Gynaecological Symptoms: Common Presentations Flashcards
Key questions you want to ask for vaginal discharge
-what is normal discharge
Normal -no strong/unpleasant smell -clear, white -thick+sticky -slippy+wet Heavier if pregnant, sexually active, contraceptive use
Any changes in Volume Colour - green, yellow, blood Consistency - cheesy? Smell - fishy
Abnormal discharge - gonorrhea, chlamydia, STIs in general
Fishy, no soreness/irritation => bacterial vaginosis
Yellow frothy, itchy, irritating => trichomonas vaginalis
Blood
- normal, benign, just started periods
- with pelvic pain =>
- bleeding post menopause => endometrial cancer?
- miscarriage?
Key questions you want to ask for abdo/pelvic pain
-possible differentials
SOCRATES
ALWAYS ASK ABOUT PREGNANCY
Ectopic - vaginal bleed/discharge, missed period, sharp pain
Endometriosis - difficulty getting pregnant, heavy periods, severe period pain to the point of feeling sick, pain during sex/pooing/peeing
PID (infection of reproductive system) - pelvic pain during sex/periods/peeing, heavy periods, yellowy green discharge + systemically unwell
Ovarian torsion - crampy pain => sudden severe unilateral pain => N+V
Key questions you want to ask for bleeding
Pattern: regular/irregular
Volume - no of pads, tampons
Anemia - tired, SOBOE
Thyroid symptoms
-Hyperthyroid => light periods/amenorrhea, weight loss, hot, anxious
-Hypothyroid => heavy periods, increased weight, cold, low mood
Post coital - trauma, PID/STI
Between periods - miscarriage, gonorrhea/chlamydia and STIs, perimenopause, malignancy
Post menopause - HRT, MALIGNANCY
Key questions you want to ask for vulval skin changes and itching
Sexually active? - Thrush, BV, STI
Other symptoms of menopause - no vaginal bleeding, joint pain, hot flushes, low mood
Key questions you want to ask for secondary amenorrhea
General - any recent weight loss/gain, stress, exercise, diet changes
Head - vision changes, headaches => pituitary issues
Thyroid - hyperthyroid symptoms
Torso - galatorrhea (pituitary), hirsuitism (Cushings), acne
IS PREGNANCY A POSSIBILITY?
Key gynecological screening questions
PV bleeding - menorrhagia, intermestrual, post coital, post menopause
PV discharge
Pain - pelvic, period pain, dyspareunia
Pregnancy
-possibility of being pregnancy
-fetal mv?
-PET - HTN, blurry vision, abdo pain, headache, edema
Systemic enquiry related to gynecological problems
Systemic - fatigue (anemia), fever (infection), weight loss (cancer)
Cardioresp - SOBOE (anemia)
GI - abdo pain (ectopic, painful periods), defecation pain (endometriosis)
GU - increased urinary frequency, urgency (UTI)
MSK - shoulder tip pain (ectopic), vulval itch (menopause, STI)
Menstrual history
-key questions
Duration
Frequency and regularity
Blood loss
- any changes
- how many pads/tampons do you get throough on your heaviest days
- blood clots?
- are your heavy periods affecting everyday life
Pain
- interfere with everyday life
- SOCRATES
Date of 1st day of last period - consider pregnancy testing esp if late
Menarche - early => increased breast cancer, CVD risk
Menopause - hot flushes, vaginal dryness, joint pain, mood swings?
Contraceptive history
-key questions if relevant
Clarify the type currently used
Past contraceptive use
Plans to have children
-trying to get pregnant?
Gravidity - no of times pregnant
Parity - no of fetuses carried to 24wk+
Current pregnancy
- how far along and recent scan results
- symptoms
- signs of PET - edema, abdo pain, headache, blurry vision, HTN
Past pregnancy
- age of children
- any complications before, during and after birth
- breastfeeding?
Past gynecological history
-areas to explore
Past gynecological problems
- ectopics
- STIs
- endometriosis
- gynae malignancy
Past surgery
- abdo/pelvic
- caesarean
- hysterectomy
Last cervical smear and result
HPV vaccination?
Past medical history
- medical conditions
- medications
- allergies
Migraine with aura - estrogen containing meds CI
Past VTE - estrogen containing meds CI
Past/present breast cancer - estrogen containing meds need specialist input
Bleeding disorders - esp if heavy vaginal bleeds
Medications that may contribute to gynecological problems
-Abx => 2ndary thrush
Medications commonly prescribed for gynae issues
- tranexemic acid
- contraceptives
- HRT
- NSAIDs - painful periods
- GnRH analogues - endometriosis management
Family history
Ovarian, endometrial, breast cancer in close relative
Bleeding disorders? - may contribute to heavy periods
Clotting problems - VTE?
-increased risk in COCP users
Social history
Social context
- accommodation and adaptations needed
- who they live with, support network
- self care, housework, food shopping?
- occupation - impacts of PC on life and work
Smoking - COCP CI
Alcohol, recreational drug use
Diet and weight
- obesity => malignancy, PCOS, COCP CI
- anorexia => irregular/no periods
PCOS
- risk factors
- core features
- investigations
- management
Risk factors
- FHx
- DM
Core features Irregular periods, difficulty with getting pregnancy Facial, chest, back hair Thin hair, hair loss Acne, oily skin Weight gain
Pregnancy test - rule out possibility Bloods - hormone profile -high T -high FSH, LH - if POI/menopausal -TSH - hypothyroidism -urinary free cortisol - Cushings Imaging - US for polycystic ovaries
Management
Lifestyle to reduce complications and presentation of PCOS - CV risk optimisation
Medical - contraception
Endometriosis
- risk factors
- core features
- investigations
- management
Risk factors
-FHx
Core features
Intense pain during period, sex, defecation that disrupts ADLs
Heavy, irregular periods
Difficulty getting pregnant
Investigations
Rule out other causes - UTI, PID, cancers
Definitive - US, laparoscopy to visualise tissue
Management
Analgesia
Contraceptives
Surgery to remove endometriosis tissue/hysterectomy
