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Gynaecology Flashcards

1
Q

Primary amenorrhoea definition?

A

not beginning menstruation before the age of 13 with no secondary sexual characteristics
not beginning menstruation before age of 15 with development of secondary sexual characteristics

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2
Q

Hypogonadotropic hypogonadism vs hypergonadotropic hypogonadism?

A

Hypo hypo -> lack of LH and FSH leading to lack of oestrogen
Hyper hypo -> lack of response to LH and FSH leading to excess LH and FSH and lack of oestrogen

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3
Q

Causes of hypogonadotropic hypogonadism?

A

problems with pituitary or hypothalamus
hypopituitarism
damage (radiotherapy, Sx)
significant chronic conditions (CF, IBD) can cause delay
excessive exercise or dieting
constitutional delay
Kallman syndrome
endocrine disorders (Cushing’s, hypothyroid, GH deficiency, hyperprolactinaemia)

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4
Q

Causes of hypergonadotropic hypogonadism?

A

Turner’s syndrome
congenital absence of ovaries
previous damage to gonads (torsion, cancer, mumps)

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5
Q

What feature is strongly associated with Kallman syndrome?

A

anosmia

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6
Q

Causes of primary amenorrhoea?

A

hypogonadotropic hypogonadism
hypergonadotropic hypogonadism
congenital adrenal hyperplasia
androgen insensitivity syndrome
structural pathology

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7
Q

What causes congenital adrenal hyperplasia?

A

congenital deficiency of 21-hydrozylase enzyme
autosomal recessive pattern
->
underproduction of cortisol and aldosterone
overproduction of androgens

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8
Q

Presentation of congenital adrenal hyperplasia?

A

tall for their age
facial hair
primary amenorrhoea
deep voice
early puberty

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9
Q

Presentation of androgen insensitivity syndrome?

A

female phenotype
male genotype

normal female breast tissue and external genitalia
internally -> testes in abdomen or inguinal canal, no upper vagina, no uterus, no fallopian tubes, no ovaries

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10
Q

Examples of structural pathology causing primary amenorrhoea?

A

imperforate hymen
transverse vaginal septae
vaginal agenesis
absent uterus
FGM

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11
Q

When to investigate primary amenorrhoea?

A

no signs of puberty at 13
no periods at 15

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12
Q

Investigations for primary amenorrhoea?

A

Full Hx and Exam
Bloods for underlying medical condition
FSH and LH
TFTs
IGF-1
prolactin
testosterone
genetic testing (microarray)
X-ray of wrist (constitutional delay)
pelvic US
MRI brain

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13
Q

Secondary amenorrhoea definition?

A

no menstruation for 3 months after previously regular cycles
investigate after 3-6 months or 6-12 months in women with previously irregular cycles

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14
Q

Causes of secondary amenorrhoea?

A

pregnancy
menopause
premature ovarian failure
contraception
hypothalamic or pituitary pathology
PCOS
uterine (Asherman’s)
thyroid pathology
hyperprolactinaemia

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15
Q

Hypothalamus causes of secondary amenorrhoea?

A

excessive exercise
low BMI and eating disorders
chronic disease
physiological stress

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16
Q

Pituitary causes of secondary amenorrhoea?

A

pituitary tumours (prolactinoma, macroadenoma)
pituitary failure (trauma, Sx, radiotherapy, Sheehan’s syndrome)

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17
Q

Treatment for hyperprolactinaemia?

A

dopamine agonists (e.g., bromocriptine, cabergoline)

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18
Q

Investigations for secondary amenorrhoea?

A

Hx and exam
Hormonal bloods (LH, FSH, prolactin, bHCG, TFTs, testosterone)
US pelvis, MRI pituitary

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19
Q

Management options for PMS?

A

lifestyle changes
COCP
SSRIs
CBT

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20
Q

Menorrhagia definition?

A

based on what the woman herself considers to be excessive bleeding
more than 80mls of blood loss

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21
Q

Causes of menorrhagia?

A

dysfunctional uterine bleeding (no cause)
extremes of reproductive age
fibroids
endometriosis
adenomyosis
PID
contraceptives (copper coil)
anticoagulants
bleeding disorders (von Willebrand)
endocrine disorders
CT disorders
endometrial hyperplasia or ca
PCOS

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22
Q

Investigations for menorrhagia?

