Gynaecological problems

Question 1

definition of menorrhagia?

Answer 1

prolonged and increased (>80ml per period) menstrual flow (heavy menstrual bleeding)

Question 2

definition of metorrhagia?

Answer 2

reuglar intermenstrual bleeding

Question 3

definition of polymenorrhoea?

Answer 3

menses occurings at <21 day interval

Question 4

definition of polymennorrhagia?

Answer 4

increased bleeding and frequent cycle

Question 5

definition of menometorrhagia?

Answer 5

prolonged menses and intermenstrual bleeding

Question 6

definition of amenorrhea?

Answer 6

absence of menstruation > 6 months

Question 7

definition of oligomenorrhea?

Answer 7

menses at intervals of >35 days OR presence of five or fewer menstrual cycles over a year

Question 8

what is dysfunctional uterine bleeding?

Answer 8

non-organic menorrhagia, occuring in the absence of pathology

Question 9

what is anovulatory DUB?

Answer 9

most common 85%
occurs at extremes of reproductive life
irregular cycle
more common in obese women

Question 10

what is ovulatory DUB?

Answer 10

more common in women aged 35-45
regular heavy periods
due to inadequate progesterone production by the corpus luteum

Question 11

how would you investigate DUB?

Answer 11

• FBC
• thyroid function tests
• coagulation screen
• renal / liver function tests
• TVUS (endometrial thickness, presence of fibroids or other pelvic masses)
• endometrial sampling

Question 12

progesterone releasing IUCD (mirena) in treating DUB?

Answer 12

• best option for compliance
• first line
• 95% reduction in blood loss
• contraception
• breakthrough bleeds
• helpful to avoid using oral progesterones or COCP

Question 13

COCP in treating DUB?

Answer 13

• 30% reduction in blood loss

- unsuitable for many

Question 14

antifibrinolytics in treating DUB?

Answer 14

eg tranexamic acid

• taken during menstruation
• decreases blood loss by 50%
• use when woman is concieving

Question 15

NSAIDS in treatment of DUB?

Answer 15

eg mefanamic acid

• taken during menstruation
• appropriate when woman is considering concieving
• decreases blood loss by 20-25%
• apototic process producing prostaglandings

Question 16

when are NSAIDS contraindicated?

Answer 16

duodenal ulcer or asthma

Question 17

oral progesterones in treatment of DUB?

Answer 17

eg norethisteron and medrocyprogesterone acetate

Question 18

GnRh analogues / antagonists in the treatment of DUB?

Answer 18

act on the pituitary to stop oestrogen production, resulting in amenorrhea, long-term use casues OP unless combined with HRT
- eg goserelin, decapeptyl. buserelin

Question 19

causes of intermenstrual bleeding?

Answer 19

cervical ectropion, PID, DTI, endometrial and cervical polyps, cervical cancer, endometrial cancer, undiagnosed pregnancy / complications, hyatidform molar disease

Question 20

when do you investigate endometrial thickness?

Answer 20

if it is >4mm, do a biopsy

Question 21

what is the Rotterdam criteria for diagnosing PCOS?

Answer 21

1. clinical or biochemical evidence of hyperandrogenism (hirsuitism, acne, high free tstosterone, low sex hormone binding globulin, high free androgen index respectively)
2. Polycystic ovaries on US (defined as an increase in ovarian volume to >10cm3, at least 12 follicles in one ovary measuring 2-9mm in diameter)
3. oligo / amenorrhoea

Question 22

what are the hormonal changes in PCOS?

Answer 22

increase in LH:FSH level

LH levels are very high and FSH levels are low or normal

Question 23

what is dysmenorrhoea?

Answer 23

painful periods

Question 24

how to manage dysmenorrhoea (painful periods)?

Answer 24

NSAIDS eg mefanamic acid and ibuprofen
COCP
levonogestrel IUS

Question 25

what size are ovarian cysts?

Answer 25

<5cm in maximum diameter

Question 26

what is Bartholin’s glands?

Answer 26

pair of glands located next to the enterance of the vagina
sit at 5 and 7 oclock
size of a pea but can become infected and enlarged - forming an abscess

Question 27

first line treatment for uterine fibroids?

Answer 27

minera IUS

Question 28

symptoms of uterine fibroids?

Answer 28

lower abdominal pain during menstruation

Question 29

symptoms of ovarian torsion

Answer 29

sudden onset of deep colicky pain associated with vomiting and distress
adnexel tenderness / acute abdomen

Question 30

classic US sign of ovarian torsion?

Answer 30

whirlpool sign

Question 31

treatment for ovarian torsion ?

Answer 31

laparoscopy to untwist ovary and remove cyst