Gynaecology🍑 Flashcards
1
Q
What is a cystocele?
A
A defect in the anterior vaginal wall that allows the bladder to prolapse backwards into the vagina
2
Q
What is a urethrocele?
A
A prolapse of the urethra through a defect in the anterior vaginal wall
3
Q
What is a urethrocystocele?
A
A prolapse of the bladder and urethra through a defect in the anterior vaginal wall
4
Q
What is a uterine prolapse?
A
Where the uterus prolapses into the vagina
5
Q
What is a rectocele?
A
Where the rectum prolapses into the vagina through a defect in the posterior vaginal wall
6
Q
What is a vault prolapse?
A
Only occurs in women that have had a hysterectomy - where the top of the vagina prolapses into the vagina below it
7
Q
Why does prolapse occur?
A
Weakness and lengthening of the ligaments and muscles surrounding the uterus, rectum and bladder
8
Q
What are the risk factors for genital prolapse? (3)
A
Multiple vaginal deliveries Instrumental, prolonged or traumatic deliveryAdvanced age - postmenopausal statusObesity Chronic respiratory disease resulting in coughing Chronic constipation - straining
9
Q
What is the presentation of a prolapse? (3)
A
Feeling of something coming down on the vagina
A dragging sensation in the pelvis
Urinary symptoms
Bowel symptoms
Sexual dysfunction
10
Q
What are the urinary symptoms that prolapse can cause? (3)
A
Urgency Frequency Weak stream Retention
11
Q
What are the bowel symptoms that prolapse can cause?
A
Constipation Incontinence Urgency
12
Q
What sexual dysfunction symptoms can prolapse cause?
A
Pain Altered sensation Reduced enjoyment
13
Q
What is the grading of a uterine prolapse?
A
Grade 0 - Normal Grade 1 - prolapse is more than 1cm above the introitus Grade 2 - prolapse is within 1cm of the introitus Grade 3 - prolapse is more than 1cm below the introitus, but not fully descended Grade 4 - full descent with eversion of the vagina
14
Q
What are the three management options for prolapse?
A
Conservative management Vaginal pessary Surgery
15
Q
What is involved in conservative management of urinary incontinence?
A
Pelvic floor exercisesWeight loss Reduction of caffeine intake Incontinence pads Anticholinergic medications for stress incontinence Vaginal oestrogen cream
16
Q
What is a vaginal pessary?
A
A structure inserted into the vagina to provide support to the pelvic organs
17
Q
What types of vaginal pessary exist?
A
Rings
Shelf
Gellhorn
Cube
Donut
Hodge
18
Q
What does oestrogen cream do for the vagina?
A
Prevents it from irritation
19
Q
What is the definitive treatment of pelvic organ prolapse?
A
Surgery - surgical repair of the prolapse, or hysterectomy
20
Q
What are the complications of pelvic organ prolapse surgery? (3)
A
Pain, bleeding and infection Damage to the bladder or bowel Recurrence of prolapse Altered experience of sex
21
Q
What are the first line investigations for pelvic organ prolapse? (3)
A
Bimanual palpation for prolapsePost-void residual urine volume (to check for retention)Urinalysis
22
Q
What are the two types of urinary incontinece?
A
Stress incontinence Urge incontinence
23
Q
What is the cause of urge incontinence?
A
Overactivity of the detrusor muscle, which causes the sudden urge to urinate
24
Q
What is the cause of stress incontinence?
A
Weakness of the pelvic floor and sphincter muscles, which allows urine to leak when pressure is high in the bladder
25
What is overflow incontinence?
Can occur when there is chronic urinary retention due to an obstruction to outflow. This results in an overflow of the urine, without the urge to pass urine.
26
What are the risk factors for urinary incontinence? (3)
Increased agePostmenopausal status Increased BMI Previous pregnancies and vaginal deliveriesPelvic organ prolapse Pelvic floor surgeryNeurological conditions Cognitive impairment
27
What modifiable lifestyle factors can contribute to symptoms of urinary incontinence? (3)
BMI Caffeine consumption Alcohol consumption Medications
28
What investigations can be used to diagnose urinary incontinence? (3)
Cough stress test Bladder diary Urinalysis Post-voidal residual measurement Urodynamic testing
29
What types of urodynamic testing can be performed?
Cystometry (looks at filling and emptying) Uroflowmetry (measures volume of urine released, the speed and how long it takes) Leak point pressure Post-void residual bladder volume Video urodynamic testing
30
What is cystometry?
Measures detrusor muscle contraction and pressure
31
What is the first line management of urinary incontinence? (3)
Conservative management - Bladder training - Pelvic floor exercises- Avoiding alcohol and caffeine - Weight loss- Avoiding excess fluid intake
32
What is the second line management of urinary incontinence?
Medication - Anticholinergics - oxybutynin (urgency)- Mirabegron (urgency)- Duloxetine (stress incontinence)
33
What are the side effects of anticholinergics? (3)
Dry mouth Dry eyes Urinary retention Constipation Postural hypotension
34
What other management options exist for urge incontinence? (3)
Botulinum toxin injection into the bladder wall Percutaneous sacral nerve stimualtion Augmentation cystoplasty - using bowel to increase the bladder size
35
How long should pelvic floor training be trialled for before further management?
3 months
36
What is pelvic inflammatory disease?
When an infection spreads into the upper genital tract through the vagina and cervix
37
What are the most common causes of PID?
Chlamydia trachomatisNeisseria gonorrhoea
38
What organism tends to cause more severe PID?
Neisseria gonorrhoea
39
How can PID be spread?
Predominantly sexually
Can also be contracted via UTI, respiratory infection and bacterial vaginosis
40
What are the non-sexually transmitted causes of PID?
E. coli Gardnerella vaginalis Haemophilus influenza
41
What are the risk factors for PID? (5)
Not using barrier protection Prior infection with chlamydia or gonorrhoea Multiple sexual partnersIUDYounger ageHistory of PID
42
What is the presentation of PID? (5)
Pelvic (adnexal tenderness) or abdominal pain Abnormal discharge Abnormal bleeding - intermenstrual or postcoital deep dyspareunia Dysuria Fever cervical excitation
43
What might be found on pelvic examination in PID?
Adnexal tendernessCervical motion tendernessUterine tenderness
44
What investigations are helpful in the diagnosis of PID?
Pelvic examinationNAAT swabs for gonorrhoea and chlamydia Pregnancy testInflammatory markers Transvaginal ultrasound
45
What is the treatment of PID?
IM ceftriaxone (gonorrhoea cover)Doxycycline (chlamydia cover)Metronidazole (for cover of aerobic bacteria)14 days of antibiotics
46
What are the complications of PID?