A

Hx and Exam
pelvic exam with speculum and bimanual
FBC (anaemia)
swabs (infection)
coag screen
TFTs

TVUS or PUS
outpatient hysteroscopy (if suspected fibroids, suspected endometrial pathology, persistent IMB)

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23
Q

Management of menorrhagia?

A

if cause -> treat
tranexamic acid + mefenamic acid
Mirena coil
COCP
cyclical oral progesterone

refer if management unsuccessful or symptoms suggest underlying pathology

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24
Q

Final options for menorrhagia?

A

endometrial ablation
hysterectomy

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25
Q

What are fibroids?

A

uterine leiomyomas
benign tumours of the smooth muscle or the uterus
oestrogen-sensitive

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26
Q

Types of fibroids?

A

intramural
subserosal
submucosal
pedunculated

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27
Q

Presentation of fibroids?

A

often asymptomatic

menorrhagia
prolonged menstruation
abdo pain
bloating or fullness
urinary or bowel symptoms
deep dyspareunia
reduced fertility

palpable pelvic mass on abdo or bimanual exam

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28
Q

Investigations for fibroids?

A

hysteroscopy
pelvic US
MRI prior to Sx

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29
Q

Mx of fibroids?

A

if <3cm:
Mirena coil (no distortion of uterine cavity)
symptomatic management with tranexamic acid and mefenamic acid
COCP
cyclical oral progesterons

GnRH analogues may be used prior to Sx to reduce size of fibroids
Sx options -> endometrial ablation, myomectomy, hysterectomy

If >3cm:
refer to gynae
mx as above + uterine artery embolisation

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30
Q

Complications of fibroids?

A

menorrhagia
iron deficiency anaemia
reduced fertility
pregnancy complications (miscarriage, premature labour, obstructive delivery)
constipation
urinary outflow obstruction
UTIs
red degeneration of fibroid
torsion of fibroid
malignant change to leiomyosarcoma (rare)

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31
Q

What is red degeneration of fibroids and how does it present?

A

ischaemia, infarct and necrosis of fibroid due to disrupted blood supply
occurs in larger fibroids during second or third trimester

severe abdo pain, low grade fever, tachycardia, vomiting

supportive management

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32
Q

What is endometriosis?

A

condition where ectopic endometrial tissue grows outside of the uterus

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33
Q

Presentation of endometriosis?

A

cyclical abdo or pelvic pain
deep dyspareunia
dysmenorrhoea
infertility
cyclical bleeding from other sites (haematuria, PR bleeding)
urinary and bowel symptoms

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34
Q

Investigations for endometriosis?

A

pelvic US (often unremarkable)
laparoscopy is gold standard (+/- biopsy)

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35
Q

Mx of endometriosis?

A

analgesia first-line (NSAIDs and paracetamol)
hormonal (COCP
POP
injection
implant
Mirena coil
GnRH analogues)
hormonal therapy will improves symptoms but not fertility

Sx -> laparoscopic excision or ablation, adhesiolysis, hysterectomy

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36
Q

What is adenomyosis?

A

condition where endometrial tissue grows inside of the myometrium

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37
Q

Presentation of adenomyosis?

A

later in reproductive years, usually in multiparous women
dysmenorrhoea
menorrhagia
deep dyspareunia
infertility
pregnancy complications

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38
Q

Investigations for adenomysosis?

A

TVUS
(MRI and TAUS are alternatives)

(gold standard is histological exam of uterus after hysterectomy -> obviously not always suitable)

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39
Q

Mx of adenomyosis?

A

non-contraceptive (tranexamic acid, mefenamic acid)
contraceptive (Mirena, COCP, cyclical oral progesterones)
Sx (GnRH analogues, endometrial ablation, uterine artery embolisation, hysterectomy)

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40
Q

Pregnancy complications associated with adenomyosis?

A

infertility
miscarriage
preterm birth
SGA
PPROM
malpresentation
need for c section
PPH

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41
Q

Rotterdam criteria for PCOS?

A

2 of the 3 key features:

oligoovulation or anovulation
hyperandrogenism (hirsutism, acne)
polycystic ovaries on US

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42
Q

Presentation of PCOS?

A

oligomenorrhoea or amenorrhoea
infertility
obesity (70%)
hirsutism
acne
hair loss in male pattern

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43
Q

Complications of PCOS?

A

insulin resistance and DM
acanthosis nigricans
CVD
hypercholesterolaemia
endometrial hyperplasia and ca
obstructive sleep apnoea
depression and anxiety
sexual problems

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44
Q

Investigations for PCOS?

