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Phase 3A > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

What are the different classifications of uterine fibroids?

A

Intramural
Submucosal
Sub-serosal (can be pedunculated)

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2
Q

What are the symptoms of uterine fibroids?

A 
Excessive or prolonged periods
Intermenstrual bleeding 
Pelvic pain 
Constipation 
Urinary symptoms
Recurrent miscarriage/infertility
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3
Q

What are the signs of uterine fibroids?

A

A palpable abdominal mass arising from the pelvis
Enlarged, often irregular, firm, non-tender uterus
Signs of anaemia secondary to menorrhagia

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4
Q

What is the differential diagnosis for uterine fibroids?

A 
Dysfunctional uterine bleeding
Endometrial polyps 
Endometrial cancer
Endometriosis
Chronic PID
Ovarian tumour 
Pregnancy
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5
Q

What investigations would you want for uterine fibroids?

A 
Pregnancy test
FBC
Iron studies
Pelvic USS
MRI
Endometrial biopsy
Hysteroscopy
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6
Q

What is the management for uterine fibroids?

A

Medical: NSAIDs, TXA, COCP, Levonorgestrel-releasing IUS e.g. Mirena, Danazol, GnRH agonists, Aromatase inhibitors
Surgical: myomectomy, hyperoscopic endometrial ablation, TAH, uterine artery embolisation

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7
Q

What are the complications of uterine fibroids?

A

Iron-deficiency anaemia
Torsion of a pedunculated fibroid
Infertility
Recurrent miscarriage

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8
Q

What is the epidemiology of ovarian cysts?

A

Benign ovarian tumours occur in 30% of females with regular menses and 50% of females with irregular menses
Predominantly in pre-menopausal females

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9
Q

What are the risk factors for ovarian cysts?

A 
Obesity
Tamoxifen therapy 
Early menarche
Infertility
Dermoid cysts can run in families
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10
Q

What are the symptoms of ovarian cysts?

A 
Asymptomatic 
Dull ache or pain 
Torsion or rupture can cause severe abdominal pain and fever
Ascites
Endocrine effects
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11
Q

What is the differential diagnosis of ovarian cysts?

A 
Non-neoplastic functional cysts
Other causes of pelvic pain 
PCOS
Endometrial tumour
Ovarian malignant tumour
Bowel issues 
Pelvic malignancies 
Gynaecological issues 
Endometrioma
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12
Q

What investigations would you do for an ovarian cyst?

A 
Pregnancy test
FBC
Urinalysis
USS, CT or MRI
Diagnostic laparoscopy 
FNA + cytology
Ca125
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13
Q

What is the risk of malignancy index?

A

RMI = U x M x Ca125
U - ultrasound score
M - menopausal status

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14
Q

What is the management of ovarian cysts?

A

Expectant management with or without follow-up

Surgical management - cystectomy, oophorectomy

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15
Q

What are the complications of ovarian cysts?

A

Torsion, haemorrhage, rupture

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16
Q

What is the classification of ovarian cancers?

A

Epithelial ovarian tumours
Germ cell tumours
Sex cord-stromal tumours
Metastatic tumours

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17
Q

What are the risk factors for ovarian cancer?

A 
Increased age
Smoking
Obesity 
Lack of exercise 
Talcum powder use
Occupational exposure to asbestos
Hormonal factors 
Genetic factors 
Medical history
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18
Q

What are some protective factors for ovarian cancer?

A

Childbearing
Breastfeeding
Early menopause
COCP

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19
Q

What are the symptoms of ovarian cancer?

A 
Abdominal discomfort
Abdominal distension/bloating
Urinary frequency 
Dyspepsia
Fatigue
Weight loss
Anorexia and depression 
Abnormal uterine bleeding
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20
Q

What are the signs of ovarian cancer?

A

Pelvic or abdominal mass
Ascites
Enlarged lymph nodes

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21
Q

What is the differential diagnosis for ovarian cancer?

A 
Benign ovarian tumour 
Fibroids 
Other pelvic malignancy
Secondary carcinoma 
Endometriosis 
Other causes of abdominal pain/bloating
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22
Q

What are the investigations for ovarian cancer?

