentation
35-55 y.o. females, multifocal, red/white/pigmented, plaques/patches/papules, erosions/nodules/warty/hyperkeratotic, pruitis, pain
199
usual type VIN associated with
HPV, CIN, cigarette smoking, chronic immunosuppression, SCC
200
differentiated type VIN presentation
rarer, older women, unifocal, ulcer/plaque, pruitis, pain
201
differentiated type VIN is associated with
lichen sclerosis, linked to keratising SCC, high risk of progression to ca
202
VIN management
Sx excision, topical emollients/steroids for symptom relief
203
carcinoma of the vulva type
SCC = majority, melanoma, basal cell carcinoma, adenocarcinoma, sarcoma
204
vulval ca associations
lichen sclerosis, immunosuppression, smoking, Paget's DZ of the vulva
205
vulva ca Hx
pruitis, bleeding, discharge, mass
206
vulval ca O/E
ulcer/mass on labia majora/clitoris, inguinal lymphadenopathy
207
stage 1 vulva ca
confined to vulval perineum
208
stage 2 vulva ca
spread to urethra/vagina/anus
209
stage 3 vulva ca
+ve LN
210
stage 4 vulva ca
further invasion/mets
211
vulval ca investigations
biopsy, Sx assessment: CXR, ECG, FBC, U+E, x-match
212
management of vulval ca
stage 1 DZ = resection, >stage 1 = wide local excision, groin lymphadenectomy
213
complications of vulva ca Sx
would breakdown, infection, leg lymphoedema, lymphocyst formation, sexual/body image problems
214
35-55 y.o. females, multifocal, red/white/pigmented, plaques/patches/papules, erosions/nodules/warty/hyperkeratotic, pruitis, pain
usual type VIN presentation
215
differentiated VIN presentation
rarer, older women, unifocal, ulcer/plaque, pruitis, pain
216
lichen sclerosis, immunosuppression, smoking, Paget's DZ of the vulva are associated with
vulval ca
217
would breakdown, infection, leg lymphoedema, lymphocyst formation, sexual/body image problems are complications of
vulval ca Sx
218
median age of menopause
51
219
perimenopause
vasomotor symptoms, menstrual irregularity
220
surgical menopause
after bx removal of ovaries
221
causes of premature menopause
infection, AI DZ, chemo, ovarian dysgenesis, metabolic DZ
222
management of premature menopause
HRT is recommended until 50 y.o.
223
systemic consequences of monopause
CVS DZ, stroke, vasomotor symptoms, urogenital problems, sexual problems, osteoporosis
224
vasomotor symptoms associated with the menopause
hot flushes, night sweats (leading to sleep disturbances, tiredness, irritability), present for < 5yrs
225
urogenital problems caused by the menopause
oestrogen deficiency causes vaginal atrophy (dyspareunia, cessationof sexual activity, reduced libido, pruitis, burning, dryness), uringary symptons: f, urgency, nocturia, incontinence, recurrent infection
226
osteoporosis definitions
```
N = T score -/- -1 and +1
osteopenia = T score -/- -2.5 and -1
osteoporosis = T score < -2.5
```
227
most common sites for osteoporotic #
wrist/Colles' #, hip, spine
228
risk factors for developing osteoporotic #
parental Hx of hip #, early menopause, chronic corticosteroid use, prolonges immobilisation, prior #, low BMI, cigarette smoking, EtOH abuse, low Ca intake, sedentary lifestyle, RA, NMD, chronic liver DZ, malabsorptionS, hyperparathyroidism, hyperthyroidism, hypogonadism
229
menopause investigations
FSH, anti-Mullerian hormone, TFT, catecholamines, LH, oestradiol, progesterone, bone density
230
FSH in menopause
gives an indicaion of ovarian reserve, increased = fewer oocytes, used in premature menopause
231
when should FSH be measured
between days 2-5 of cycle, in amenorrhoeic do 2 samples 2/52 apart
232
anti-Mullarian hormone
gives direct measurement of ovarian reserve, low = ovarian failure
233
when should anti-Mullarian hormone be measured
any day
234
menopause management
HRT (oestrogen alone in women w/o uterus, combined in others)
235
methods of administration of HRT
PO, transdermally, s/c (implant - oestrogens), topical (vaginally - oestrogens), IUS (progestogens)
236
pros of HRT
Rx for hot flushes, vaginal dryness, soreness, superficial dyspareunia, urinary f, urgency, reductionin risk of osteoporosis, reduced risk of CRC, reduced risk of CVS DZ, protection against ovarian ca
237
cons of HRT
breast ca (combined), endometrial ca (oetrogen only), VTE (PO HRT), gall bladder DZ (PO HRT)
238
duration of HRT
5 years, reassess
239
alternatives to HRT for menopausal symptoms
hot flushes/night sweats: progestogens, clonidine, SSRI, SNRI, gabapentin
vaginal atrophy: lubricants, moisturisers
osteoporosis: bisphosphonates, strontium ranelate, raloxifene, PTH peptides, denosumab, Ca, vit D
240
after bx removal of ovaries
surgical menopause
241
infection, AI DZ, chemo, ovarian dysgenesis, metabolic DZ could be causes of
premature menopause
242
CVS DZ, stroke, vasomotor symptoms, urogenital problems, sexual problems, osteoporosis are all complications of
the menopause
243
gives an indicaion of ovarian reserve, increased = fewer oocytes, used in premature menopause
FSH
244
take sample between days 2-5 of cycle, in amenorrhoeic do 2 samples 2/52 apart
FSH
245
gives direct measurement of ovarian reserve, low = ovarian failure
anti-Mullarian hormone
246
contraception in perimenopausal women is recommended for
12/12 after last period, 24/12 in menopausal women <50 y.o.
247
COCP CI
person Hx/FH VTE, currently pregnant, unexplained vaginal bleeding, severe liver DZ, HbSS, smoking, migraine
248
endometriosis causes
inflammation which leads to fibrosis and adhesions to form w/i the uterus, chocolate cysts
249
chocolate cysts
named so becuase accumulated altered blood is dark brown
250
endometriosis Hx
cyclical chronic pelvic pain, menstrual irregularity, dysmenorrhoea, subfertility, deep dyspareunia, asymptomatic, pain on defaecating during menses, rupture of chocolate cyst leads to acute pain, cyclical bowel/bladder symptoms
251
endometriosis O/E
VE: tenderness, thickening behind uterus/in adenexa, retroverted innomile uterus (in advnced cases), may be N
252
endometriosis investigations
laparoscopy +/- biopsy, active lesions = red vesicles/punctate marks, less active lesions = white scars/brown spots
TVUS, MRI
253
endometriosis DD
adenomyosis, chronic PID, chronic pelvic pain, pelvic mass, IBS
254
endometriosis Mx
NSAIDs, paracetamol, opiates, IUS, COCP, POP, GNRH analogues, laparascopic diathermy/laser, dissection, hysterectomy + BSO
255
POP SE
fluid retention, weight gain, erratic bleeding, PMS-like symptoms
256
GNRH analogues SE
menopausal symtoms, reversible bone demineralisation, (limits therapy to 6/12)
257
endometritis
infection of the endometrium
258
endometritis causes
2' to STI, complication of Sx (c/s, intrauterine termination), IUD, retained products of conception, malignancy (post-menopausal)
259
endometritis presentation
persistent, heavy bleeding, pain, tender uterus
260
HRT CI
breast ca, PV bleeding, breastfeeding, DVT/PE