A

Hormonal bloods:
raised LH
raised LH:FSH ratio
raised testosterone
raised insulin
normal or raised oestrogen
prolactin may be slightly raised

Pelvic US/TVUS:
12 or more developing follicles in one ovary
ovary volume > 10cm3
‘string of pearls’ appearance

screen for diabetes (OGTT)

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45
Q

Mx of PCOS?

A

reduce risks for obesity, CVD, hypercholesterolaemia and T2DM:
weight loss, smoking cessation, diet, exercise, antihypertensive and statins when necessary

protect against endometrial hyperplasia/ca:
Mirena coil
COCP
cyclical progesterones

Mx infertility:
weight loss
metformin
clomifene
ovarian drilling
IVF

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46
Q

Presentation of ovarian cysts?

A

most are asymptomatic -> found incidentally on scans

pelvic pain
bloating
fullness in abdo
palpable pelvic mass

acute pelvic pain -> torsion, rupture or haemorrhage of cyst

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47
Q

Most common type of ovarian cyst?

A

follicular cyst

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48
Q

Types of ovarian cyst?

A

follicular cyst
corpus luteum cyst (early pregnancy)
serous cystadenoma
mucinous cystadenoma (can get v big)
endometrioma (chocolate cyst)
dermoid cyst/ GCT (teratoma)
sex cord-stromal tumour

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49
Q

Hx of ovarian cysts?

A

benign vs malignant!!!
Red flags:
abdo bloating
anorexia
early satiety
weight loss
urinary symptoms
pain
ascites
lymphadenopathy

RFs:
age
post-menopause
incr. no. of ovulations
obesity
HRT
smoking
BRCA1 and BRCA2

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50
Q

Investigations for ovarian cysts?

A

no investigations needed for premenopausal woman with simple cyst <5cm

pelvic US
TVUS
CA 125
women under 40 with complex ovarian mass -> LDH, AFP, HCG (GCT)

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51
Q

Risk of Malignancy Index for ovarian ca?

A

menopausal status (1,3)
US findings (1,2,3)
CA 125 level

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52
Q

Mx of simple ovarian cysts?

A

<5cm -> self-resolve within 3 cycles, no follow up required
5-7cm -> routine referral to gynae and yearly US follow up
>7cm -> consider MRI or Sx

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53
Q

Complications of ovarian cysts?

A

torsion
haemorrhage
rupture

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54
Q

What is Meig’s syndrome?

A

a triad of:
pleural effusion
ascites
ovarian fibroma

ascites and pleural effusion resolve on removal of mass

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55
Q

RFs for ovarian torsion?

A

ovarian mass >5cm
benign tumours more common
pregnancy
before menarche in younger girls with long infundibulopelvic ligaments

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56
Q

Presentation of ovarian torsion?

A

sudden onset severe unilateral pelvic pain
nausea
vomiting
pain can come and go intermittently
localised tenderness
may be a palpable mass

57
Q

Investigations for ovarian torsion?

A

pelvic US (TVUS, TAUS)
‘whirlpool’ sign
free fluid in pelvis
oedema of ovary
lack of blood flow on Doppler
definitive diagnosis made with laparoscopic sx

58
Q

Mx of ovarian torsion?

A

surgical emergency
detorsion
oophorectomy

59
Q

Complications of ovarian torsion?

A

loss of function in affected ovary
infection
abscess formation
sepsis
rupture
peritonitis
adhesions

60
Q

What is Asherman’s Syndrome?

A

adhesions form within the uterus, following damage to the uterus

61
Q

Causes of Asherman’s syndrome?

A

D&C
ERPC
myomectomy
endometritis

62
Q

Presentation of Asherman’s syndrome?

A

secondary amenorrhoea
significantly lighter periods
dysmenorrhoea
infertility

63
Q

Diagnosis for Asherman’s syndrome?

A

hysteroscopy gold standard (can treat)

hysterosalpingography
sonohysterography
MRI

64
Q

Mx of Asherman’s syndrome?

A

dissection of adhesions during laparoscopic sx
recurrence common

65
Q

RFs for cervical ectropion?

A

higher oestrogen levels:
younger women
COCP
pregnancy

66
Q

Presentation of cervical ectropion?