Infertility Chronic pelvic pain Ectopic pregnancyFitz-Hugh-Curtis syndrome
47
What is Fitz-Hugh-Curtis syndrome?
Adhesions between the anterior liver capsule and the peritoneum, in someone with a background of PID
48
What is the presentation of Fitz-Hugh-Curtis syndrome?
Right upper quadrant pain
49
How is Fitz-Hugh-Curtis syndrome diagnosed?
Laparoscopy
50
What is seen on laparoscopy in Fitz-Hugh-Curtis syndrome?
Violin string perihepatic lesions, no involvement of the liver parenchyma
51
What is the treatment of Fitz-Hugh-Curtis syndrome?
Same antibiotic regime as for PIDAdhesiolysis during laparoscopy
52
What are the differentials of PID? (3)
Ectopic pregnancy
Appendicitis
Ovarian cyst complications
Endometriosis
53
When should a coil be removed in someone with PID?
A coil should be left in, in a patient with PID, unless there is no response to antibiotics after 48-72 hours
54
What is the definition of menopause?
A permenant end to menstruation
55
What is the average age of menopause?
51 years
56
What does postmenopausal describe?
The period from 12 months after the final menstruation
57
When can menopause be diagnosed?
After a woman has had no periods for 12 months
58
What is the perimenopausal phase?
The time around menopause where women experience symptoms and irregular periods. It goes up to 12 months after the final period.
59
Before what age is menopause premature?
40 years
60
What are the symptoms of menopause? (6)
Vasomotor:- Hot flushes - Night sweats Sexual:- Vaginal dryness- Dyspareunia - Reduced libido Psychological:- Depression - Anxiety- Mood swings - Lethargy
61
What is the physiology of menopause?
- Decline in growth of follicles - Reduction in production of oestrogen - Lack of negative feedback on pituitary results in more LH and FSH release- Ovulation stops due to decline in follicle growth - Endometrial growth ceases due to lack of oestrogen
62
What conditions does the menopause increase the risk of? (2)
Osteoporosis Cardiovascular disease and stroke Pelvic organ prolapse Urinary incontinence
63
What investigations are used to diagnose menopause?
In women over 45 - Diagnosis can be made clinically Women under 45 - FSH levels
64
What level of FSH is indicative of menopause?
FSH > 30
65
For how long after the menopause are women considered fertile?
2 years after their last menstruation in women under 50
1 year after their last menstruation in women above 50
All women are considered infertile after 55
66
What are the differentials of menopause? (3)
Pregnancy Polycystic ovary syndrome Hyperthyroidism HypothyroidismAdverse effects of medication
67
What is the non-hormonal management of menopause? (3)
Lifestyle changesSSRIs or SNRIs Clonidine CBT Vaginal moisturisers
68
What is the hormonal management of menopause?
HRT
69
What are fibroids?
Benign smooth muscle tumours of the myometrium of the uterus
70
What is the epidemiology of fibroids?
Fibroids affect 40-60% of women in later reproductive years Prevelance is slightly lower in women under 30
71
How do fibroids grow?
They grow in response to oestrogen It is thought that they originate from a single smooth muscle cell
72
What are the types of fibroids?
Submucosal - just below the lining of the uterus Intramural - within the myometrium Subserosal - just below the outer layer of the uterus Pedunculated - on a stalk
73
What are the differentials of fibroids? (3)
AdenomyosisEndometriosisEndometrial polyps Endometrial hyperplasia Uterine sarcoma Pregnancy
74
What is the presentation of fibroids? (4)
Often asymptomatic Heavy menstrual bleeding Prolonged menstruation Abdominal pain BloatingUrinary or bowel symptoms Dyspareunia Reduced fertility
75
What are the risk factors for fibroids? (3)
Black ethnicity Increasing ageBeing overweight
76
What is the first line investigation for diagnosis of fibroids?
Transvaginal and transabominal ultrasoundHysteroscopy
77
What other investigations may be useful in diagnosis of fibroids? (2)
MRI Endometrial biopsy
78
What is the non-surgical management of fibroids? What is considered 1st line?
Mirena coil - often first line Anti-fibrinolytics NSAIDsCombined hormonal contraceptionGnRH agonist
79
What is the surgical management of fibroids? (3)
Endometrial ablation Resection of fibroids Uterine artery embolisationHysterectomy
80
What are the complications of fibroids? (5)
Reduced fertilityHeavy menstrual bleeding Pregnancy complications Torsion of fibroidMalignant change to leiomyosarcoma Ischaemia and necrosis of the fibroid (red degeneration)Constipation Urinary tract outflow obstruction
81
What happens during red degeneration?
A fibroid rapidly outgrows it's blood supply during pregnancy and becomes ischaemic
82
Why does red degeneration occur?
Increased oestrogen during pregnancy promotes growth of the fibroids
83
What medication is used in a patient with fibroids before surgery?
GnRH agonists to reduce the size of the fibroids
84
What type of HRT should a woman that is still having periods be on?
Cyclical HRT with cyclical progesterone
85
What type of HRT should women without a uterus be on?
Oestrogen-only HRT
86
What type of HRT should women who have not had periods for more than 12 months be on?
Continuous combined HRT
87
Why is progesterone given to women with a uterus?
To protect the endometrium from endometrial hyperplasia and endometrial cancer, caused by the oestrogen
88
What is clonidine?
Clonidine is a alpha-2 adrenergic receptor agonist that can be useful for vasomotor symptoms and hot flushes
89
What are the indications for HRT? (3)
Replacing hormones in premature ovarian insufficiency
Reducing vasomotor symptoms
Improving symptoms of reduced libido, poor sleep and low mood
Reducing osteoporosis risk
90
What are the risks of HRT? (4)
Increased risk of breast cancerIncreased risk of endometrial cancerIncreased risk of venous thromboembolism Increased risk of stroke
91
What are the contraindications to HRT? (4)
Undiagnosed abnormal bleedingEndometrial hyperplasia Breast cancerUncontrolled hypertensionVenous thromboembolism Liver diseaseAngina or previous MIPregnancy
92
What is the most common type of ovarian cancer?
Epithelial cell tumour
93
What are the other types of ovarian tumours?
Germ cell tumours Sex-cord stromal tumours
94
What are germ cell ovarian tumours associated with?
Ovarian torsion
95
What tumour markers may be present in someone with a germ cell ovarian tumour?
Alpha fetoprotein Beta hCG
96
What age group are germ cell ovarian tumours most common in?
Young women
97
What are the risk factors for ovarian cancer? (3)
Age > 60 BRCA 1 and 2 genesIncreased number of ovulations Obesity Smoking
98
What are the protective factors for ovarian cancer? (3)
Oral contraceptive pillPregnancyBreastfeeding Early menopause
99
What is the presentation of ovarian cancer? (5)
Abdominal pain Bloating Early satietyLoss of appetite Pelvic pain Weight lossAbdominal or pelvic massAscites
100
When should someone be referred on a 2 week wait? (Ovarian cancer)
Ascites Pelvic massAbdominal mass
101
What are the initial investigations for ovarian cancer?
