Gynae Core Conditions Flashcards
What causes atrophic vaginitis?
Lack of oestrogen during the menopause (genitourinary syndrome of menopause)
Causes of post menopausal bleeding
Endometrial carcinoma Endometrial hyperplasia Cervical carcinoma Atrophic vaginitis Cervicitis Ovarian carcinoma Cervical polyps
What is the menopause?
Permanent cessation of menstruation resulting from loss of ovarian follicular activity (recognised after 12 consecutive months of amenorrhoea)
What is the median age at which the menopause occurs at?
51
What is premature menopause?
Menopause before 40 years old
What is the perimenopause?
The time preceeding the menopause where menstruation is often erratic
Early features of the menopause
Hot flushes
Insomnia
Psychological symptoms
Late features of the menopause
Skin and breast atrophy Hair loss Atrophic vaginitis Prolapse Urinary symptoms Osteoporosis Cadiovascular disease
How is the menopause investigated?
Usually clinical diagnosis
Low anti-mullerian hormone (AMH)
Raised FSH
Symptoms of atrophic vaginitis
Discomfort Dyspareunia Cessation of sexual activity Itching Burning Dryness
Treatment of atrophic vaginitis
Topical oestrogens (oestriol cream/pessary or oestradiol tablets/ring) Oral ospemifene (selective oestrogen receptor modulator - SERM) Lubricants and moisturisers
Atrophic vaginitis may make _____________ so a hysteroscopy may have to be performed under ___________
Vaginal access difficult; general anaesthetic
How is atrophic vaginitis diagnosed?
Diagnosis of exclusion
Urinary symptoms of genitourinary syndrome of menopause
Frequency Urgency Nocturia Incontinence Recurrent infection
What is the most common cause of vaginal discharge in women of reproductive age?
Bacterial vaginosis (Gardnerella/anaerobic vaginosis)
Is bacterial vaginosis an STI?
No
What is bacterial vaginosis?
Loss of normal lactobacilli and an increase in anaerobic and highly fastidious BV associated bacteria in the vagina
What are distinctive features of bacterial vaginosis?
Malodour
Worse with intercourse
Not usually associated with vulvovaginitis
BV bacteria produce __________ which break down vaginal peptides into volatile, ___________
Proteolytic enzymes; malodorous amines
The rise in pH in BV facilitates adherence of ____________ and ____________ to exfoliating epithelial cells and development of a ________ which adheres to the epithelium
G. vaginalis; atopobium vaginae; biofilm
Clinical features of bacterial vaginosis
Grey-white discharge
Fishy odour
No vulvovaginitis
How is bacterial vaginosis diagnosed?
Raised vaginal pH
Typical discharge
‘Whiff’ test
Presence of ‘clue cells’ on microscopy
Wat is the ‘Whiff’ test for BV?
Fishy odour when 10% potassium hydroxide added to secretions
What are ‘clue cells’ for BV?
Epithelial cells studded with gram-variable coccobacilli
