Gynae Flashcards
Endometriosis symptoms
Dysmenorrhoea (cyclical, just before start of bleed)
Menorrhagia
Deep dyspareunia
Infertility
Dyschezia
Urinary symptoms
Many incidental findings
Endometriosis demographics
Reproductive age
Nulliparous
Endometriosis investigations
TvUSS
Laparoscopy is gold standard
Endoscopic rectal US is good too
Endometriosis non-fertility sparing Mx
Treat if symptomatic.
Conservative - Mefanamic acid + paracetamol
Induce menopause:
COCP
IUS
POP
GnRH agonist
Endometriosis fertility sparing
GnRH agonists to shrink lesions + laparoscopic surgery for mild disease improves fertility.
Scarce evidence to suggest it helps fertility in more severe disease.
Endometriosis complications and prognosis
Most therapies help symptoms
35% remain infertile
Increased risks of:
Ovarian cancers
adhesions (esp. if surgical Mx)
IBD
Endometriosis definition
Endometrial stroma and glands found outside the uterus.
Common sites for endometriosis
Fallopian tubes!!
Ovaries (endometrioma)
Pouch of Douglas
Ligaments, colon, bladder, ureter.
Definition of fibroids
Leiomyoma - benign tumours of smooth muscle and connective tissue
Fibroids patient demographics
30-50
Afro-Caribbean
Overweight and early menarche (raised Oest exposure)
Fibroids classifications
Intramural (majority)
Submucosal - growing into uterine cavity (may be pedunculated or poke through cervix)
Subserosal - Growing outwards from uterus
Fibroids presentation
Most asymptomatic
30% - menorrhagia
dysmenorrhoea
central pelvic mass
bloating
uncommonly: infertility(submucosal), urinary symptoms, pain (if torted/degenerating)
Investigations for fibroids
TvUSS (assess distortion of uterine cavity!)
pelvic USS
MRI
Endometrial biopsy
Mx of fibroids - non fertility sparing
Conservative - Tranexamic acid + paracetamol
Hormonal:
1) IUS (if no distortion of cavity on USS)
COCP
UPA
2) GnRH agonist
Surgical:
UAE
Hysterectomy
Mx of fibroids for fertility
1) Hysteroscopic removal of submucosal fibroids if <3cm
2) Laparoscopic myomectomy
Complications of fibroids
IDA
Infertility
Red degeneration - Due to inadequate blood supply. Commonly during pregnancy.
Malignant form of fibroids
Leiomyosarcoma - 0.1% of fibroids
What is adenomyosis?
Presence of endometrial tissue within the myometrium
Presentation of adenomyosis?
Enlarged, tender uterus
Menorrhagia
Dysmenorrhoea
Ix adenomyosis
MRI is the best
Mx adenomyosis
IUS or COCP
Hysterectomy if severe/fertility not an issue
Endometritis can occur after?
Post partum - especially C section Prolonged rupture of membranes Manual removal of placenta TOP Uterine surgery
Presentation of endometritis?
Fever Abdo pain Foul smelling lochia/discharge PV bleeding Tachycardia
Management of menorrhagia
Conservative: tranexamic acid (and mefanamic if painful)
Hormonal:
1) IUS
2) COCP
3) Progestogens (oral or IM)
Causes of primary amenorrhoea
Turner's - short, webbed neck, wide spaced nipples Constitutional delay PCOS AIS Mullerian abnormalities Chronic illness
Causes of secondary amenorrhoea
Hypothalamic - anorexia, excess exercise
Pituitary - prolactinoma, Sheehan’s
Hypo/hyperthyroid
CAH
Ovarian - PCOS, POI
Types of amenorrhoea?
Primary - never menstruated
secondary - no periods for 6 months
Oligomenorrhoea - cycle varies between 35 days and 6 months
Causes of post-coital bleeding
Cervical carcinoma
Cervical polyps
Cervicitis (STI)
Ectropion - Most common. More when pregnant or on COCP
Treatment of ectropion?
Cryotherapy
Causes of PMB
Most common - atrophic vaginitis
Endometrial hyperplasia
Endometrial Ca
Ovarian Ca
Polyps
Investigations for PMB
All women with abnormal PV bleed after age of ?40 TvUSS for endometrial thickness
Above what thickness endometrium do you Ix further?
Hysteroscopy with pipelle biopsy if >4mm
Symptoms of PMS
Psychological - depression, anxiety, mood swings
Physical - Bloating, mastalgia
Symptoms free week before ovulation!
Symptoms worse during luteal phase
Ix of PMS
Daily Record of Severity of Problems (DSRP) for 2 cycles.
Exclude organic cause: FBC, TFT, vit D
Mx of PMS
Exercise helps
1) COCP - continuous regimen
CBT or SSRI for severe psychological sx
Danazol - mastalgia
PID presentation
Lower abdominal pain
Deep dyspareunia
PV bleeding
Purulent discharge
classic exam finding in PID
Cervical excitation (!!!)
Organisms in PID
Chlamydia trachomatis
Neisseria gonorrhoea
Mycoplasma genitalium
Ix of PID
Endocervical swabs for chlam/gonorr
Pelvic USS- exclude cysts or abscess
Mx of PID
IM cef 250mg + PO metro 500mg + PO doxy 100mg
Complications of PID
Tubal damage
Adhesions
Hydro/pyosalpinx due to obstruction
Subfertility
Ix for amenorrhoea
You BETTER GO PRO AND check EAST THYROID!
- BETA-HCG
- GOnadotrophins
- PROlactin
- ANDrogens
- oESTradiol
- THYROID function
