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Clinical Modules > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Menstrual Cycle

A

Follicular Phase (Day1-ovulation): FSH stimulates follicular development -> follicles grow, secrete oestrogen -> oestrogen thickens endometrium, makes cervical mucus more permeable, inhibits FSH and stimulates LH -> LH causes ovulation
Luteal Phase (last 14 days): corpus luteum secretes oestrogen and progesterone which inhibits LH and FSH and maintains endometrial lining -> if fertilisation then HCG from embryo syncytiotrophoblast, if no fertilisation then corpus luterum degenerates -> fall in oestrogen and progesterone -> FHS/ LH rise and endometrium breaks down -> cycle restarts

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2
Q

Amenorrhoea

A
  • primary: lack of menstruation by 14 or 16 (depending on secondary sexual features)
  • secondary: absence for 6 months
  • causes: functional, PCOS, hyperthyroid, perimenopause, pregnancy, Kallmans, Turners, contraceptives
  • Ix: pregnancy test, FSH/LH, prolactin, TFTs, Pelvic USS, karyotype
  • Mx: depends on cause
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3
Q

Premenstrual Syndrome

A
  • psychological, emotional and physical symptoms that occur during luteal phase - impact on quality of life
  • Sx: varies between individuals (mood, fatigues, pain etc)
  • Mx: healthy lifestyle changes, COCP, SSRI, CBT, oestrogen patches, GnRH analogues (severe)
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4
Q

Menorrhagia

A
  • excessive menstrual blood loss = >80ml (normally 40ml)
  • causes: DUB (50%), fibroids, endometriosis, PID, contraceptives, bleeding disorders, PCOS, cancer
  • Ix: FBC, hysteroscopy, pelvic/TV USS, swabs, coag screen, TFT, ferritin
  • Mx: exclude pathology, tranexamic acid (no pain), mefenamic acid/ NSAID (pain), contraception (Mirena, COCP, POP), endometrial ablation, hysterectomy
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5
Q

Fibroids

A

benign neoplasia of uterine smooth muscle, oestrogen sensitive, intramural/ subserosal/ submucosal/ pedunculated
RF: obesity, early menarche, older age, FH, African
Sx: often asymptomatic, menorrhagia, prolonged menstruation, abdo pain, urinary/ bowel sx, dyspareunia
Ix: hysteroscopy (submucosal), pelvic USS, MRI if needed
Mx: <3cm: Mirena, NSAIDs, COCP/POP, surgery (endometrial ablation, resection of fibroids, hysterectomy)
>3cm: Mirena, NSAIDs, COCP/POP, surgery (uterine artery embolisation, myomectomy, hysterectomy, GnRH short-term)
Complications: subfertility, torsion, red generation

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6
Q

Endometriosis

A

ectopic endometrial tissueoutside theuterus
Sx: Cyclical abdominal or pelvic pain, Deep dyspareunia, Dysmenorrhoea, Infertility, Cyclical bleeding from other sites
Ix: pelvic USS, laparoscopic surgery
Mx: analgesia, COCP/ POP/ Mirena, GnRH, surgery (excision/ ablation/ hysterectomy)

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7
Q

Dysmenorrhoea

definition

A

painful menstruation

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8
Q

Dysmenorrhoea

causes

A
  • Primary dysmenorrhoea (no underlying pathology)
  • Endometriosis or adenomyosis
  • Fibroids
  • Pelvic inflammatory disease
  • Copper coil
  • Cervical or ovarian cancer
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9
Q

Oligomenorrhoea

definition

A

infrequent menstrual periods (fewer than six to eight periods per year)

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10
Q

Oligomenorrhoea

causes

A
  • PCOS
  • borderline low BMI
  • obesity without PCOS
  • ovarian resistance leading to anovulation (eg incipient POF)
  • milder degrees of hyperprolactinaemia
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11
Q

Oligomenorrhoea

management

A
  • Treat any underlying causes
  • Exclude serious pathology
  • Attain normal BMI
  • Provide regular cycles:
    • COCP or cyclical progestagens
    • minimum of 3 periods/yr recommended for PCOS
  • Full fertility screening if ovulation induction required
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12
Q

Abnormal uterine bleeding

definition

A
  • diagnosis of exclusion
  • any abnormal uterine bleeding in the absence of pregnancy, genital tract pathology, or systemic disease
  • also called dysfunctional uterine bleeding (DUB)
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13
Q

Abnormal uterine bleeding

presentation

A
  • menorrhagia - heavy/ prolonged vaginal bleeding with clots and flooding
  • possible dysmenorrhoea
  • Systemic symptoms of anaemia and disruption of life due to bleeding
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14
Q

Abnormal uterine bleeding

Red flags

A

Totally erratic bleeding, IMB, or PCB should prompt a search for cervical or endometrial pathology

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15
Q

Abnormal uterine bleeding

investigations

A
  • consider and exclude pregnancy
  • FBC - Hb and MCV
  • consider Ferritin, TFTs, and clotting screens if clinically indicated
  • STI screen
  • <45 yrs - no further investigations
  • > 45 yrs - TVUSS (identify fibroids/ polyps/ measure endometrial thickness), pipelle biopsy, hysteroscopy
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16
Q

Abnormal uterine bleeding

management

A
  • regular DUB:
    • Mirena IUS
    • anti-fibrinolytics - tranexamic acid
    • NSAIDs - mefenamic acid
    • COCP
    • oral progestagens (norethisterone)
  • irregular DUB:
    • Mirena IUS
    • tranexamic acid and mefenamic acid
    • progesterone only tablets
  • GnRH analogues if still bleeding (induce medical menopause)
  • surgical mx: endometrial ablation, hysterectomy
17
Q

Ovarian cysts

definition

A

Clinical Modules (11 decks)

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