Gynaecology Flashcards
What are the presentations of fibroids?
Often asymptomatic
Heavy menstrual bleeding (menorrhagia)
Prolonged menstruation
Abdominal pain (especially when menstruating)
Bloating
Urinary/bowel symptoms (due to pressure on surrounding structures)
Deep dyspareunia
Reduced fertility
What investigations are done with fibroids?
Hysteroscopy –> Initial investigation for submucosal fibroids
Pelvic ultrasound –> Larger fibroids
MRI –> Determine size, shape and blood supply before surgery
What is the management of fibroids less than 3cm?
Same as heavy menstrual bleeding:
Mirena coil (first line)
Manage symptoms –> NSAIDs, tranexamic acid
Combined oral contraceptive pill
Cyclical oral progestogens
Surgical options:
Endometrial ablation
Resection
Hysterectomy
What is the management of fibroids >3cm?
Refer to gynaecology
Symptomatic management with NSAIDs and tranexamic acid
Mirena coil
COCP
Cyclical oral progestogens
Surgical options:
Uterine artery embolisation
Myomectomy
Hysterectomy
What drug can help reduce the size of a fibroid?
Triptorelin (GnRH agonists)
What are possible complications of fibroids?
Heavy menstrual bleeding –> anaemia
Reduced fertility
Miscarriage/premature labour
Constipation
UTI/urinary outflow obstruction
Ischaemia/infarction/necrosis of the fibroid
Malignant change to leiomyosarcoma
What is the difference in significant in ovarian cysts in pre- vs post-menopausal women?
Pre-menopausal = often benign
Post-menopausal = more concerning, potentially malignant, need further investigation
What is the presentation of ovarian cysts?
Mostly asymptomatic and found incidentally
Pelvic pain
Bloating/fullness
Palpable pelvic mass
What are the different types of ovarian cysts?
Follicular cyst = When the follicle fails to rupture and release the egg –> Often disappears after a few menstrual cycles
Corpus luteum cyst = When the corpus luteum fails to break down and fills with fluid –> Seen in early pregnancy
Serous/mucinous cystadenoma = Benign tumour of epithelium
Endometrioma = Lumps of endometrium in the ovary due to endometriosis
Dermoid cyst/germ cell tumour = Benign ovarian tumours
What are the risk factors for ovarian malignancy?
Increasing age
Post-menopausal
Increased number of ovulations (eg. early menarche, late menopause, no Mirena/COCP etc, no pregnancies, infertility treatment)
Obesity
HRT
Smoking
No breastfeeding (breastfeeding is protective)
Family history/BRCA1 and BRCA2 genes
What factors reduce the risk of ovarian cancer?
Later menarche
Early menopause
Any pregnancies
Use of COCP/Mirena
Breastfeeding
What is the management of ovarian cysts?
Raised CA125/complex cyst = 2 week wait
Dermoid cyst = Referral
Simple + <5cm = Self limiting and will most likely resolve
Simple + 5-7cm = Routine referral to gynaecology
Simple + >7cm = MRI/surgical evaluation
What is Meig’s syndrome?
Ovarian fibroma (benign ovarian tumour)
Pleural effusion
Ascites
Removal of tumour resolves symptoms
What is the presentation of ovarian cancer?
Bloating/fullness
Loss of appetite
Pelvic pain
Urinary symptoms
Weight loss
Abdominal/pelvic mass
Ascites
What findings on physical examination would indicate a 2-week-wait referral for suspected ovarian cancer?
Ascites
Pelvic mass (unless clearly due to fibroid)
Abdominal mass
What are the initial investigations in suspected ovarian cancer?
CA125 blood test
Pelvic ultrasound
What are the stages of ovarian cancer?
Stage 1 = Confined to the ovary
Stage 2 = Spread past the ovary but still in the pelvis
Stage 3 = Spread past the pelvis but in the abdomen
Stage 4 = Spread outside abdomen (distant metastasis)
What is the management of ovarian cancer?
Surgery and chemotherapy
What are non-ovarian cancer causes of a raised CA125?
Breast, endometrial and metastatic lung cancer
Adenomyosis
Ascites
Endometriosis
Menstruation
Ovarian torsion
Liver disease
NOT VULVAL CANCER
What is endometrial hyperplasia?
Precancerous condition involving thickening of the endometrium
Risk factors, presentation and investigations are the same as for endometrial cancer
Most cases return to normal over time
What is the management of endometrial hyperplasia?
IUS (Mirena)
Continuous oral progestogens
What are the risk factors for endometrial cancer?
Increase exposure to unopposed oestrogen
Increased age
Early menarche
Late menopause
Oestrogen-only HRT
No/fewer pregnancies
Obesity –> Adipose tissue is a source of oestrogen in post-menopausal women
PCOS
Tamoxifen
Also:
Type 2 diabetes
Lynch syndrome
What factors are protective against endometrial cancer?
COCP
Mirena
Increased pregnancies
Cigarette smoking
What is the presentation of endometrial cancer?
Postmenopausal bleeding –> Endometrial cancer until proven otherwise
Postcoital bleeding
Intermenstrual bleeding
Unusually heavy bleeding
Abnormal vaginal discharge
Haematuria
Anaemia
Raised platelets