A

Ca125
Pelvic and abdominal USS, CT or MRI
RMI

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23
Q

What is the management for ovarian cancer?

A

Surgery

Chemotherapy

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24
Q

What is the definition of stress incontinence?

A

The involuntary leakage of urine on effort or exertion or on sneezing or coughing. Due to an incompetent sphincter, may be associated with GU prolapse.

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25
Q

What are the risk factors for stress incontinence?

A 
Pregnancy
Vaginal delivery 
DM
Oral oestrogen therapy 
High BMI
Vaginal hysterectomy
Perimenopause 
Parity
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26
Q

What are the symptoms of stress incontinence?

A

Leakage of urine on sneezing, coughing, exercise, rising from sitting or lifting.

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27
Q

What are the signs of stress incontinence?

A

Possible vaginal atrophy

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28
Q

What are the investigations for stress incontinence?

A 
Bladder chart for 3 days 
In history ask about sexual dysfunction and quality of life, assess functional status, bowel habit 
MSU & urinalysis
Urodynamic 
Urinary flow rates 
Assessment of residual urine
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29
Q

What is the management for stress incontinence?

A

Pelvic floor exercises (3 month trial)
Drug treatment e.g. duloxetine
Surgical treatment e.g. retropubic mid-urethral tape, open colposuspension, autologous rectal fascial sling
Temporary containment products to achieve social continence should be offered until there is a specific diagnosis and management plan

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30
Q

What is the epidemiology for overactive bladder?

A

It is the second most common cause of female urinary incontinence.
Prevalence increases with age.
It may be associated with Parkinson’s disease, spinal cord injury, MS, dementia, stroke or diabetic neuropathy

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31
Q

What is the presentation of overactive bladder?

A

Sudden urge to urinate that is difficult to delay and may be associated with leakage, frequency in micturition, nocturia, abdominal discomfort and urge incontinence.

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32
Q

What is the differential diagnosis of overactive bladder?

A 
Stress incontinence
Functional incontinence
Overflow incontinence
Urinary fistula
Enuresis 
UTI
DM
Bladder cancer 
Bladder stones
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33
Q

What investigations would you perform for overactive bladder?

A

MSU & urinalysis
Blood for renal function, U&Es, Ca2+ and fasting glucose
Urodynamic studies

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34
Q

What is the management for overactive bladder?

A

Lifestyle changes: reduce caffeine, modification of fluid intake, weight loss if BMI >30
Bladder training: first line for 6 weeks, pelvic muscle training, scheduled voiding intervals with stepped increases and suppression of urge with distraction/relaxation techniques
Drug treatment: anticholinergics, intravaginal oestrogens, mirabegron
Botox into the bladder wall
Sacral nerve stimulation
Surgery: only indicated for intractable and severe idiopathic OAB. Augmentation cystoplasty

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35
Q

What are the risk factors for GU prolapse?

A 
Increased age
Vaginal delivery
Increased parity 
Obesity 
Previous hysterectomy
Possible: obstetric factors, family history of prolapse, constipation, connective tissue disorders, occupations involving heavy lifting
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36
Q

Name the types of GU prolapse.

A

Anterior compartment: urethrocele, cystocele, cystourethrocele
Middle compartment: uterine prolapse, vaginal vault prolapse, enterocele
Posterior compartment: rectocele

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37
Q

What is the presentation of a GU prolapse?

A

May be asymptomatic and an incidental finding.
Vaginal symptoms: sensation of pressure, fullness or heaviness, sensation of bulge/protrusion/something coming down, seeing/feeling a bulge/protrusion, spotting, difficulty retaining tampons
Urinary symptoms: incontinence, frequency, urgency, weak/prolonged urinary stream, incomplete bladder emptying
Coital difficulty: dyspareunia, loss of vaginal sensation, vaginal flatus, loss of arousal
Bowel symptoms: constipation/straining, urgency of stool, faecal incontinence

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38
Q

What investigations would you do for GU prolapse?

A

Examination.
If patient has urinary symptoms then MSU, post-void residual urine, urea and creatinine levels. Renal USS.
Occasionally USS and MRI

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39
Q

What is the management for GU prolapse?

