Gynae Qs Flashcards
What is menorrhagia?
Loss greater than 80ml which is affecting the quality of daily living
Name 6 differentials for menorrhagia
Fibroids, Endometrial polyps, Infections (cervicitis), iatrogenic (COCP, obesity), Dysfunctional uterine bleeding, clotting disorders
Name treatment for menorrhagia 1st-4 line
1st-Tranxaemic acid, mirena
2nd-TCRF, removal polyp
3rd-Endometrial ablation
4th-Hysterectomy
Name differentials for post-menopausal bleeding
atrophic vaginitis, endometrial cancer, polyps, HRT oestrogen only, tamoxifen, hypoplasia
What is tamoxifen?
oestrogen selective receptor modulator
What is the normal thickness of the endometrium?
<4mm
Name 6 types of prolapse
uterine, vault, cystocele, urethrocele, rectocele, enterocele
What does Procidentia mean?
everything has moved outside
What tool is used to determine what is going up and down in prolapse?
POP-Q
pelvic organ prolapse quantitator
What is the difference between an ovarian cyst and PCOS?
ovarian cyst-on the ovary
PCOS-inside the ovary
What is an ovarian cyst?
fluid filled sac on the surface
What can be used to determine the risk of malignancy?
RMI
What is the RMI?
CA125 (cancer tumour marker)
Menopausal status
Ultrasound findings (size, solid components, multiple septae, daughter cells)
What is the criteria used for PCOS?
Rotterdam criteria need to have 2 of the 3 findings -->ultrasound findings (large ovary, lots of follicles) -->high androgens -->anovulation or very irregular periods
How do you determine high androgens?
blood test testosterone
male pattern hair growth
serum binding gobulin
Why is obesity significant in menorrhagia?
Adipose tissue releases aromatase which converts androgens into oestrogen
Complications of PCOS?
subfertility
diabetes
How many periods should there be minimum in a year and why?
3 periods a year to allow endometrial protection otherwise there is a risk of hyperplasia and malignancy
What is the definition of infertility?
regular sexual intercourse (vaginal) 2-3 times a week for 12 months
What are the 3 causes of infertility?
Her: is there an egg being produced
Him: sperm analysis
Tube patency
How do we know if someone is ovulating?
mid-luteal day 21 progesterone
(if raised they have ovulated)
May need to check LH, FSH to check HPO axis
If semen analysis comes back abnormal, what do you do and why?
repeat the test in 3 months if abnormal as the life cycle of sperm is 70 days
If the semen analysis comes back azoospermic what do you do?
lack of vas deferens
retrograde ejaculation in urine sample
Pituitary axis investigations
What is the treatment for anovulation?
1st: Clomiphene
2nd: Ovarian drilling
Causes of recurrent miscarriage
- acquired thrombophilias
- Uterine abnormalities (uterine septum)
- Chromosomal (aneuploidy)-too many chromosomes in each cell
What is antiphospholipid syndrome?
antiphospholipid antibodies, blood prone to clotting therefore in a hypercoagulable state
associated with thrombosis and complications of pregnancy
What is pre-menstrual disorder and why does it happen?
occurs in the luteal phase
fluctuation in oestrogen and progesterone and increased sensitivity to progesterone
How is pre-menstrual disorder managed?
Lifestyle management COCP SSRI CBT GnRH analogues-induces menopausal state Pain management
Why is danazole and tamoxifen used in pre-menstrual syndrome?
reduce cyclical breast pain
What is the side effect of GnRH analogues?
osteoporosis, therefore require HRT to add back the hormones and mitigate the effects
What is Sheehan Syndrome?
Rare complication of post partum haemorrhage, drop in circulating blood volume leads to avascular necrosis of the pituitary gland
Low blood pressure, low perfusion to anterior pituitary gland leads to ischaemia and cell death.
Leads to reduced lactation, (secondary) amenorrhoea, adrenal insufficiency
Hypothyroidism
How is Sheehan Syndrome managed?
Oestrogen and Progesterone
Hydrocortisone
Levothyroxine
Growth hormone
What is Asherman’s syndrome?
Adhesions within the uterus form following damage to the uterus
usually happens after a pregnancy related dilatation and curettage procedure for the treatment of retained products of conception or uterine surgery, pelvic infection (endometritis)
How does Asherman’s syndrome present?
secondary amenorrhoea
lighter periods
dysmenorrhoea
How do you check for tube patency?
HSG- Hysterosalpingography
Lap and dye
HPO axis what cells does LH and FSH stimulate?
Theca and Granulosa cells
HPG axis what cells does LH and FSH stimulate?
Leydig and sertoli cells
What does the anterior pituitary release?
thyroid stimulating adrenocortiocotrophic FSH, LH GH prolactin
What does the posterior pituitary release/
Oxytocin
Antidiuretic hormone
What is the introitus?
Opening of the vagina
