Gynaecology Flashcards
What is Androgen insensitivity syndrome?
X-linked recessive condition due to end-organ resistance to testosterone
mutation in the androgen receptor gene
causing genotypically male children (46XY) to have a female phenotype
What are the features of Androgen insensitivity syndrome?
‘primary amenorrhoea’
little or no axillary and pubic hair
undescended testes causing groin swellings
breast development may occur as a result of the conversion of testosterone to oestradiol
How is Androgen insensitivity syndrome diagnosed?
buccal smear or chromosomal analysis to reveal 46XY genotype
after puberty, testosterone concentrations are in the high-normal to slightly elevated reference range for postpubertal boys
What would hormone results for Androgen insensitivity syndrome show
Raised LH
Normal or raised FSH
Normal or raised testosterone levels (for a male)
Raised oestrogen levels (for a male)
How is Androgen insensitivity syndrome managed?
counselling - raise the child as female
bilateral orchidectomy (increased risk of testicular cancer due to undescended testes)
oestrogen therapy
What is Adenomyosis
endometrial tissue within the myometrium
Who is Adenomyosis more common in
multiparous women towards the end of their reproductive years
It may occur alone, or alongside endometriosis or fibroids.
What conditions tend to resolve after menopause
Adenomyosis endometriosis and fibroids.
How does Adenomyosis present
Painful periods (dysmenorrhoea)
Heavy periods (menorrhagia)
Pain during intercourse (dyspareunia)
How would Adenomyosis feel on examination
an enlarged and tender uterus.
What is first line investigation for Adenomyosis
Transvaginal ultrasound
MRI and transabdominal ultrasound are alternative investigations
What is the gold standard investigation for Adenomyosis
histological examination of the uterus after a hysterectomy
How is Adenomyosis managed when the woman does not want contraception
Tranexamic acid when there is no associated pain (antifibrinolytic – reduces bleeding)
Mefenamic acid when there is associated pain (NSAID – reduces bleeding and pain)
How is Adenomyosis managed when contraception is wanted
Mirena coil (first line)
Combined oral contraceptive pill
Cyclical oral progestogens
What are other management options of Adenomyosis beside tranexamic acid and contraception
GnRH analogues to induce a menopause-like state
Endometrial ablation
Uterine artery embolisation
Hysterectomy
What conditions are associated with Adenomyosis
Infertility
Miscarriage
Preterm birth
Small for gestational age
Preterm premature rupture of membranes
Malpresentation
Need for caesarean section
Postpartum haemorrhage
What is Atrophic Vaginitis
dryness and atrophy of the vaginal mucosa related to a lack of oestrogen
Who does Atrophic Vaginitis occur in
post menopausal
how does Atrophic Vaginitis present
Itching
Dryness
Dyspareunia (discomfort or pain during sex)
Bleeding due to localised inflammation
how does Atrophic Vaginitis appear on examination
Pale mucosa
Thin skin
Reduced skin folds
Erythema and inflammation
Dryness
Sparse pubic hair
how is Atrophic Vaginitis managed
Vaginal lubricants - Sylk, Replens and YES
Topical oestrogen - cream, pessaries, tablets, ring
What is Asherman’s Syndrome
adhesions (sometimes called synechiae) form within the uterus, following damage to the uterus and form physical obstructions and distort the pelvic organ
When does Asherman’s Syndrome occur
typically presents following recent dilatation and curettage, uterine surgery or endometritis
How does Asherman’s Syndrome present
Secondary amenorrhoea (absent periods)
Significantly lighter periods
Dysmenorrhoea (painful periods)
sometimes infertility