CA-125 Pelvic ultrasound
102
What other investigations may be performed for diagnosis of ovarian cancer? (3)
CT scan Laparotomy for biopsy Alpha fetoprotein and beta hCGAscitic tap to look for cancer cells
103
What are the other causes of a raised CA-125? (5)
EndometriosisFibroidsPelvic infection Liver diseasePregnancy AdenomyosisAscites Endometrial cancer, breast cancer, metastatic lung cancer Menstruation
104
What is the staging of ovarian cancer?
Stage 1 - Confined to the ovary Stage 2 - Spread from the ovary but still inside the pelvis Stage 3 - Spread past the pelvis, but inside the abdomen Stage 4 - Spread outside the abdomenA - confined to one ovary B - Both ovaries
105
What is the management of ovarian cancer?
Surgery - Removal of ovaries, fallopian tubes and uterus Chemotherapy
106
Where does ovarian cancer commonly metastasise to?
Liver Lung
107
What is endometriosis?
Endometriosis is a condition where there is ectopic endometrial tissue outside of the uterus
108
What are the features of endometriosis? (3)
Abdominal or pelvic pain (cyclical)
Deep dyspareunia
Dysmenorrhoea
Subfertility
Cylical urinary and bowel symptoms
Cyclical bleeding from other areas
109
What might be seen on examination of someone with endometriosis? (3)
Endometrial tissue in the vagina
Fixed cervix
Tenderness in the vagina, cervix and adnexa
110
What is the gold standard investigation of endometriosis?
Laparascopic surgery and biopsy of lesions
111
What is the initial investigation in patients with symptoms of endometriosis and what does it show?
Trans-vaginal ultrasound - often normal
112
What are the differentials of endometriosis? (3)
AdenomyosisInterstitial cystitis PIDIBS Ovarian cyst Ovarian cancer
113
What is the medical management of endometriosis? (5)
Analgesia - paracetamol or NSAIDsHormonal therapies - Combined OCP- Progesterone only pill- Depo injection GnRH agonists Mirena coil
114
What are the surgical management options for endometriosis?
Laparascopic surgery to ablate or excise endometrial tissueHysterectomy
115
What do GnRH agonists do in endometriosis?
Essentially induce menopause
116
How long must symptoms have persisted for a diagnosis of endometriosis?
Cyclical or continuous pain for over 6 months
117
Where is endometrial tissue commonly found outside of the uterus? (3)
Pouch of douglas Ovaries Uterosacral ligaments
118
What is an endometrioma?
A cystic lesion that stems from endometriosis
119
What is the appearance of endometriomas?
Cysts filled with dark brown endometrial fluid commonly found on the ovaries
120
What is the management of endometriomas?
Laparoscopic ovarian cystectomy with excision of the cyst wall
121
What is the definition of miscarriage?
The spontaneous loss of pregnancy prior to 24 weeks gestation
122
What is defined as early and late miscarriage?
Early - before 12 weeks Late - 12-24 weeks
123
What is a missed miscarriage?
Fetus is no longer alive, but there were no symptoms of miscarriage
124
What is a threatened miscarriage?
Vaginal bleeding with a closed cervix, and a fetus that is still alive
125
What is an inevitable miscarriage?
Vaginal bleeding with an open cervix
126
What is an incomplete miscarriage?
Retained products of conception remain in the uterus after miscarriage
127
What is a complete miscarriage?
A full miscarriage has occurred and there are no products of conception that remain in the uterus
128
What is an anembryonic pregnancy?
A gestation sac is present but contains no fetus
129
What is the investigation of choice for diagnosis of a miscarriage?
Transvaginal ultrasound
130
What other investigation is useful in diagnosis of miscarriage?
Beta hCG levels
131
What features on ultrasound will a sonographer look for to determine if a pregnancy is viable?
Fetal heartbeat Fetal pole and crown-rump length Mean gestational sac diameter
132
What is the definition of recurrent miscarriage?
The loss of 3 or more consecutive pregnancies
133
When would a fetal heartbeat be detectable?
When crown-rump length is more than 7mm
134
What is a fetal pole?
When the margin of the yolk sac thickens
135
When would a fetal pole be expected to develop?
When crown-rump length is 25mm
136
What is the main differential diagnosis for miscarriage?
Ectopic pregnancy
137
What are the fetal causes of miscarriage? (2)
Placental failureAbnormal development Genetic disorders
138
What are the maternal causes of miscarriage? (3)
PCOS Poorly controlled diabetesUterine abnormality Poorly controlled thyroid disease Anti-phospholipid syndrome
139
What are the three management routes for miscarriage?
Expectant management Medical management Surgical management
140
What is expectant management of miscarriage?
Giving 1-2 weeks for miscarriage to occur naturally Pregnancy test after 3 weeks to confirm pregnancy has ended
141
What is the medical management of miscarriage?
Misoprostol (given as a suppository, or orally) to quicken the process of miscarriage
142
What is misoprostol?
Misoprostol is a prostaglandin analogue - it binds to prostaglandin receptors to soften the cervix and stimulate contractions
143
What are the surgical management options of miscarriage?
Manual vacuum aspiration under local anaesthetic Electric vacuum aspiration under general anaesthetic
144
What is the presentation of miscarriage?
Vaginal bleeding Vaginal tissue lossPain - worse than normal period pain
145
What are the features of PCOS? (5)
OligomenorrhoeaSubfertility Hirtuism Obesity Mood swings and depression Male pattern baldnessAcanthosis nigricans
146
What is the definition of oligomenorrhoea?
Infrequent, and irregular menstruation
147
What is the Rotterdam criteria?
2 of the 3 criteria are required for a diagnosis of PCOS:- Polycystic ovaries - more than 12 cysts seen on imaging or ovarian volume > 10cm cubed- Hyperandrogenism - hirtuism or acne - Oligoovulation or anovulation (presenting as irregular or infrequent periods)
148
What are alternative causes of hirtuism? (3)
Medications Ovarian or adrenal tumours (that secrete androgens)Cushing's syndrome Congenital adrenal hyperplasia
149
What investigations are used to help diagnose PCOS, and what are the corresponding results? (3)
LH/FSH ratio (more than 2)Raised LH Total testosterone (raised)Prolactin (mildly elevated)17-hydroxyprogesterone (to exclude CAH)Oral glucose tolerance testTSH
150
What is the gold standard investigation for visualising the ovaries?
