Gynaecology 2 Flashcards
Contraception in menopausal women
> 50yo 12 months post last period
<50 24 months post last period
Average age of menopause
Average length of menopausal symptoms
51yo
7 years
Menopause Mx Classification (3)
Lifestyle
Hormonal
Non-hormonal
Lifestyle mx of menopause
Hot flushes (3)
Sleep disturbance (2)
Mood (3)
Cognitive symptoms (2)
Hot flushes
Regular exercise, weight loss and reduce stress
Sleep disturbance
Good sleep hygiene, avoid late evening exercise
Mood
Regular exercise, good sleep hygiene and relaxation
Cognitive symptoms
Regular exercise and good sleep hygiene
HRT CI (4)
Breast ca
Oestrogen sensitive ca
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
HRT with a uterus, without
Combined PO or transdermal
Oestrogen only
Non HRT Mx of menopause
Vasomotor (3)
Vaginal dryness (2)
Psychological sx (3)
Urogenital sx (1)
Fluoxetine, citalopram, venlafaxine
Lubricant/ moisturiser
Self help, CBT, antidepressants
Vaginal oestrogen
How long should HRT be taken?
2-5 years
Menopause long term complications (2)
Osteoporosis
Increased risk of ischaemic heart disease
Menorrhagia can be caused by hyper or hypothyroidism?
Hypo
Menstrual cycle
Explain the cycle/ phases in a 28 day cycle
(Split into 4)
Days:
1-4 menstruation
5-13 follicular phase
14 ovulation
15-28 luteal phase
What happens to the basal body temperature during the menstrual cycle?
Falls prior to ovulation and rises following ovulation due to high prog
What happens during the follicular phase?
Endometrium
Ovary
Hormones
Mucus
Temperature
Endometrial proliferation
Increasing follicles with one becoming dominant
Increased FSH + oestradiol and LH surge leading to ovulation
Thick mucous, just prior to ovulation it becomes clear and stretchy
Falls prior to ovulation
What happens during the luteal phase?
Ovary
Hormones
Mucus
Temperature
Corpus luteum
Prog secreted by corpus luteum and rises
Oestrodial also increases
If corpus luteum degenerates then prog falls
Mucous thick and scant
Temp rises post ovulation
Ovarian ca RF (4)
FH
Early menarche
Late menopause
Nulliparity
Cervical ca RF
Increased number of sexual partners
High parity
HPV
Smoking
HIV
Endometrial ca RF
Nulliparity
Early menarche
Late menopause
Obesity
Unopposed oestrogen
DM
Tamoxifen
PCOS
Hereditary colorectal ca
Features of ovarian ca (6)
Abdominal distension
Bloating
AP/ pelvic pain
Urinary symptoms
Early satiety
Diarrhoea
Ovarian ca Ix (2)
Ca125
US
VIN what is it?
Vulval intraepithelial neoplasia
Pre cancerous lesion of the vulva
RF for VIN (4)
HPV 16 & 18
Smoking
Herpes simplex virus 2
Lichen planus
VIN features (2)
Describe the lesions
Itching
Burning
Raised, well defined skin lesions
RF for vulval ca (4)
VIN
HPV
Immunosuppression
Lichen sclerosus
RF for vulval ca (4)
VIN
HPV
Immunosuppression
Lichen sclerosus
Inguinal lymphadenopathy
Itching
Irritation
Lump/ ulcer on the majora
=
Vulval ca
Offensive, thin, white/grey, fishy discharge
BV
Offensive, yellow, green, frothy, strawberry cervix, vulvovaginitis
TV
Mx candidiasis
1st line
2nd line
If there are vulval sx
Oral fluconazole 150mg
Clotrimazole pessary 500mg
Topical imidazole
Definition of recurrent vaginal candidiasis
Ix (2)
4 or more episodes
HVS for MCS
HbA1c
Mx recurrent candidiasis
Induction
Maintenance
Induction PO fluconazole every 3 days for 3 doses
Maintenance PO fluconazole weekly for 6 months
What is the most common ovarian cyst?
Follicular cyst
Most common benign ovarian tumour in women under 30yo
Dermoid cyst
Cysts on premenopausal women mx
Conservative if:
especially if <35yo and <5cm and reported as simple
Repeat US 8-12 weeks
Cysts on postmenopausal women mx
Refer to gynae
Whirlpool sign on USS =
Ovarian torsion
Ovulation induction for PCOS mx
First line
2nd line (medical) (2)
- Weight loss
- Letrozole, clomiphene
What is letrozole? (MOA)
Aromatase inhibitor
Clomiphene MOA
Oestrogen receptor modulator
What treatment can be used in hypogonadotropic hypogonadal anovulation
Gonadotropin therapy
OHSS features/ life-threatening complications (3)
Hypovalaemic shock
Acute renal failure
VTE
Most common cause of PID (2)
N. gonorrhoeae
Mycoplasma genitalium
Mx PID (2)
PO ofloxacin, metro
OR
IM cef, PO doxy, PO metro
What is Fitzy Hugh Curtis Syndrome
Perihepatitis with PID/ post PID
PID complications (4)
Fitz Hugh Curtis
Infertility
Chronic pelvic pain
Ectopic pregnancy
What is mittelschmerz?
Pain the middle of menstrual cycle secondary to ovulation
Mx of PMS
Mild
Mod
Severe
Mild lifestyle advice
Moderate COCP e.g Yasmin
Severe SSRI either continuous or just during day 15-28
Baseline Ix for PCOS (7) bloods
FSH, LH, prolactin, TSH, testosterone, sex hormone binding globulin
Raised LH:FSH
Raised testosterone
Prolactin elevated
SHBG low
HbA1c/ impaired glucose tolerance
What is the Rotterdam criteria for PCOS
2 out of 3 for diagnosis
Infrequent or no ovulation/ menstruation
Clinical or biochemical signs of hyperandrogenism
PCO seen on US >= 12 follicles measuring 2-9mm OR increase ovarian volume >10
PCOS Mx
General (2)
Weight reduction
COCP
PCOS mx
Infertility (4)
Infertility
Weight loss
Clomiphene
Metformin
Gonadotrophins
PCOS hirsutism and acne (2)
COCP
Topical eflornithine
Classification of urinary incontinence (5)
Explain/ examples
Overactive bladder/ urge - detrusor overactivity
Stress - coughing/ laughing
Mixed - urge and stress
Overflow e.g obstruction such as prostate enlargement
Functional e.g dementia, sedating meds etc
Ix urinary incontinence (4)
Bladder diaries for 3/7
VE to r/o prolapse
Urine dipstick + culture
Urodynamic studies
Mx urge (5)
Hint 4 are medication examples
- Bladder retraining - 6 weeks (gradually increase intervals between voids)
Antimuscarinics
2. Oxybutynin IR
3. Tolterodine
4. Darifenacin
Beta 3 agonist
5. Mirabegron
Mx stress (3)
- Pelvic floor muscle training
8 contractions performed 3 times per day for a minimum of 3 months - Surgery (midurethral tape procedures)
- Duloxetine