A

asymptomatic (picked up on smears)

increased vaginal discharge
vaginal bleeding
dyspareunia
postcoital bleeding

exam of cervix -> well-demarcated border between red columnar epithelium and pale pink squamous ectocervix (transformation zone)

67
Q

Mx of cervical ectropion?

A

asymptomatic -> no treatment needed
not pre-malignant, not a contraindication to the COCP

only treat if problematic bleeding -> cauterisation of ectropion using silver nitrate or cold coagulation during colposcopy

68
Q

What are Nabothian cysts?

A

fluid-filled cysts often seen on the surface of the cervix

harmless and unrelated to cervical cancer

69
Q

What is atrophic vaginitis?

A

dryness and atrophy of the vagina due to a lack of oestrogen
v common post-menopause

70
Q

Presentation of atrophic vaginitis?

A

itching
dryness
dyspareunia
bleeding
recurrent UTIs
stress incontinence
POP

71
Q

Most common cause of post-menopausal bleeding?

A

atrophic vaginitis

**BUT PMB is endometrial ca until proven otherwise

72
Q

Mx of atrophic vaginitis?

A

vaginal lubricants
topical oestrogen (cream, pessaries, ring)

73
Q

What is menopause?

A

retrospective clinical diagnosis made when a woman has had no periods for 12 months

74
Q

Average age of menopause in Ireland?

A

51 years

75
Q

What is considered to be premature menopause?

A

menopause before the age of 40
due to premature ovarian failure

76
Q

Symptoms of menopause?

A

due to a lack of oestrogen

vasomotor (hot flushes, headaches, night sweats, palpitations, insomnia)
urogenital (atrophy, vulvitis, incontinence, prolapse, dyspareunia)
psychological (concentration, memory loss, irritability, depression, anxiety, libido loss)
cutaneous (skin, nails, hair)

77
Q

Long-term risks associated with menopause?

A

osteoporosis
CVD
ischaemic CVA
POP
urinary incontinence

78
Q

Contraception during the perimenopausal period?

A

necessary for 12 months after LMP >50
necessary for 24 months after LMP <50

79
Q

3 questions to ask when prescribing HRT?

A

oestrogen-only or combined?
cyclical or continuous?
mode of delivery?

80
Q

When is oestrogen-only HRT indicated?

A

**only acceptable if the woman has had a hysterectomy

unopposed oestrogen increases risk for endometrial hyperplasia and ca and thus progesterone is added as protection

81
Q

When is there an increased risk of breast cancer in HRT?

A

when it is combined

no increased risk in oestrogen only HRT

82
Q

When to used cyclical vs continuous HRT and why?

A

cyclical used for women who have had a period in the last 12 months >50 or last 24 months <50

period-like bleeding occurs during the oestrogen-only phase of HRT

otherwise -> irregular breakthrough bleeding may occur on continuous HRT -> unnecessary investigations because of ‘PMB’

83
Q

Types of oestrogen?

A

tablet, patch, gel, vaginal oestrogen, spray

84
Q

Types of progesterone?

A

Mirena
pill
patch

85
Q

Benefits of HRT?

A

symptomatic treatment
lowers osteoporosis risk
decreases CVD risk (if started before 60)
decreases colorectal ca risk
diminished risk of T2DM

86
Q

Risks of HRT?

A

endometrial hyperplasia and ca (oestrogen-only)
VTE (oral tablets only)
CVD (when commenced in women >60 or with pre-existing CVD)
stroke (when oral HRT commenced in women >60)
breast ca (when progesterone is added)

87
Q

Contraindications to HRT?

A

endometrial hyperplasia or ca
breast ca
abnormal bleeding
uncontrolled HTN
VTE
liver disease
active CVD
pregnancy
migraine with aura (oral)

88
Q

Non-hormonal alternatives to HRT?

A

lifestyle changes
SSRIs
venlafaxine (SNRI)
gabapentin
clonidine
CBT
natural remedies (evening primrose oil, ginseng) -> caution drug interactions

89
Q

What is premature ovarian insufficiency?

A

menopause before the age of 40
presents with perimenopausal symptoms

90
Q

Hormonal blood tests in premature ovarian failure?

A

low oestrogen
high LH and FSH

91
Q

Causes of premature ovarian failure?

A

idiopathic
iatrogenic (chemo, radiation, oophorectomy)
autoimmune
genetic
infections (mumps, TB, CMV)

92
Q

Management of premature ovarian failure?