Transvaginal ultrasound
151
What is the initial management of PCOS? (3)
Weight lossLow glycaemic index, calorie controlled diet ExerciseSmoking cessation
152
What are the complications of PCOS? (3)
Endometrial hyperplasia and cancerType 2 diabetesInfertility Depression and anxietyObstructive sleep apnoea
153
What medications might patients be started on to reduce cardiovascular complications of PCOS?
Antihypertensives Statins
154
What medication can be used to reduce hirtuism?
Co-cyprindol (combined oral contraceptive pill)
155
What medication can be used to regulate menstrual bleeding in PCOS?
Combined oral contraceptive pill
156
What medication can be started in PCOS to increase fertility?
Clomifene
157
What is the action of clomifene?
Increase ovulation
158
What is the second line management for increasing fertility in PCOS?
Laparoscopic ovarian drilling- A laser is used to damage the hormone producing cells of the ovaries - this lowers the amount of testosterone made by the ovaries
159
What is the first line treatment for the management of acne in PCOS?
Combined oral contraceptive pill
160
What risk factors do women with PCOS have for endometrial cancer? (3)
Amenorrhoea Obesity DiabetesInsulin resistance
161
How is endometrial cancer risk reduced in women with PCOS?
Mirena coil Inducing a withdrawal bleed via:- Combined oral contraceptive pill (with a withdrawal bleed at least once every 3 months)- Cyclical progesterone only
162
What is an ectopic pregnancy?
When a pregnancy is implanted outside of the uterus
163
Where is the most common site of ectopic pregnancy?
Fallopian tube (ampulla)
164
What are the risk factors for ectopic pregnancy? (3)
PID
Previous ectopic
Endometriosis
IVF
POP
165
At what gestation does ectopic pregnancy typically present?
6-8 weeks
166
What are the features of ectopic pregnancy? (5)
Missed period Constant pain in left or right iliac fossaVaginal bleeding Lower abdominal or pelvic tendernessCervical motion tendernessShoulder tip painDizziness
167
What is the main differential of an ectopic pregnancy?
Miscarriage
168
What is the investigation of choice for diagnosis of an ectopic?
Pregnancy test Transvaginal ultrasound
169
What may be seen on transvaginal ultrasound in the investigation of en ectopic pregnancy?
Gestational sac in the fallopian tube Non-specific mass in the fallopian tube An empty uterus Fluid in the uterus
170
What is a pregnancy of unknown location?
Where a pregnancy test has confirmed a pregnancy, but there is no evidence of pregnancy on an ultrasound scan
171
What are the three management options for ectopic pregnancy?
Expectant management Medical management Surgical management
172
What is the expectant management of ectopic pregnancy?
For women with few symptoms - await natural termination, and follow up with beta hCG levels
173
What is the medical management of ectopic pregnancy?
A one off dose of IM methotrexateFollow up to check B-hCG levels falling
174
What are the surgical management options of ectopic pregnancy?
Laparoscopic salpingectomy - removal of affected fallopian tube and ectopic pregnancy Laparoscopic salpingotomy - removal of the ectopic pregnancy, preserving the fallopian tube
175
What are the signs of an advanced ectopic pregnancy? (4)
Patient in significant amount of pain Adnexal mass size of >35mmB-hCG levels > 5000Ultrasound identifies a fetal heartbeat All of these are indication for surgical management
176
What are the other differentials of ectopic pregnancy? (3)
Acute appendicitis Ovarian torsion PID UTI Ruptured corpus luteum cyst
177
What is atrophic vaginitis?
Dryness and atrophy of the vaginal mucosa due to a lack of oestrogen
178
Why does atrophic vaginitis occur?
During menopause, a reduction in oestrogen causes the vaginal mucosa to become thinner, less elastic and drier - this tissue is more prone to inflammation
179
In what age does atrophic vaginitis occur?
Women entering the menopause
180
What is the presentation of atrophic vaginitis? (3)
Vaginal dryness
Itching
Dyspareunia
Bleeding
Frequent UTIs
Stress incontinence
181
What will be seen on vaginal examination in a woman with atrophic vaginitis? (3)
Pale mucosaThin skin Reduced skin folds Erythema and inflammation Dryness
182
What is the management of atrophic vaginitis?
Lubricants and topical oestrogen
183
What forms does topical oestrogen come in?
PessaryCreamTablets Ring
184
What is the most common cause of post-menopausal bleeding?
Atrophic vaginitis
185
What type of tumour are most cervical cancers?
Squamous cell carcinoma
186
What is the second most common type of cervical cancer?
Adenocarinoma
187
What virus is heavily associated with cervical cancer?
Human papillomavirus
188
What strains of HPV is cervical cancer primarily associated with?
HPV 16, 18 (and 33)
189
How does HPV cause cervical cancer?
HPV produces the E6 and E7 oncogenes E6 oncogene inhibits the p53 suppressor gene E7 oncogene inhibits the pRB supppressor gene
190
What are the risk factors for cervical cancer? (3)
HPV types 16, 18 and 33Smoking HIVEarly first intercourseMany sexual partnersHigh parity Long term combined contraceptive pill use
191
What is the presentation of cervical cancer?
Abnormal vaginal bleeding Vaginal dischargePelvic pain Dyspareunia
192
What is the first line investigation of cervical cancer?
Vaginal examination and urgent colposcopy
193
What is colposcopy?
Colposcopy is an imaging technique using a colposcope, where the cervix is magnified which allows the epithelial lining to be examined
194
What other investigations are useful in the diagnosis of cervical cancer? (3)
BiopsyHPV testing FBC CT chest/abdo/pelvis
195
How is epithelial dysplasia graded?
CIN (cervical intraepithelial neoplasia) 1 - mild dysplasia, affecting 1/3 of the thickness of the epithelium CIN 2 - moderate dysplasia, affecting 2/3 of the thickness of the epithelium CIN 3 - severe dysplasia - likely to turn into cancer if untreated
196
At what age is cervical screening offered?
25-64
197
How often are women screened for cervical cancer?
Every 3 years for those 25-49Every 5 years for those 50-64
198
What is dyskaryosis?
Abnormal cervical cells detected on a cervical smear
199
How are cervical smear results interpreted?
HPV negative - return to normal recall HPV positive and normal cytology - repeat HPV test in 12 months HPV positive and abnormal cytology - refer for colposcopy
200
What is the treatment of cervical intraepithelial neoplasia to prevent cancer?
LLETZ procedure (large loop excision of the transformation zone)
201
What is a LLETZ procedure?
A loop of wire with electrical current removes abnormal cervical tissue. This can be performed under local anaesthetic during colposcopy
202
What is the staging of cervical cancer?