A

Conservative: watchful waiting, lifestyle changes, pelvic floor muscle exercises, vaginal oestrogen creams.
Vaginal pessary insertion
Surgery

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40
Q

What are the two peaks of incidence for lichen sclerosus?

A

Prepubertal girls

Postmenopausal women

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41
Q

What are the symptoms of lichen sclerosus?

A

Itch - can disturb sleep, usually worse at night
Pain - dyspareunia
Perianal lesions - constipation
Can be asymptomatic

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42
Q

What are the signs of lichen sclerosus?

A

White lesions, may progress to crinkled white patches. Active lesions may have areas of ecchymosis, hyperkeratosis or bullae. Destructive scarring may cause shrinkage of the labia, narrowing of the introitus or the clitoris. Perianal lesions occur in approx 30% of cases

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43
Q

What are the investigations for lichen sclerosus?

A

Biopsy
Swabs to rule out infection
Bloods including autoimmune screen and TFTs

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44
Q

What is the differential diagnosis for lichen sclerosus?

A 
In children, signs may mimic those of child sexual abuse. Vitiligo
Localised Scleroderma
Lichen planus 
Leukoplakia 
Vulval intraepithelial neoplasia 
Bowen's disease
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45
Q

What is the management for lichen sclerosus?

A

A reducing course of clobetosol propionate is the usual treatment.
Wash with bland emollients
Scarring may require surgery

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46
Q

What is the epidemiology for cervical cancer?

A

3rd most commonly diagnosed cancer worldwide

More common in those aged 25-34

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47
Q

What is the histopathology of cervical cancers?

A

70% are squamous carcinomas
15% are a mixed pattern
15% are adenocarcinomas
All 3 cause pre-invasive and invasive disease

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48
Q

What is the presentation of cervical cancer?

A

Many cases are detected by screening.
First symptoms: vaginal discharge, bleeding (can be spontaneous but can occur after sex, micturition or defecation), vaginal discomfort/urinary symptoms.
Late symptoms: painless haematuria, chronic urinary frequency, painless fresh rectal bleeding, altered bowel habit, leg oedema, pain, hydronephrosis

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49
Q

What are the signs of cervical cancer?

A

White or red patches on the cervix

DRE may reveal a mass or bleeding due to erosion

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50
Q

What is the differential diagnosis for cervical cancer?

A 
Cervicitis
Dysfunctional uterine bleeding 
Ectropion 
PID 
Endometrial cancer
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51
Q

What investigations would you perform for cervical cancer?

A 
Chlamydia test 
Colposcopy 
Cone biopsy 
FBC, renal function and LFTs
CT chest, abdo and pelvis
PET scan
52
Q

What is the management of cervical cancer?

A

Surgery - extent of which is dictated by tumour stage, age of patient and co-morbidites. Patients fertility options/wishes should be taken into account.
Radiotherapy
Chemotherapy

53
Q

What are the risk factors for endometrial cancer?

A 
Prolonged periods of unopposed oestrogen 
Being nulliparous 
Menopause past the age of 52 
Obesity 
Endometrial hyperplasia 
HNPCC
PCOS 
DM 
Tamoxifen
54
Q

What is the presentation of endometrial cancer?

A

Post-menopausal bleeding
Irregularities of the menstrual cycle
Unlikely to be any physical abnormality unless the disease is well advanced

55
Q

What investigations would you perform for endometrial cancer?

A

Transvaginal USS
Endometrial biopsy e.g. pipelle
Hysteroscopy and biopsy
Many women also have a CXR and bloods (FBC, LFTs)

56
Q

What is the management of endometrial cancer?

A

Surgery - TAH and BSO, use of progesterone to protect fertility
Radiotherapy
Chemotherapy

57
Q

What is the aetiology for vulval cancer?

A

90% are squamous cell carcinoma, others are basal cell carcinomas, adenocarcinomas, sarcomas and melanomas

58
Q

What are the risk factors for vulval cancer?

A

VIN
Lichen sclerosus
HPV
Paget’s disease of the vulva

59
Q

What is the presentation of vulval cancer?

