Gynaecology Flashcards
What is Amenorrhoea?
Primary amenorrhoea
Secondary amenorrhoea
refers to a lack of menstrual periods.
Primary amenorrhoea is when the patient has never developed periods
Secondary amenorrhoea is when the patient previously had periods that subsequently stopped
Primary amenorrhoea can be due to
- Abnormal functioning of the hypothalamus or pituitary gland (hypogonadotropic hypogonadism)
- Abnormal functioning of the gonads (hypergonadotropic hypogonadism)
- Imperforate hymen or other structural pathology
Secondary amenorrhoea is due to
- Pregnancy (the most common cause)
- Menopause
- Physiological stress due to excessive exercise, low body weight, chronic disease or psychosocial factors
- Polycystic ovarian syndrome
- Medications, such as hormonal contraceptives
- Premature ovarian insufficiency (menopause before 40 years)
- Thyroid hormone abnormalities (hyper or hypothyroid)
- Excessive prolactin, from a prolactinoma
- Cushing’s syndrome
Abnormal uterine bleeding or menstral bleeding is due to?
- Extremes of reproductive age (early periods or perimenopause)
- Polycystic ovarian syndrome
- Physiological stress (excessive exercise, low body weight, chronic disease and psychosocial factors)
- Medications, particularly progesterone only contraception, antidepressants and antipsychotics
- Hormonal imbalances, such as thyroid abnormalities, Cushing’s syndrome and high prolactin
What is Intermenstrual Bleeding
Intermenstrual bleeding (IMB) refers to any bleeding that occurs between menstrual periods.
Intermenstrual bleeding is a red flag that should make you consider ______ and ________ _____, although other causes are more common.
This is a red flag that should make you consider cervical and other cancers, although other causes are more common.
The key causes of intermenstrual bleeding are:
- Hormonal contraception
- Cervical ectropion, polyps or cancer
- Sexually transmitted infection
- Endometrial polyps or cancer
- Vaginal pathology, including cancers
- Pregnancy
- Ovulation can cause spotting in some women
- Medications, such as SSRIs and anticoagulants
What is Dysmenorrhoea
Dysmenorrhoea describes painful periods.
Causes of Dysmenorrhoea are
- Primary dysmenorrhoea (no underlying pathology)
- Endometriosis or adenomyosis
- Fibroids
- Pelvic inflammatory disease
- Copper coil
- Cervical or ovarian cancer
What is Menorrhagia
Menorrhagia refers to heavy menstrual bleeding
What is the causes of Menorhagia?
- Dysfunctional uterine bleeding (no identifiable cause)
- Extremes of reproductive age
- Fibroids
- Endometriosis and adenomyosis
- Pelvic inflammatory disease (infection)
- Contraceptives, particularly the copper coil
- Anticoagulant medications
- Bleeding disorders (e.g. Von Willebrand disease)
- Endocrine disorders (diabetes and hypothyroidism)
- Connective tissue disorders
- Endometrial hyperplasia or cance
- Polycystic ovarian syndrome
What is Postcoital Bleeding
Postcoital bleeding (PCB) refers to bleeding after sexual intercourse.
Postcoital Bleeding
is a red flag that should make you consider ________ and _____ _____, although other causes are more common. Often no cause is found.
is a red flag that should make you consider cervical and other cancers, although other causes are more common. Often no cause is found.
Postcoital Bleeding
The key causes are:
- Cervical cancer, ectropion or infection
- Trauma
- Atrophic vaginitis
- Polyps
- Endometrial cancer
- Vaginal cancer
Pelvic Pain Causes
- Urinary tract infection
- Dysmenorrhoea (painful periods)
- Irritable bowel syndrome (IBS)
- Ovarian cysts
- Endometriosis
- Pelvic inflammatory disease (infection)
- Ectopic pregnancy
- Appendicitis
- Mittelschmerz (cyclical pain during ovulation)
- Pelvic adhesions
- Ovarian torsion
- Inflammatory bowel disease (IBD)
g. Excessive, discoloured or foul-smelling discharge may indicate:
- Bacterial vaginosis
- Candidiasis (thrush)
- Chlamydia
- Gonorrhoea
- Trichomonas vaginalis
- Foreign body
- Cervical ectropion
- Polyps
- Malignancy
- Pregnancy
- Ovulation (cyclical)
- Hormonal contraception
What is Pruritus Vulvae
Pruritus vulvae refers to itching of the vulva and vagina.
Pruritus Vulvae Causes
- Irritants such as soaps, detergents and barrier contraception
- Atrophic vaginitis
- Infections such as candidiasis (thrush) and pubic lice
- Skin conditions such as eczema
- Vulval malignancy
- Pregnancy-related vaginal discharge
- Urinary or faecal incontinence
- Stress
What is Endometriosis?
Endometriosis is a condition where there is ectopic endometrial tissue outside the uterus
A lump of endometrial tissue outside the uterus is described as an__________. ___________ in the ovaries are often called “chocolate cysts”. ____________ refers to endometrial tissue within the myometrium (muscle layer) of the uterus.
A lump of endometrial tissue outside the uterus is described as an endometrioma. Endometriomas in the ovaries are often called “chocolate cysts”. Adenomyosis refers to endometrial tissue within the myometrium (muscle layer) of the uterus.
Causes of Endometriosis?
One notable theory for the cause of ectopic endometrial tissue is that during menstruation, the endometrial lining flows backwards, through the fallopian tubes and out into the pelvis and peritoneum. This is called retrograde menstruation. The endometrial tissue then seeds itself around the pelvis and peritoneal cavity.
- Embryonic cells destined to become endometrial tissue may remain in areas outside the uterus during the development of the fetus, and later develop into ectopic endometrial tissue.
- There may be spread of endometrial cells through the lymphatic system, in a similar way to the spread of cancer.
- Cells outside the uterus somehow change, in a process called metaplasia, from typical cells of that organ into endometrial cells.
Presentation of endometriosis?
Endometriosis can be asymptomatic in some cases, or present with a number of symptoms:
- Cyclical abdominal or pelvic pain - main symptom
- Deep dyspareunia (pain on deep sexual intercourse)
- Dysmenorrhoea (painful periods)
- Infertility
- Cyclical bleeding from other sites, such as haematuria
There can also be cyclical symptoms relating to other areas affected by the endometriosis:
- Urinary symptoms- blood in urine
- Bowel symptoms- blood in stool
Examination may reveal:
- Endometrial tissue visible in the vagina on speculum examination, particularly in the posterior fornix
- A fixed cervix on bimanual examination
- Tenderness in the vagina, cervix and adnexa
Having Endometriosis means you are infertile
TRUE OR FALSE
FALSE- reduced fertility
Diagnosis of Endometriosis?
Pelvic ultrasound may reveal large endometriomas and chocolate cysts
Laparoscopic surgery is the gold standard way to diagnose abdominal and pelvic endometriosis.- biopsy