Stage 1 - Confined to the cervix Stage 2 - Invades the uterus or upper 2/3 of the vagina Stage 3 - Invades the pelvic wall or lower 1/3 of the vagina Stage 4 - Invades the bladder, rectum or beyond the pelvis
203
What is the different between stage 1A and 1B cervical cancer?
Stage 1A is only visible by microscopy and is less than 7mm large, whereas stage 1B is clinically visible, or more than 7mm
204
What is the treatment of cervical cancer?
CIN or stage 1A - LLETZ procedure or cone biopsyStage 1B- 2A - radical hysterectomy and removal or local lymph nodes Stage 2B-4A - Chemotherapy and radiotherapy Stage 4B - combination of chemo, radiotherapy and surgery
205
What is a cone biopsy?
A procedure that involves moving a small, cone shaped piece of the cervix
206
To who and when is the HPV vaccine given to?
The HPV vaccine is given to boys and girls aged 12 and 13 (before they become sexually active)
207
When should a patient be recalled if they have a +ve HPV screen, and is -ve after a 12 month follow up?
Return to normal recall
208
When should a patient be recalled if they have two +HPV screens, but cytology is normal for both?
Recall after 12 months
209
What should be done if a patient has +HPV screen with normal cytology after two follow up 12 month screens?
Refer for colposcopy
210
When should a patient who has had treatment for CIN next have a cervical smear?
6 months after treatment
211
What is lichen sclerosus?
A chronic inflammatory condition that presents with patches of white, shiny patches of skin
212
What is the presentation of lichen sclerosus? (3)
Vaginal itching Burning and soreness of the vulva Skin tightnessDyspareunia Erosions and fissures
213
What is the appearance of the labia in lichen sclerosus? (3)
Porcelain white in colour Shiny Tight Thin Slightly raised Papules or plaques
214
What is the definitive investigation for diagnosis of lichen sclerosus?
Biopsy (but diagnosis is usually made clinically)
215
What is the most serious complication of lichen sclerosus?
Vuval cancer (squamous cell carcinoma)
216
What is ovarian torsion?
A gynaecological emergency where the ovary twists in relation to the fallopian tube, connective tissue and blood supply
217
What is the main cause of ovarian torsion?
A mass larger than 5cm (for example a cyst or tumour)
218
In which women does ovarian torsion occur in? When is it more common?
Mainly occurs in women of reproductive age
More common during pregnancy
Can occur in young girls before menarche
219
What is the pathophysiology of ovarian torsion?
Twisting of the adnexa (fallopian tube and ovary) leads to ischaemia. Necrosis can occur if the torsion is prolonged
220
What is the presentation of ovarian torsion?
Sudden onset severe unilateral pelvic pain Nausea and vomiting
221
What are the risk factors for ovarian torsion? (3)
Previous ovarian torsionPregnancyOvarian hyperstimulation PCOS Benign or malignant ovarian cysts
222
What are the differentials of ovarian torsion? (3)
Ectopic pregnancy Ruptured graafian follicle Urolithiasis PID AppenditicitisFunctional ovarian cystsEndometriosis UTI
223
What is the first line investigation for ovarian torsion?
Transvaginal ultrasound
224
What signs may be seen on transvaginal ultrasound in someone with ovarian torsion? (2)
Whirlpool sign Free fluid in the pelvis Oedema around the ovary
225
What is the definitive investigation for someone with ovarian torsion?
Laparascopic surgery
226
What other investigations are performed to help diagnose ovarian torsion? (3)
Pregnancy test Urinalysis FBC CRP CT abdo/pelvis
227
What is the management of ovarian torsion?
Laparoscopic detorsion Laparoscopic oophorectomy
228
What are the complications of ovarian torsion? (3)
Rupture - peritonitis, adhesions Infertility if only functioning ovary Abscesses - sepsis
229
What is the most common type of vulval cancer?
Squamous cell carcinoma
230
What is the presentation of vulval cancer? (3)
Lump with or without lymphadenopathy Itching Non-healing ulcer Vulval pain BleedingChanges to vulval skin
231
Where does vulval cancer most commonly affect?
Labia majora
232
What are the risk factors for vulval cancer? (3)
Advanced age
Immunosuppression
HPV infection
Lichen sclerosis
233
What is the pre-malignant condition of vulval cancer?
Vulval intraepithelial neoplasia
234
What are the treatment options for VIN? (3)
Watch and wait Excision of lesion Imiquimod cream Laser ablation
235
What is the definitive investigation for vulval cancer?
Examination of vulva and 2 week urgent referralBiopsy
236
What further investigations will be performed once vulval cancer is diagnosed? (2)
Sentinel node biopsy to determine lymph node involvement CT abdo pelvis for staging
237
What is the treatment of vulval cancer?
Wide local excision Groin lymph node dissection Chemotherapy Radiotherapy
238
What is adenomyosis?
Adenomyosis refers to endometrial tissue inside the myometrium
239
Who is adenomyosis more common in? (2)
Later reproductive years Women who have had multiple children (multiparous)
240
What is the presentation of adenomyosis? (3)
Menorrhagia Dysmenorrhoea DyspareuniaCan be asymptomatic
241
What is the first line investigation of adenomyosis?
Transvaginal ultrasound
242
What other investigations may be performed to diagnose adenomyosis?
MRI Transabdominal ultrasound
243
What is the definitive investigation for diagnosis of adenomyosis?
Histological examination of uterus after hysterectomy
244
What is the management of adenomyosis?
Symptomatic relief:Tranexamic acid for menorrhagia with no pain Mefenamic acid for menorrhagia with pain Contraception:Mirena coil GnRH analoguesHysterectomy
245
What is a molar pregnancy?
A benign tumour of trophoblastic material that grows in the uterus like a pregnancy
246
What is a complete mole?
When a sperm cell fertilises an empty egg
247
What is a partial mole?
When two sperm cells fertilise a normal ovum
248
What is the presentation of a molar pregnancy vs a normal pregnancy? (3)
More severe morning sickness
Vaginal bleeding
Increased enlargement of the uterus
Abnormally high hCG
Thyrotoxicosis
249
What are the first line and definitive investigations of a molar pregnancy? (3)
Transvaginal ultrasound, bHCG levels
Histology of the mole after evacuation
250
What is the management of a molar pregnancy?
Evacuation of the mole by surgical curettageMonitoring of hCG
251
How is hCG monitored in a complete molar pregnancy?
Monthly hCG samples are sent for 6 months following evacuation
252
How is hCG monitored in a partial molar pregnancy?
A hCG sample is sent 4 weeks later - if this is normal, the patient is discharged
253
What is the karyotype of a complete mole?
XX - diploid
254
What is the karyotype of a partial mole?
XXY or XXX - triploid
255
What is Asherman's syndrome?
A condition where adhesions form in the uterus following damage to the uterus
256
What is the most common cause of Asherman's syndrome?
