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Y4 Obs & Gyn > Gynae - Menstrual conditions > Flashcards

Gynae - Menstrual conditions Flashcards

1
Q

What is PCOS?

A

common endocrine disorder characterised by excess androgen production and presence of multiple immature, follicles (cysts) within the ovaries

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2
Q

What is the pathophysiology of PCOS?

A

hormonal imbalance - excess androgens
insulin resistance - suppressing SHBG
increased androgen circulation + inhibiting ovulation

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3
Q

what are some risk factors of developing PCOS?

A
  • diabetes
  • irregular menstruation
  • family history of PCOS
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4
Q

how might PCOS present?

A
  • oligomenorrhoea
  • infertility
  • hirsutism & acne
  • obesity
  • chronic pelvic pain
  • depression
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5
Q

what are some clinical signs you may notice in PCOS?

A

O/E → acne, hirsutism, acanthosis nigricans, male pattern hair loss, obesity and hypertension

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6
Q

What are some differentials for PCOS?

A

hypothyroidism
hyperprolactinaemia
cushings

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7
Q

how is PCOS diagnosed?

A

Rotterdam criteria - 2/3
- oligo or anovulation
- clinical or biochemical signs of hypernandrogenism
- polycystic ovaries on imaging

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8
Q

what investigations are carried out for PCOS?

A

pelvic USS - ovarian cysts
FSH, LH, TSH, SHBG, TSH, testosterone, prolactin
oral glucose tolerance

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9
Q

how is PCOS managed?

A

COCP, dydrogesterone for endometrial protection
weight reduction
clomifene + metformin to induce ovulation for infertility
anti-androgens for hirsutism -> eflornithine
Acne mx

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10
Q

What are fibroids and what types are there?

A

🩸 benign smooth muscle tumours of the uterus
- most common benign tumours in women - 20-40% incidence
- leimyoma

types - intramural, submucosal, subserosal

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11
Q

what are some risk factors for fibroids?

A

obesity
early menarche
increasing age
family history
ethnicity - Americans

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12
Q

how might fibroids present, when they are symptomatic?

A

pressure sx - urinary frequency, retention
abdo distention
menorrhagia
sub-fertility
acute pelvic pain

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13
Q

what might you feel on examination of fibroids?

A
  • solid mass or enlarged uterus may be palpable on abdominal or bimanual examination
    • uterus is usually non-tender
    • mobile
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14
Q

what are some differentials for fibroids?

A

endometrial polyps
ovarian tumours
leiomyosarcoma
adenomyosis

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15
Q

how might you investigate a fibroid?

A
  • pelvic ultrasound
  • MRI - if sarcoma suspected
  • bloods if diagnosis uncertain, pre-op surgery ix
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16
Q

how might you manage fibroids?

A

medication - tranexemic acid, COCP, GnRH analogue Zolidex, ulipristal to reduce size

surgical - hysteroscopy and transcervical resection, myomectomy, uterine artery embolisation , hysterectomy

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17
Q

what are some complications of fibroids?

A

iron deficiency anaemia
compression of pelvic organs - recurrent UTI, incontinence, hydronephrosis, retention
sub fertility or infertility
degeneration
torsion

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18
Q

what is endometriosis?

A

chronic condition where endometrial tissue is located at sites other than the uterine cavity - 2 million in UK suffer, 25 to 40 year olds

19
Q

what is the pathophysiology of endometriosis?

A

retrograde menstruation - endometrial cells travel backwards from uterine cavity, through fallopian tubes and deposit on pelvic organs

symptoms arise due to the ectopic tissue and their response to oestrogen

repeated inflammation + scarring → adhesions

20
Q

where is the ectopic endometrial tissue commonly found?

A

ovaries, pouch of Douglas, uterosacral ligaments, pelvic peritoneum, bladder, umbilicus and lungs

21
Q

what are some risk factors of developing endometriosis?

A
  • early menarche
  • family history
  • short menstrual cycles
  • long duration of menstrual bleeds
  • heavy menstrual bleeds
  • uterus or fallopian defects
22
Q

what is the presentation of endometriosis?

A
  • cyclical pelvic pain
  • constant painmay suggest adhesions
  • dysmenorrhoea, deep dyspreunia, dysuria, dyschezia, subfertility
  • focal sx of bleeding → haemothorax at time of menstruation
23
Q

what would the bimanual examination show for endometriosis?