A

Vulval lump
Vulval bleeding due to ulceration, pruritus or pain
75% of all growths are primarily on the labia; there should be a high index of suspicion for abnormal lesions in the vulva including “warts” in the post-menopausal woman.

60
Q

What investigations would you perform for vulval cancer?

A

Examination and biopsy
Cystoscopy
Proctoscopy
CXR and MRI for staging

61
Q

What is the differential diagnosis for vulval cancer?

A 
Lichen planus 
Ulcers 
Dermatitis 
Fungal infection 
Other causes of swellings of the vulva e.g. boils, Bartholin's cyst
62
Q

What is the management for vulval cancer?

A

Surgery
Radiotherapy
Chemotherapy

63
Q

What is the epidemiology of vaginal cancer?

A

Usually squamous cell carcinoma involving the posterior wall of the upper 1/3 of the vagina.
Lesions ay be ulcerative or exophytic
85% of cases are SCC, 10% are adenocarcinoma (peak incidence 17-21), rarely melanoma and sarcomas are primary vaginal cancers

64
Q

What is the presentation of vaginal cancer?

A

Vaginal bleeding or bloody discharge may be seen.

Advanced tumours may affect the rectum or bladder or extend to the pelvic wall causing pain or leg oedema

65
Q

What investigations would you perform for vaginal cancer?

A 
Colposcopy 
Biopsy 
Cervical cytology
Endometrial biopsy 
CT scan 
FDG-PET
CXR
Cystoscopy 
Sigmoidscopy
66
Q

What is the management for vaginal cancer?

A

Treatment options depend on tumour stage. Surgery and radiotherapy are very effective in early stage disease. Radiotherapy is the primary treatment for more advanced stages. Chemotherapy has not yet show to be curative.
Surgery: radical TAH with removal of upper vagina

67
Q

What are the classifications of GTD?

A

Premalignant: hydatidiform mole - complete or partial
Malignant: GTN - invasive mole, choriocarcinoma, placental site trophoblastic tumour, epithelioid trophoblastic tumour

68
Q

What are the risk factors for GTD?

A

More common in women >45 and < 16 years old

Increased risk with multiple pregnancy and previous molar pregnancy

69
Q

What is the presentation for GTD?

A

Vaginal bleeding in the 1st trimester and uterine evacuation at approx 10 weeks.
All products of conception from a non-viable pregnancy should undergo histological examination. Women with persistent abnormal vaginal bleeding after a non-pregnancy should have bhGC done to exclude GTN

70
Q

What investigations would you perform for GTD?

A

Urine and blood levels of hCG
Histology of products of conception
USS
Staging investigations where metastatic disease is suspected

71
Q

What is the management for GTD?

A

Registration
Suction curettage for complete and partial molar pregnancies and surveillance after hydatidiform mole
Chemotherapy

72
Q

What is the epidemiology for endometriosis?

A

Estimated to affect 10-15% of women of reproductive age.

Endometriosis has a higher prevalence in infertile women, estimated 25-40%

73
Q

What are the risk factors for endometriosis?

A 
Early menarche 
Late menopause 
Delayed childbearing 
Short menstrual cycles 
Long menstrual flow 
Obstruction to vaginal outflow 
Family history
74
Q

What are the symptoms of endometriosis?

A 
Dysmenorrhoea 
Dyspareunia 
Cyclic or chronic pelvic pain 
Subfertility 
Bloating 
Lethargy 
Constipation 
Low back pain
75
Q

What are the signs of endometriosis?

A

Examination is often normal but can have posterior fornix or adnexal tenderness
Palpable nodules in the posterior fornix or adnexal masses
Bluish haemorrhagic nodules visible in the posterior fornix

76
Q

What is the differential diagnosis for endometriosis?

A 
PID 
Ectopic pregnancy 
Torsion of ovarian cyst 
Appendicitis 
Primary dysmenorrhoea 
IBS
Uterine fibroids 
UTI
77
Q

What investigations would you perform for endometriosis?

A 
Transvaginal USS and pelvic USS
Diagnosis laparoscopy - GOLD STANDARD 
MRI 
FBC 
Urinalysis and MC&amp;S 
Cervical swabs 
bhCG
78
Q

What is the management for endometriosis?

