Gynaecological problems 1 Flashcards
What occurs on day 1-4 of the menstrual cycle?
menstruation
endometrium is shed myometrial contraction (poss pain due to vasopressin receptors)
What occurs on day 5-13 of the menstrual cycle?
GnRH (hypothalamus) stimulate LH+FSH
Follicular growth
Follicles produce oestradiol + inhibin
FSH secretion suppressed so only one follicle/oocyte matures
Oestradiol rises
LH rises - ovulation follows 36 hours after
Endometrium reforms, thickens when stromal cells proliferate + glands elongate
What happens on day 14-28 of the menstrual cycle?
Follicle become corpus luteum
Oestradiol and Progesterone = secondary changes in endometrium
Corpus luteum fails if eggs not fertilised
Progesterone and oestradiol
Endometrium breaks down
How are menstrual disorders managed?
FBC
Pelvic US
Sometimes endometrial biopsy and hysterectomy if intermenstrual bleeding/thickened/irregular endometrium/ ages >40
What is the medical treatment for menstrual disorders?
reduce volume (IUS/tranexamic acid/mefanamic acid/combined contraceptive)
What is the surgical treatment for menstrual disorders?
hysteroscopic surgery
hysterectomy
myomectomy/embolization if fibroids
What is menarche?
onset of menstruation
last stage of puberty in females
on average 13 years
may be irregular at first
What is precocious puberty?
if menstruation occurs before 10/other secondary sexual characteristics before 8
What are the causes of precocious puberty?
increased GnRH due to meningitis
encephalitis
CNS tumours
hydrocephaly and hyperthyroidism/ increased oestrogen secretion due to tumours
What is menopause?
permanent cessation of menstruation resulting from loss of ovarian follicular activity
median age 51 years
What is defined as premature menopause?
menopause occurring before the age of 40
What are the causes of premature menopause?
usually no cause surgical menopause - if bilateral oophorectomy infections autoimmune disorders chemotherapy ovarian dysgenesis metabolic diseases
How is premature menopause managed?
HRT until at least 50
Oocyte donation for fertility
What are the symptoms of menopause?
vasomotor symptoms - hot flushes and night sweats
Urogenital problems - vaginal atrophy causing dyspareunia, cessation of sexual activity, itching, burning and dryness
urinary symptoms - frequency, urgency, nocturia, incontinence
sexual problems
osteoporosis
What are the RFs for osteoporosis after menopause?
parental history of fracture early menopause chronic use of corticosteroids prolonged immunisation prior fracture diseases - RA, NM disease
Why is osteoporosis common after menopause?
compromised bone strength predisposes to increased risk of fracture
What are the different types of HRT that can be given?
Oestrogen
Progesterone
Tibolone
Androgens
How can oestrogen be given as part of HRT?
orally
transdermally
subcutaneously
topically
How can progesterone be given as part of HRT?
cyclically or continuously with oestrogen
orally, patch, IUS
How is tibolone given as part of HRT?
synthetic steroid compound
used in post menopausal women who desire amenorrhoea and treats
conserves bone mass and reduces risk of vertebral fracture
What androgens can be used in post menopausal women?
testosterone administered either as a patch or submit implant
used to improve libido but not successful in all women
What are the benefits of HRT?
treat hot flushes within 4 weeks vaginal dryness, soreness, pain, urinary frequency and urgency respond well to oestrogen sexuality may be improved osteoporosis - reduced fracture risk reduces risk of colorectal cancer
What are the risks of HRT?
Breast cancer - increased risk if combined
Endometrial cancer - increased risk if oestrogen only
VTE - increased risk
Gall bladder - increased risk
What are the causes of post menopausal bleeding?
endometrial carcinoma endometrial hyperplasia cervical carcinoma atrophic vaginitis cervicitis ovarian carcinoma cervical polyps
What are the basic investigations for post menopausal bleeding?
bimanual and speculum examination
cervical smear
transvaginal (TVS) sonography
if thickened/multiple bleeds then endometrial biopsy and hysterectomy
What is the initial management for postmenopausal bleeding?
dependent on cause
removal of cervical polyps
endometrial atrophy - treat with oestrogen cream/pessaries
endometrial hyperplasia - IUS/hysterectomy
HRT - stop after treatment
Describe normal vaginal discharge?
physiological discharge common and non offensive
increased at ovulation, pregnancy and when taking OCP
cervical everyone and ectropion may cause discharge
What are the pathological causes of vaginal discharge?
- bacterial vaginosis - treat with abx
- candidiasis - treat with imidazole
- chlamydial infection
- gonorrhoea
- trichomonas vaginalis - treat with abx
- atrophic vaginitis - due to oestrogen deficiency so common before menarche, after menopause and during lactation
- foreign body - retained tampons and swabs after childbirth (offensive discharge)
- malignancy - cervical carcinoma (bloody and offensive discharge - biopsy)