A
  • fixed, retroverted uterus
  • tenderness in posterior fornix
  • uterosacral ligament nodules
  • general tenderness
    • enlarged, tender, boggy uterus = adenomyosis
24
Q

what are the differential diagnosis for endometriosis?

A

PID
ectopic pregnancy
fibroids
IBS

25
Q

how would endometriosis be investigated?

A

gold - laparoscopy shows chocolate cysts, adhesions, peritoneal deposit s
pelvis USS - kissing ovaries

26
Q

how is endometriosis managed?

A

pain - NSAIDs
ovulation - suppress for 6-12m with COCP, norethisterone, mirena coil
surgery - excision, fulguration and laser ablation to remove ectopic tissue, hysterectomy

27
Q

what are the differences between cervical and endometrial polyps?

A

cervical - benign growths protruding from the inner surface of the cervix

endometrial - small soft growths on the endometrium of uterus

28
Q

what is the pathophysiology of cervical polyps?

A
  • focal hyperplasia of thecolumnar epitheliumof the endocervix
  • chronic inflammation, abnormal response to oestrogen, localised congestion of cervical vasculature
29
Q

what is the pathophysiology of endometrial polyps?

A

overgrowth of tissue lining, no cause known

30
Q

what are some risk factors for endometrial polyps?

A

endometrial - obesity, tamoxifen use, hypertension, cervical polyps

31
Q

what is the presentation of cervical polyps?

A

asymptomatic
abnormal vaginal bleeding
increased vaginal discharge
cervix blocked and may cause infertility
o/e - polyphoid growths progesting though external os

32
Q

what is the presentation of endometrial polyps?

A
  • asymptomatic
  • irregular menstrual bleeding
  • intermenstrual menstrual periods
  • menorrhagia
  • post-menopausal bleeds
  • infertility
33
Q

what are the investigations done for cervical polyps?

A
  • histological examination after removal
  • triple swabs - if infection suspected, endocervical + high vaginal + vulvovaginal
  • cervical smear - rule out neoplasia (CIN)
  • USS of endometrial cavity if sx persists
34
Q

what investigations are done for endometrial polyps?

A
  • pelvic exam - seen if protruding through cervix
  • pap smear
  • USS
  • hysteosalpingogram
  • dilation and curretage for biopsy
  • hysteroscopy
35
Q

how is cervical polyps managed?

A
  • small - polypectomy with forceps in primary care setting + silver nitrate cautery
  • large - diathermy loop excision in colposcopy clinic, or under GA
    *<0.5% malignancy transformation risk
36
Q

what is the management of endometrial polyps?

A
  • watch & wait - polyps small and not sx
  • medication - shrink polyp
  • removal - during hysteroscopy, curettage
  • hysterectomy?
37
Q

what are some complications of endometrial polyp removal?

A
  • infection
  • haemorrhage
  • uterine perforation
38
Q

what is the physiology of the endometrial response to the menstrual cycle?

A

🩸 lining of uterus which changes during menstrual cycle in response to oestrogen release

  • after ovulation, progesterone levels increase and prepares uterus for implantation
  • with the lack of this progesterone levels drop and the endometrial lining is shed → menstruation
39
Q

what is the pathophysiology of endometrial hyperplasia?

A
  • imbalance of hormones cause endometrial thickening and overgrowth
    • too much oestrogen etc
  • two types based on cell kind
    • simple (without atypia) - consists of normal cells, not cancerous
    • complex atypical endometrial hyperplasia - pre-cancerous and results form overgrowth of abnormal cells
40
Q

what are some risk factors for endometrial hyperplasia?

A
  • menopause transition
  • family history of colon, ovarian and uterine cancer
  • diabetes
  • nullparity
  • PCOS
  • smoking
  • hormone therapy
  • early menarche and late menopause
41
Q

what is the presentation of endometrial hyperplasia?

A
  • heavy menstrual bleeding
  • post-menopausal bleeds
  • menstrual cycles shorter than 21 days
42
Q

how is endometrial hyperplasia investigated?

A
  • hormonal bloods
  • USS - transvaginal USS to see thickness of lining
  • biopsy - of uterus lining
  • hysteroscopy - abnormalities
  • dilation and curettage
43
Q

how is endometrial hyperplasia managed?

A
  • progestin - orally, via injection, vaginal, IUD
    • for atleast 6m
    • stops further proliferation, prepares for shedding, opposes oestrogen
  • hysterectomy if atypical endometrial hyperplasia, no improvement after 12m, relapse, bleeding not stopping

Y4 Obs & Gyn (16 decks)

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