Dilatation and curettage procedure to evacuate retained products of conception after birth or msicarriage
257
What are the other causes of Asherman's syndrome?
Other uterine surgeries
After pelvic infections
258
What is the presentation of Asherman's syndrome? (3)
Secondary amenorrhoea Lighter periods Dysmenorrhoea May present with infertility Patients may have has D&C procedure, uterine surgery or endometritis
259
What is the gold standard investigation for Asherman's syndrome?
Hysteroscopy - adhesions can be identified and treated
260
What other investigations can be performed to diagnose Asherman's syndrome?
Hysterosalpinography - contrast injected into uterus and X-rayed Sonohysterography MRI
261
What is the management of Asherman's syndrome?
Removal of the adhesions during hysteroscopy
262
What is dysfunctional uterine bleeding?
Menorrhagia that has no pathological cause, or bleeding between monthly periods, or prolonged bleeding
263
What are the other causes of menorrhagia? (5)
FibroidsEndometriosis PCOS PID Contraceptives Bleeding disordersEndometrial cancer Anticoagulant medicationsAdenomyosis
264
What investigations should be performed in someone with heavy menstrual bleeding?
FBC for iron deficiency anaemia Bimanual pelvic examination Speculum examination
265
What investigations may be performed in someone with heavy menstrual bleeding? (4)
Transvaginal ultrasound
Hysteroscopy
Swabs
Coagulation screen
TFT
Ferritin
266
What is the non-hormonal management of dysfunctional uterine bleeding?
Tranexamic acid if there is no associated pain Mefenamic acid if there is associated pain
267
What is the first line hormonal management of dysfunctional uterine bleeding?
Mirena coil
268
What are the second line hormonal management options for dysfunctional uterine bleeding?
COCP Cyclical oral progestogens e.g norethisterone
269
What are the third line management options for dysfunctional uterine bleeding?
Endometrial ablation Hysterectomy
270
What is the definition of menorrhagia?
Heavy menstrual bleeding that has an impact on day to day life (or is >80ml)
271
What is an ovarian cyst?
A fluid filled sac on the ovaries
272
What are the types of ovarian cysts? (5)
Physiological/functional:
- Follicular cyst (MC)
- Corpus luteum cyst
Benign germ cell tumours:
-Dermoid (teratomas and torsion more likely)
Benign epithelial tumours:
-Serous cystadenoma
-Mucinous cystadenoma
273
What is a follicular cyst?
A follicle that fails to rupture and release the egg
274
What is corpus luteum cyst?
A corpus luteum that fails to break down when the body doesn't get pregnant - it can fill with blood or fluid to form a cyst
275
What is a dermoid cyst?
A benign germ cell tumour (or teratoma) that contains hair, teeth, skin and bone
276
What is a serous cystadenoma?
Benign tumours of epithelial cells of the ovaries
277
What is a mucinous cystadenoma?
Another benign tumour of epithelial cells in the ovaries
They can grow larger than serous cystadenomas
278
What is the presentation of an ovarian cyst? (3)
Pelvic pain BloatingFullness in the abdomen Palpable pelvic mass
279
What features suggest an ovarian malignancy? (5)
Bloating
Reduced appetite
Early satiety
Weight loss
Urinary symptoms
Ascites
Lymphadenopathy
280
What are the risk factors for ovarian malignancy? (3)
Age Postmenopausal Increased number of ovulations Obesity HRT Smoking Family history (BRCA genes)
281
What is the first line investigation for an ovarian cyst?
Transvaginal ultrasound
282
What further investigations may be performed in someone with an ovarian cyst?
CA125
MRI or CT abdo/pelvis
hCG and alpha feto protein
Laparoscopy
283
What are the differentials of an ovarian cyst? (3)
Ovarian cancerOvarian torsion PCOS Uterine fibroidsPID
284
What is the management of simple ovarian cysts?
Less than 5cm - Will resolve on their own in three cycles 5-7cm- Routine referral and monitoring by ultrasound every year >7cm - Consider MRI
285
What are the surgical management options of an ovarian cyst?
Laparotomy - ovarian cystectomy or oophorectomy
286
When is an ovarian cyst likely to rupture?
During physical activity such as sex or exercise
287
What investigation can confirm an ovarian cyst rupture?
Laparoscopy
288
What is meig's syndrome?
A rare complication of ovarian cysts
289
What is the triad of symptoms in meig's syndrome?
Ovarian fibroma Pleural effusion Ascites
290
What is endometrial cancer?
A malignancy that occurs in the endometrium of the uterus
291
What is the most common form of endometrial cancer?
Adenocarcinoma
292
What are the risk factors for endometrial cancer? (5)
Increased ageEarlier onset of menstruation Late menopause Oestrogen only HRT Nulliparity Obesity PCOS Tamoxifen
293
What are the protective factors against endometrial cancer? (3)
COCPMirena coil Multiple pregnancies Cigarette smoking
294
What is the presentation of endometrial cancer? (7)
Post-menopausal bleeding Post coital bleeding Intermenstrual bleeding Menorrhagia Abnormal vaginal dischargeHaematuriaAnaemia Raised platelet countDyspareunia Pelvic pain Weight loss
295
Who should be referred via an urgent 2 week wait pathway for endometrial cancer?
Anyone with post-menopausal bleeding
296
Who should be referred for a transvaginal ultrasound to investigate for endometrial cancer?
Women over 55 years with:- Unexplained vaginal discharge - Visible haematuria plus raised platelets, anaemia, or elevated glucose
297
What are the investigations used to diagnose endometrial cancer?
Transvaginal ultrasound Pipelle biopsy Hysteroscopy with endometrial biopsy
298
What is measured in a transvaginal ultrasound investigating endometrial cancer?
Endometrial thickness - Normal endometrial thickness is <4mm post-menopause
299
What staging system is used to stage endometrial cancer?
FIGO staging system (International federation of gynaecology and obstetrics)
300
What are the different FIGO stages of endometrial cancer?
Stage 1 - confined to the uterus Stage 2 - Invades the cervixStage 3 - invades the fallopian tubes, vagina, ovaries or lymph nodes Stage 4 - Invades bladder, rectum or beyond the pelvis
301
What are the differential diagnoses of endometrial cancer? (3)
Uterine fibroidsEndometrial polypsCervical cancerEndometrial hyperplasia Endometriosis
302
What is the typical treatment of stage 1 and 2 endometrial cancer?
Total abdominal hysterectomy with bilateral salpingo-oopherectomy
303
What additional treatments may be used in the management of endometrial cancer? (3)
Radiotherapy Progesterone to slow progression Chemotherapy Radical hysterectomy - Also involved removing lymph nodes around the area, and the top of the vagina
304
What is prolactinoma?