A

HRT until at least 50
traditional HRT or COCP
no incr. risks as same hormones as anyone else
slight VTE risk increase in oral HRT

93
Q

How many couples will fail to conceive after 1yr of UPSI?

A

1 in 7

94
Q

When to investigate for infertility?

A

after 12 months of UPSI
can be reduced to 6 months in women >35 as their ovarian stores are more likely to be reduced

95
Q

Causes of infertility?

A

sperm problems
ovulation problems
tubal problems
uterine problems
unexplained

often mixed male and female factors

96
Q

General advice for couples trying to get pregnant?

A

400mcg folic acid daily
healthy BMI
avoid smoking and excess alcohol
reduce stress
intercourse every 2-3 days
avoid timing intercourse

97
Q

Investigations for infertility?

A

BMI
chlamydia screening
semen analysis
female hormone testing
rubella immunity in mother
pelvic US
hysterosalpingogram
laparoscopy and dye test

98
Q

Female hormone testing in infertility?

A

serum LH and FSH on day 2-5 (high LH indicates PCOS, high FSH poor ovarian reserve)
serum progesterone on day 21 (if 28 day cycle) (indicates ovulation occurring if raised)
anti-Mullerian hormone (high level show good ovarian reserve)
TFTs
prolactin

99
Q

Management of anovulation?

A

weight loss if indicated
clomifene
letrozole
gonadotropins
ovarian drilling (PCOS)
metformin

100
Q

Management of tubal factors causing infertility?

A

tubal cannulation during hysterosalpingogram
laparoscopy to remove adhesions or endometriosis
IVF

101
Q

Mx of uterine problems causing infertility?

A

Sx to correct polyps, fibroids, adhesions or structural abnormalities

102
Q

Mx of sperm problems causing infertility?

A

surgical sperm retrieval
surgical correction of blockage in vas deferens
intra-uterine insemination
intracytoplasmic sperm injection
donor insemination

103
Q

Causes of anovulation infertility?

A

hypogonadotropic hypogonadism (hypothalamus, Kallmann)
PCOS
premature ovarian failure

104
Q

Tubal causes of infertility?

A

PID
endometriosis
previous sterilisation

105
Q

Uterine causes of infertility?

A

endometriosis
adhesions (Asherman’s)
uterine fibroids
uterine anomalies

106
Q

Semen analysis includes?

A

semen volume
pH
sperm concentration
total sperm number
total motility
vitality
sperm morphology

107
Q

Causes of male factor infertility?

A

pre-testicular causes i.e., low testosterone (pathology of pituitary or hypothalamus, suppression due to stress, chronic illness or hyperprolactinaemia, Kallman syndrome)

testicular causes (mumps, undescended testes, trauma, chemo, radiation, cancer, Klinefelter syndrome)

post-testicular causes (vas deferens damage, ejaculatory duct obstruction, retrograde ejaculation, scarring from epididymitis, absence of vas (CF))

108
Q

Further analysis of males when abnormal semen analysis?

A

hormonal analysis with LH, FSH, testosterone
genetic testing
imaging (transrectal US, MRI)
vasography
testicular biopsy

109
Q

Complications of IVF?

A

failure
multiple pregnancy
ectopic pregnancy
ovarian hyperstimulation syndrome

collection procedure:
pain
bleeding
pelvic infection
damage to bladder or bowel

110
Q

Steps involved in IVF?

A

suppressing the natural menstruation cycle
ovarian stimulation
oocyte collection
insemination / ICSI
embryo culture
embryo transfer

111
Q

What is ovarian hyperstimulation syndrome?

A

complication of ovarian stimulation during the IVF process
associated with the use of HCG to mature the follicles in the final steps of ovarian stimulation

112
Q

Risk Factors for ovarian hyperstimulation syndrome?

A

younger age
lower BMI
raised anti-Mullerian hormone
higher antral follicle count
PCOS
raised oestrogen levels during ovarian stimulation

113
Q

Features of OHSS?

A

abdo pain and bloating
N&V
diarrhoea
hypotension
hypovolaemia
ascites
pleural effusions
renal failure
peritonitis from rupturing follicles
prothrombotic state (DVT, PE risk)

114
Q

Types of urinary incontinence?

A

stress incontinence
urge incontinence
overflow incontinence
functional incontinence

mixed incontinence

115
Q

RFs for urinary incontinence?

