Gynaecology Flashcards
common microbe for vaginal candidiasis
candida albicans
predisposing factors for candidiasis
diabetes
immunosuppression e.g. HIV
increased estrogen e.g. pregnancy
antibiotics, steroids
management of primary dysmennorhoea
NSAIDs e.g. ibuprofen, mefenamic acid
COCP second line
primary vs secondary dysmennorhoea
primary - no underlying pelvic pathology, pain starts before or within a few hours of the period starting
secondary - develops many years after the menarche, pain starts 3-4 days before onset of the period
- endometriosis
- adenomyosis
- PID
- fibroids
- IUD
management of urge incontinence
bladder retraining exercises (minimum 6 weeks)
bladder stabilising drugs (anti-muscarinics)
oxybutynin (immediate release = first line), tolterodine
** mirabegron if scared of fall risk in frail elderly patients
management of PCOS
infertility:
weight loss can help induce ovulation
clomifene, metformin started under specialist guidance
hirsutism:
weight loss
COCP e.g. Co-cyprindiol (Dianette) = anti-androgenic effect, but does increase risk of VTE
Topical eflornithine can be used for facial hirsutism, takes around 6-8 weeks to work and facial hair returns after 2 months
spironolactone, finasteride = anti-androgen effects
acne:
COCP e.g. co-cyprinidol
what is premenstrual syndrome & its features
the emotional and physical symptoms that women may experience in the luteal phase of the normal menstrual cycle
emotional:
anxiety
stress
fatigue
mood swings
physical:
bloating
breast pain
management of premenstrual syndrome
mild: lifestyle changes
e.g. stop smoking, drink less alcohol, exercise, good sleep hygiene, regular & frequent small meals rich in complex carbohydrates
moderate: COCP
severe: SSRIs
taken continuously or just during the luteal phase
what causes nausea & vomiting of pregnancy/hyperemesis gravidarum
raised b-HCG levels
therefore symptoms normally start between 4-7 weeks, most common at 10-12 weeks, and tend to go by 16-20 weeks, but can persist
increased risk:
multiple pregnancies
molar pregnancies
obesity
nulliparity
what decreases the risk of hyperemesis
smoking
criteria for hyperemesis gravidarum
More than 5 % weight loss compared with before pregnancy
Dehydration
Electrolyte imbalance
management of hyperemesis
antihistamines first line
e.g. oral cyclizine or oral promethazine
ondansetron and metoclopramide may be used second-line
** metoclopramide should not be used for more than 5 days due to extrapyramidal side effects
ondansetron during the first trimester is associated with a small increased risk of the baby having a cleft lip/palate
criteria for admission for nausea & vomiting in pregnancy
Continued nausea and vomiting and is unable to keep down liquids or oral antiemetics
Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics
A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection)
complications of HRT
increased risk of breast cancer
- increased by adding progesterone due to longer time of use
increased risk of endometrial cancer
- estrogen should not be given by itself to women with a womb
increased risk of VTE
- increased by adding progesterone
transdermal patch does not increase the risk
increased risk of stroke
increased risk of IHD if taken more than 10 yrs after the menopause
what is premature ovarian insufficiency
menopause before the age of 40yrs
characterised by hypergonadotropic hypogonadism
under-activity of the gonads means there is negative feedback on the pituitary gland
results in high FSH and LH, low estrogen
causes of premature ovarian failure
idiopathic
iatrogenic e.g. bilateral oophorectomy, radiotherapy, chemotherapy
autoimmune (other autoimmune conditions they might have)
infections e.g. mumps, TB
presentation of premature ovarian failure
classical symptoms: hot flushes, night sweats, vaginal dryness
infertility
secondary amenorrhoea
** elevated FSH levels should be demonstrated on 2 separate occasions 4-6 weeks apart
management of premature ovarian failure
HRT/COCP should be offered until the average age of the menopause e.g. 51 yrs
** reduces the cardiovascular, osteoporosis, cognitive and psychological side effects of early menopause
HRT - associated with lower BP than COCP, but still a chance of getting pregnant so still might need contraception
**increased risk of VTE with HRT under 50yrs, avoid this using transdermal patch
**no increased risk of breast cancer with HRT before 50yrs as would be producing these hormones anyway
risk factors for endometrial cancer
obesity
nulliparity
early menarche
late menopause
PCOS
tamoxifen
unopposed estrogen
diabetes mellitus
what is protective for endometrial cancer
smoking
COCP
management of urge & stress incontinence
urge:
bladder re-training for a minimum of 6 weeks
antimuscarinics:
oxybutynin, tolterodine
mirabegnon: frail elderly patients
stress:
pelvic floor exercises
surgical
duloxetine
types of cervical cancer
squamous: 80%
adenocarcinoma: 20%
symptoms of cervical cancer
abnormal vaginal bleeding: intermenstrual, post coital
vaginal discharge
cervical cancer risk factors
HPV 16,18
HIV
smoking
COCP
multiple sexual partners
high parity
underlying causes of vaginal itching/pruritus vulvae
irritant contact dermatitis e.g. latex, condoms
atopic eczema
seborrhoeic dermatitis
lichen planus/sclerosis
what does fibroid degeneration present with
fever, abdominal pain, vomiting
features of cervical ectropion
vaginal discharge
post-coital bleeding
when would you suspect ovarian cancer
in a female >50yrs who has IBS symptoms that have presented within a year
** IBS likely to present at this age
risk factors for ovarian cancer
BRCA1/2 gene mutations
many ovulations