A tumour of the pituitary gland that secretes excessive prolactin
305
What is a microadenoma?
A pituitary adenoma less than 1cm
306
What is a macroadenoma?
A pituitary adenoma larger than 1cm
307
What are the features of excess prolactin in women? (3)
Amenorrhoea Galactorrhoea Infertility Osteoporosis
308
What are the general features of a pituitary adenoma? (3)
Headache Visual disturbance - bitemporal hemianopia or upper temporal quandrantanopiaSigns of hypopituitarism
309
What are the definitive investigations in the diagnosis of prolactinoma? (2)
MRI Serum prolactin
310
What are the differentials of prolactinoma? (2)
Drug induced hyperprolactinaemiaPrimary hypothyroidismPregnancyNon-functioning pituitary adenoma
311
What is the first line management for a symptomatic prolactinoma?
Dopamine agonists
312
What dopamine agonists are commonly given for prolactinoma?
CarbergolineBromocriptine
313
What is the second line management for prolactinoma?
Trans-sphenoidal adenoma resection
314
When does puberty start in girls?
Age 8-14
315
Why do obese children go through puberty earlier?
Adipose tissue contains aromatase that converts androgens into oestrogen
316
What is tanner stage 1 in girls?
No pubic hair development No breast development
317
What is tanner stage 2 in girls?
Light and thin pubic hair Breast bud development
318
What is tanner stage 3 in girls?
Course and curly pubic hair Breast elevates beyond the areola
319
What is tanner stage 4?
Adult like pubic hair, but not reaching the thigh Areolar mound forms and projects from surrounding breast
320
What is tanner stage 5?
Hair extending to medial thigh Areolar mound reduces and adult breasts form
321
What hormonal changes occur during puberty?
Growth hormone increases, causing a growth spurt GnRH begins production - causes release of FSH and LH, which causes release of progesterone and oestrogen
322
When is the follicular phase of menstruation?
From menstruation to ovulation (first 14 days of a 28 day cycle)
323
When is the luteal phase of menstruation?
From ovulation to the start of menstruation (the final 14 days of the cycle)
324
What are the stages of development of follicles in the ovaries?
Primordial follicles Primary follicles Secondary follicles Graafian follicles corpus luteum corpus albicans
325
How do secondary follicles develop in graafian follicles?
Secondary follicles develop receptors for FSH - FSH allows them to develop into graafian follicles
326
What are granulosa cells?
Cells that sit around the oocytes and secrete oestrogen
327
What causes ovulation to occur?
A spike in LH
328
When does ovulation occur?
14 days before the start of menstruation
329
What does the dominant follicle develop into after ovulation?
Corpus luteum
330
What does the corpus luteum secrete?
High levels of progesterone and a small amount of oestrogen
331
What happens when the corpus luteum is not fertilised?
It degenerates and stops producing oestrogen and progesterone - this causes the endometrium to break down and menstruation to occur
332
What embryological structure do the female reproductive organs originate from?
Mullerian ducts
333
Why do males not develop a uterus?
Male fetuses secrete anti mullerian hormone
334
What is a bicornate uterus?
Where there are two 'horns' to the uterus, giving it a heart shaped appearance
335
What are the complications of a bicornate uterus? (2)
Miscarriage Premature birth Malpresentation
336
What is an imperforate hymen?
Where the hymen at the entrance to the vagina is fully formed, without an opening
337
When may an imperforate hymen be discovered?
When menstruation first occurs and blood is sealed in the vagina
338
What is the clinical presentation of an imperforate hymen?
Cyclical pelvic pain and cramping Not associated with vaginal bleeding
339
What is the treatment of an imperforate hymen?
Surgical incision to open the hymen
340
What is a transverse vaginal septum?
An abnormality where a septum forms transversely across the vagina - this can be perforate or imperforate
341
How is a transverse vaginal septum diagnosed?
Clinical examination MRI Ultrasound
342
What are the complications of a transverse vaginal septum?
Vaginal stenosis Recurrence of the septum
343
What is vaginal hypoplasia?
An abnormally small vagina due to failure of the mullerian ducts to develop properly
344
What is the most effective emergency contraception?
Copper IUD
345
How long after sex is a copper IUD effective for emergency contraception?
120 hours (5 days)
346
How does the copper IUD work?
It prevents implantation as it is toxic to both egg and sperm
347
How long can a copper IUD stay in place?
Up to 10 years
348
What are the contraindications to the copper IUD? (3)
Up to 28 days postpartum Repeated history of STIs Current pelvic infection Distorted uterus Abnormal cervix Unexplained bleeding
349
What is the UKMEC criteria?
UKMEC1 - no restriction in use UKMEC2 - benefits outweigh risksUKMEC3 - risks outweigh benefits UKMEC4 - absolute contraindication
350
What contraception should women with breast cancer avoid?
Any hormonal contraception - Copper IUD or barrier methods are best choice
351
What contraception should women with Wilson's disease avoid?
Copper IUD
352
What contraception should women with cervical or endometrial cancer avoid?
IUS
353
What are diaphragms and cervical caps?
Silicone caps that fit across the cervix to prevent semen from entering the uterus
354
How is a diaphragm/cervical cap used?
Fitted before sex, and left in for 6 hours after sexUsed alongside spermicide gel
355
How effective is the COCP?
99% with perfect use 91% with typical use
356
How does the COCP prevent pregnancy? (3)
Prevents ovulation (primary method)Progesterone thickens cervical mucus Progesterone inhibits proliferation of the endometrium
357
How does the COCP prevent ovulation?
Oestrogen and progesterone have negative feedback on the release of GnRH from the hypothalamus In turn, less FH and LSH is released from the anterior pituitary, without which ovulation cannot occur
358
What are the first line choices of progesterone for the COCP?
Levonorgestrel or norethisterone
359
Why are levonorgestrel and norethisterone the first line choices of progesterone?
They have a lower VTE risk
360
What is the first line COCP for PMS?
Yasmin - containing drospirenone
361
Which is the first line COCP for acne and hirtruism?
Dianette - containing cyprotenone acetate
362
What are the three regimes for COCP use?
21 days on, 7 days off 63 days on, 7 days offContinuous use
363
What are the common side effects of the COCP? (3)
Unscheduled bleeding in first 3 months Breast pain and tendernessMood changes and depression Headaches
364
What are the risks of the COCP? (4)
Hypertension
Small increase in risk of breast cancer, and cervical cancer
VTE
Small risk of MI and stroke
365
What are the contraindications to the COCP? (4)
Over 35 and smoking more than 15 cigarettes per day Migraine with aura History of VTEUncontrolled hypertensionIshcaemic heart diseaseHistory of vascular disease or strokeLiver cirrhosis SLE
366
What extra protection is required when starting the COCP?