A

incr. age
postmenopausal status
incr. BMI
prev. pregnancies and vaginal deliveries
POP
pelvic floor sx
neurological conditions (MS)
cognitive impairment and dementia

116
Q

What is urge incontinence?

A

caused by overactivity of the detrusor muscle
OAB
suddenly feeling the urge to pass urine, and happening straight away

117
Q

What is stress incontinence?

A

occurs due to weakness of the pelvic floor and sphincter muscles
leakage of urine when laughing or coughing

118
Q

What is overflow incontinence?

A

chronic urinary retention resulting in leakage of urine without the urge to pass urine
more common in men
caused by anticholinergics, fibroids, pelvic tumours or neurological conditions

119
Q

Assessment of urinary incontinence?

A

Hx
assess for modifiable lifestyle factors
severity and QOL
Exam (pelvic tone, look for atrophic vaginitis, POP, ask patient to cough and look for leakage, modified Oxford grading system)

120
Q

What is the modified Oxford grading system used for?

A

to assess the strength of the pelvic floor muscles

121
Q

Grades to modified Oxford grading system?

A

0- no contraction
1- faint contraction
2 - weak contraction
3 - moderate contraction with some resistance
4- good contraction with resistance
5 - strong contracting, drawing finger inwards

122
Q

Investigations for urinary incontinence?

A

bladder diary
urine dipstick testing
post-void residual bladder volume
urodynamic testing

123
Q

Urodynamic testing includes?

A

cytometry
uroflowmetry
leak point pressure
post-void residual bladder volume
video urodynamic testing

124
Q

Mx of stress incontinence?

A

lifestyle factors
weight loss if appropriate
pelvic floor exercises
Sx (tension-free vaginal tape, autologous sling procedures, colposuspension, intramural urethral bulking)
duloxetine
artificial urinary sphincter

125
Q

Mx of urge incontinence?

A

bladder retraining
anticholinergic meds (oxybutynin, tolterodine)
mirabegron alternatively (beta-3-agonist)
Sx (Botox injection, percutaneous sacral nerve stimulation, augmentation cystoplasty, urinary diversion)

126
Q

Mx of mixed incontinence?

A

discover which form of incontinence is affecting the woman more and treat as such

127
Q

Types of POP?

A

anterior compartment prolapse (urethrocele, cystocele)
posterior compartment prolapse (enterocele, rectocele)
apical compartment prolapse (vault prolapse, uterine prolapse)

128
Q

What is pelvic organ prolapse?

A

the herniation of the pelvic organs to or beyond the vaginal walls

129
Q

What are the levels to De-Lancey’s Biomechanical Support?

A

Level 1 -> the uterosacral/ cardinal ligament complex
Level 2 -> pubocervical fascia, rectovaginal fascia, levator ani muscle (through the tendinous fasciae pelvis)
Level 3 -> perineal membrane, urogenital diaphragm

130
Q

What does defects in each layer of support cause?

A

level 1 -> suspension defect, apical prolapse
level 2 -> attachment defect, cystocele, rectocele
level 3 -> fusion defect, deficient perineum, urethrocele

131
Q

RFs for POP?

A

multiple vaginal deliveries
instrumental, prolonged or traumatic deliveries
advanced age
postmenopausal
obesity
chronic resp disease causing chronic cough
chronic constipation

132
Q

Presentation of POP?

A

feeling of ‘something coming down’
dragging or heavy sensation
urinary symptoms
bowel symptoms
sexual dysfunction

133
Q

Investigations for POP?

A

clinical exam using Sim’s speculum
empty bladder and bowel
held to the anterior wall to look for rectocele and posterior wall to look for cystocele

134
Q

Grading system for pelvic organ prolapse?

A

Baden-Walker system

135
Q

Baden-Walker system for grading POP?

A

Grade 0 -> no prolapse
Grade 1 -> descent halfway to the hymen
Grade 2 -> descent to the hymen
Grade 3 -> descent halfway past the hymen
Grade 4 -> maximal descent

136
Q

What is a uterine procidentia?

A

when a prolapse extends past the introitus

137
Q

Mx options for POP?

A

conservative (lifestyle, weight loss, physio, symptomatic, oestrogen cream)
pessary
surgical

138
Q

Sx management of POP?

A

reconstructive (anterior colporrhaphy, posterior colporrhaphy, sacrolopoplexy)
obliterative (LeFort colpocleisis)
hysterectomy

Obs Gynae (4 decks)

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