Gynaecology

Question 1

What medication can help with premenstrual syndrome and when should it be taken?

Answer 1

SSRIs, either continuously or during the luteal phase, may help premenstrual syndrome
COCP

Question 2

What is the medical treatment for premature menopause?

Answer 2

COCP should be offered to women until the age of 51 years
HRT

Question 3

A patient has a large fibroid, what treatment options are suitable for if they are trying to conceive vs if they are not

Answer 3

If trying to conceive, myomectomy
If not trying, hormonal therapies (anti-progestogen or GnRH agonist), uterine artery emobilisation, endometrial ablation if menorrhagia is main concerning symptoms

Question 4

What are the two drugs used for miscarriages?

Answer 4

Missed miscarriage
- oral mifepristone. Mifepristone is a progesterone receptor antagonist → weakening of attachment to the endometrial wall + cervical softening and dilation + induction of uterine contractions
- 48 hours later, misoprostol (vaginal, oral or sublingual) unless the gestational sac has already been passed. Misoprostol is a prostaglandin analogue, binds to myometrial cells → strong myometrial contractions → expulsion of products of conception
if bleeding has not started within 48 hours after misoprostol treatment, they should contact their healthcare professional
Incomplete miscarriage
- a single dose of misoprostol (vaginal, oral or sublingual)

Question 5

What is first line treatment for infertility in PCOS?

Answer 5

Clomifene. Metformin is often prescribed along side this

Question 6

When in cycle should progesterone be measured to check for successful ovulation?

Answer 6

7 days before next expected menses.

Question 7

What is the management of a simple ovarian cyst found on US scan depending on size? How does it differ if the woman is pre or post-menopausal?

Answer 7

RCOG:
Pre-menopausal women with small (less than 50 mm diameter) simple ovarian cysts generally do not require follow-up as these cysts are very likely to be physiological and almost always resolve within 3 menstrual cycles - repeat US scan in 12 weeks to confirm resolution

Pre-menopausal women with simple ovarian cysts of 50-70 mm in diameter should have yearly ultrasound follow-up and those with larger simple cysts should be considered for either further imaging (MRI) or surgical intervention

Any postmenopausal woman with an ovarian cyst regardless of nature or size should be referred to gynaecology for assessment

Question 8

What medication can be taken in preparation of surgical hysterectomy for the management of fibroids?

Answer 8

GnRH agonists (e.g. leuprolide) may reduce the size of the fibroid but are typically useful for short-term treatment

Question 9

When would Wertheim’s radical hysterectomy be a treatment option for endometrial cancer?

Answer 9

Includes removal of lymph nodes and is used to treat stage IIB endometrial carcinoma
Stage 1 & 2 is TAH + BSO

Question 10

When should early referral be made for a couple who are failing to get pregnant?

Answer 10

Female Male
Age above 35 Previous surgery on genitalia
Amenorrhoea Previous STI
Previous pelvic surgery Varicocele
Previous STI Significant systemic illness
Abnormal genital examination Abnormal genital examination

Question 11

If a patient with endometriosis is trying to conceive, when should referral be made?

Answer 11

After 6 months of regular unprotected vaginal sexual intercourse and failure to conceive