Gynaecology Flashcards
What questions should you ask about a womans menstrual cycle in a Gynae History?
Menarche Date of LMP Usual Cycle Menstrual Loss (slight, normal, heavy) Type of protection worn and frequency of changing Any intermenstrual Bleeding Pain? Other cyclical symptoms e.g. weight gain, bloating, mood change
What should you ask about sex in a Gynae History?
Are they sexually active?
Do they have a partner?
Pain or Bleeding during/after sex?
What should you ask about vaginal discharge in a Gynae History?
Timing in cycle
Colour, Consistency, odour
Any itching or bleeding
What should you ask if you are looking for prolapse in a Gynae History?
Heaviness, bulging in the vagina
Feeling a lump
Discomfort during sex
Define Primary Amenorrhoea
Lack of menstruation by 16 years of age in a girl with normal growth and secondary sexual characteristics
Define Secondary Amenorrhoea
Amenorrhoea for 6 months (or >3 times their regular cycle) after an individual has formerly had menstrual periods
Define Oligomenorrhoea
Infrequent periods with a menstrual cycle longer than 35 days
Define Menopause.
Lack of menstruation for more than 12 month associated with cessation of ovarian function and reproductive capacity.
When is menopause defined as premature?
If it occurs before the age of 35
What is needed to make a diagnosis of Polycystic Ovarian Syndrome?
2 OF THE FOLLOWING
1) Oligo- or anovulation
2) Hyperandrogenism - clinical or biochemical
3) Polycystic Ovaries on USS
What effect does PCOS have on the endocrine system?
1) Increased LH
2) Elevated androgens
3) Decreased sex hormone binding globulin - lead to increased free testosterone levels
4) Increased fasting insulin - associated with insulin resistance and impaired glucose tolerance - increased risk of T2DM
What are fibroids and how common are they?
Benign Tumours of the Myometrium
Occur in at least 25% of women
How might Fibroids present?
50% are asymptomatic and only discovered by chance at pelvic/abdo examination
Menorrhagia occurs in 30%, can get IMB, and dysmenorrhoea
May press on bladder - causing freqency or retntion
Can cause infertility if blocking tube/preventing implantation
List some of the complications of fibroids.
Pedunculated ones can undergo torsion, causing pain
Degeneration of Fibroid - pain,, uertine tenderness and haemorrhage
Malignant Fibroids (0.1%) - malignant change of a fibroid or de novo malignant transformation of natural smooth muscle
Increased vaginal bleeding may cause anaemia
What complications can fibroids cause in pregnancy?
Premature labour Malpresentation/ Transverse Lie Obstructed Labour PPH Red degeneration is more common
