Gynaecological Pathologies Flashcards
What are symptoms of Mittelschmerz?
- Usually mid cycle pain with often sharp onset.
- Little systemic disturbance.
- May have recurrent episodes that usually settles over 24-48 hours.
What are investigations and management for Mittelschmerz?
- Investigations
- Full blood count – usually normal
- Ultrasound – may show small quantity of free fluid
- Management is conservative
What are fibroids?
Fibroids are benign smooth muscle tumours of the uterus.
- More common in Afro-Caribbean women (50%) compared to white women (20%) in the later reproductive years)
- Rare before puberty, develop in response to oestrogen, and don’t tend to progress following menopause
What are symptoms and signs of Fibroids?
Symptoms
- May be asymptomatic
- Menorrhagia
- Lower abdominal pain: cramping pains, often during menstruation
- Bloating
- Urinary symptoms e.g. frequency
Signs
- Subfertility
- Rare features: polycythaemia secondary to autonomous production of erythropoietin
What are investigations for Fibroids?
- Transvaginal ultrasound
What is the immediate management for Fibroids?
- Symptomatic management
- 1st line: Levonorgestrel-releasing intrauterine system
- Other options include tranexamic acid, combined oral contraceptive pill etc
- GnRH agonists may reduce the size of the fibroid but are typically useful for short-term treatment
What is the definitive management for Fibroids?
- Surgery is sometimes needed:
- Myomectomy, Hysteroscopic endometrial ablation, Hysterectomy. This is done using magnetic resonance-guided focused ultrasound
- Uterine artery embolization
- Has a small risk of menopause when ovarian circulation arises dominantly from uterine arteries.
- An increased risk of abnormal placental implantation
What are complications of Fibroids?
- Subfertility
- Red degeneration: haemorrhage into tumour commonly occuring in pregnancy
What is Endometriosis?
- Common condition characterised by growth of ectopic endometrial tissue outside of the uterine cavity
- Predominantly found in pelvis – peritoneal lesions, superficial impacts or cysts on the ovary or deep infiltrating. Responds to cyclical hormonal changes and bleeds at menstruation
- 25% asymptomatic and 25% associated with pelvic organ pathology
What are aetiology of Endometriosis?
Unclear picture but thought to be due to:
- Retrograde menstruation
- Coelomic metaplasia
- Mullerian remnants
What are symptoms and signs of Endometriosis?
Symptoms
- Chronic pelvic pain
- Menstrual irregularity
- Dysmenorrhoea - pain often starts days before bleeding
- Deep dyspareunia
- Subfertility
- Non-gynaecological: urinary symptoms e.g. dysuria, urgency, haematuria. Dyschezia (painful bowel movements)
- Intermenstrual bleeding and post coital bleeding
What are examination signs of Endometriosis?
On pelvic examination
- Reduced organ mobility
- Tender nodularity in the posterior vaginal fornix and visible vaginal endometriotic lesions may be seen
- Thicken uterosacral ligaments
- Fixed retroverted uterus
- Uterine tenderness
What are complications of endometriosis?
- Complex disease may result in pelvic adhesional formation with episodes of intermittent small bowel obstruction.
- Intra-abdominal bleeding may produce localised peritoneal inflammation
What is the investigations of Endometriosis?
- Laparoscopy is the gold-standard investigation
-
Ultrasound – may show free fluid
- Has a little role in investigations. If symptoms are significant, patient should be referred for a definitive diagnosis
What is the symptomatic managment of Endometriosis?
- 1st line: NSAIDs and/or paracetamol
- 2nd line: If analgesia doesn’t help then hormonal treatments such as the combined oral contraceptive pill or progestogens e.g. medroxyprogesterone acetate should be tried
Referral to secondary care if analgesia/hormonal treatment does not improve symptoms or if fertility is a priority.