Up to day 5 - no extra protection requiredDay 5 onwards - condoms for the first 7 days of pill taking
367
What extra protection is required in the case of a missed pill?
If it is less than 72 hours since the last pill taken: - Take the missed pill as soon as possible - No extra action requried
368
What extra protection is required in the case of more than 1 missed pill?
Take the missed pill as soon as possible Additional contraception needed for 7 days Day 1-7 of packet - emergency contraception neededDay 8-14 - no emergency contraception neededDay 15-21 - no emergency contraception required, but skip 7 day pill free period
369
Can the COCP be used during a major operation?
No - the COCP should be stopped 4 weeks before a major operation
370
What is the only absolute contraindication to the POP?
Breast cancer
371
What are the two types of POP?
Traditional POPDesogestrel only pill
372
What is the time window for taking the traditional POP?
3 hours
373
What is the time window for taking the desogestrel only pill?
12 hours
374
What is the mechanism of action of the traditional POP?
Inhibits proliferation of the endometrium Thickens cervical mucus Reduces ciliary action in the fallopian tubes
375
What is the mechanism of action of the desogestrel only pill?
Inhibits ovulation
Inhibits proliferation of the endometrium
Thickens cervical mucus
Reduces ciliary action in the fallopian tubes
376
What extra protection is needed when starting the POP?
No extra protection needed if started on days 1-5Day 6 onwards - additional contraception required for 48 hours
377
What are the side effects of the POP? (3)
Unscheduled bleeding during first three months Breast tendernessHeadaches Acne
378
What are the risks of the POP? (3)
Increased risk of ovarian cystsRisk of ectopic pregnancy with traditional POPIncreased risk of breast cancer
379
What extra protection is required in the case of a missed POP pill?
Take the missed pill as soon as possible Use additional contraception for the next 48 hours
380
How often is the progestogen-only injection given?
Every 12 to 13 weeks
381
How long can it take for fertility to return after stopping the progestogen-only injection?
12 months
382
What are the two types of progestogen-only injection given in the UK?
Depo-provera - IM injection Sayana Press - self administered SC injection
(Medroxyprogesterone acetate)
383
What are UKMEC3 contraindications to the POP? (3)
Ischaemic heart disease and stroke
Liver disease
Unexplained vaginal bleeding
384
What is the main mechanism of action of the depo injection?
Inhibits ovulation(also works by inhibiting proliferation of the endometrium and thickening cervical mucus)
385
When is extra protection required when starting the depo injection?
No extra protection required before day 5 After day 5 - additional protection required for 7 days
386
What are the side effects of the depo injection? (3)
Weight gain Acne Reduced libidoMood changesHeadaches Flushes Hair lossSkin reactions at injection sites
387
What is the most important side effect of the depo injection?
Reduced bone mineral density
388
What is the progestogen only implant?
A small 4cm plastic rod that is inserted underneath the skin, above the subcutaneous fat
389
How long does the implant last for?
3 years
390
What is the only UKMEC4 criteria for the implant?
Active breast cancer
391
How does the implant work?
Inhibits ovulation Makes the endometrium less accepting of implantation Thickens cervical mucus
392
What are the two types of coils?
IUD - copper containing coil IUS - levonorgestrel containing coil
393
What are the contraindications to the coil? (4)
PID Immunosuppression Pregnancy Unexplained bleeding Pelvic cancerDistortion of the uterus by fibroids
394
What are the risks relating to insertion of the coil? (3)
Bleeding Pain on insertion Vasovagal reactions Uterine perforationPIDExpulsion
395
How long can an IUD remain in place?
5-10 years
396
How does the IUD work?
Copper is toxic to ova and spermAlso makes the endometrium less accepting of implantation
397
When is the copper coil contraindicated?
In wilson's disease
398
What are the types of IUS and how long can they be used for?
Mirena - 5 years Levosert - 5 years Kyleena - 5 years Jaydess - 3 years
399
What other uses is the mirena coil licensed for?
Contraception, menorrhagia and HRT
400
What other uses is the levosert coil licensed for?
Contraception and menorrhagia
401
How does the IUS work?
Thickens cervical mucus Makes the endometrium less accepting of implantation Inhibits ovulation in some women
402
What are the side effects of the IUS? (3)
Can cause spotting or irregular bleeding Pelvic pain Acne Headaches Breast tenderness
403
What are the risks of the IUS?
Ectopic pregnancies Ovarian cysts
404
What are the three types of emergency contraception?
Copper IUD Levonorgestrel (Levonelle)Ulipristal acetate (EllaOne)
405
When can levonelle be taken?
Within 72 hours of unprotected sex
406
When can EllaOne be taken?
Within 120 hours of unprotected sex
407
What is the most effective form of emergency contraception?
Copper IUD
408
What are the side effects of levonelle? (3)
Nausea and vomiting Spotting and changes to the next menstrual period Diarrhoea Breast tendernessDizziness Depressed mood
409
What are the side effects of EllaOne? (3)
Nausea and vomiting Spotting and changes to the next menstrual period Back pain Mood changes Headache DizzinessBreast tenderness
410
What is the Pearl Index?
The number of pregnancies that would be seen if 100 women used that form of contraception for one year
411
At what age should a woman stop taking the COCP?
50 years
412
When can the mirena coil or IUD be inserted after childbirth?
Within 48 hours of childbirth or after 4 weeks
413
When can the COCP be started after childbirth?
After 21 daysor After 6 weeks if breastfeeding
414
When can the progesterone only pill be started after childbirth?
Can be started at any time
415
When can patients be given the copper IUD after 5 days post intercourse?
If the patient is up to 5 days after their earliest ovulation date
416
When after childbirth is contraception needed?
After 21 days postpartum
417
What is premature ovarian insufficiency?
Menopause before 40 years
418
What will hormonal analysis show in someone with premature ovarian insufficency?
High FSH (>30, 2 samples taken 4-6 weeks apart)
High LH
Low oestradiol (<100)
419
What is the main cause of premature ovarian insufficency?
50% of cases are idiopathic
420
What are the other causes of premature ovarian insufficency? (3)
Iatrogenic Autoimmune Genetic Infections
421
What is the presentation of premature ovarian insufficiency? (3)
Irregular menstrual periodsHot flushes Night sweats Vaginal drynessInfertility
422
What level of FSH is indicative of premature ovarian insufficency?
FSH> 30
423
How is premature ovarian insufficency diagnosed?
Two FSH levels > 30 IU/L taken more than 4 weeks apart
424
What are the complications of premature ovarian insufficency? (3)
Cardiovascular diseaseOsteoporosis Cognitive impairment Dementia Parkinsonism Stroke
425
What is the management of premature ovarian insufficency?
HRT until age 51