A

Medical: COCP, mednoxyprogesterone acetate and GnRH agonists, Mirena IUS
Surgery: remove severe and deep infiltrating lesions, ovarian cystectomy, adhesiolysis, TAH & BSO
Pain management specialists and clinical psychologists

79
Q

What is the pathophysiology of adenomyosis?

A

The presence of functioning endometrial tissue which has penetrated the myometrium by direct spread from the uterine lining

80
Q

What are the symptoms of adenomyosis?

A

1/3 of patients are asymptomatic
Progressively increasing pain usually associated with menstruation
Menstrual irregularities e.g. premenstrual staining and spotting, increased flow or more frequent periods

81
Q

What are the signs of adenomyosis?

A

Enlarged and tender uterus

82
Q

What investigations would you perform for adenomyosis?

A

Transvaginal USS
Pelvic USS
MRI of the uterus

83
Q

What is the management for adenomyosis?

A

Anti-inflammatories during the period, hormonal treatments e.g. COCP, progesterone-only pill/injection mirena IUS, GnRH analogues, endometrial ablation, uterine artery embolisation, TAH
If the patient is asymptomatic then treatment may not be necessary

84
Q

What are the risk factors for adenomyosis?

A

Being in 40s or 50s before menopause
Having children
Previous uterine surgery e.g. LSCS

85
Q

What are the two different classifications of dysmenorrhoea?

A

Primary - occurs in young females with no pelvic pathology

Secondary - occurs in association with some form of pelvic pathology

86
Q

What are the causes of dysmenorrhoea?

A 
Endometriosis 
Adenomyosis 
PID
Fibroids 
Adhesions 
Developmental abnormalities 
Copper IUD
87
Q

What may examination reveal in a patient with dysmenorrhoea?

A

Adenomyosis - uterus may be enlarged and tender with a “boggy” feel
Endometriosis - generalised tenderness in the pelvic area
Partially imperforate hymen
Vaginal septum

88
Q

What investigations would you perform for dysmenorrhoea?

A 
Vaginal swabs 
Cervical smear 
Pelvic USS 
Transvaginal USS
MRI scan 
Laparoscopy +/- biopsy
89
Q

What is the management for dysmenorrhoea?

A

Lifestyle changes e.g. smoking cessation, self-help techniques
NSAIDs
Hormonal treatment

90
Q

What is the aetiology of atrophic vaginitis?

A

It is very common in post-menopausal women due to the falling levels of oestrogen.
Natural menopause
Oopherectomy
Anti-oestrogenic treatments, radiotherapy or chemotherapy
Post-partum or with breastfeeding

91
Q

What are the symptoms of atrophic vaginitis?

A 
Asymptomatic 
Vaginal dryness
Burning or itching of the vagina or vulva 
Dyspareunia 
Vaginal discharge 
Vaginal bleeding 
Post-coital bleeding 
Urinary symptoms
92
Q

What are the signs of atrophic vaginitis?

A 
External genitalia may show reduced pubic hair 
Reduced turgor/elasticity 
Narrow introitus 
Thin mucosa with erythema
Occasional petechiae or ecchymoses s
Dryness
Lack of vaginal folds
93
Q

What is the differential diagnosis for atrophic vaginitis?

A

Genital infections e.g. BV, trichomonas, candidiasis, endometritis
Local irritation due to soap, panty liners etc

94
Q

What investigations would you perform for atrophic vaginitis?

A

Investigation may not be necessary but is useful to exclude other potential diagnosis.
Vaginal pH testing
Vaginal cytology

95
Q

What is the management of atrophic vaginitis?

A

Vaginal lubricants and moisturisers
Vaginal oestrogen
Hormone replacement therapy

96
Q

What is the pathophysiology of PCOS?

A

Excess androgens are produced by the theca cells of the ovaries (either due to hyperinsulinaemia or increased LH), insulin resistance, increased LH and increased oestrogen in some women

97
Q

What are the symptoms of PCOS?

A 
Oligomenorrhoea (<9 periods/year)
Infertility or subfertility 
Acne
Hirsutism 
Alopecia 
Obesity or difficulty losing weight 
Psychological symptoms - mood swings, depression, anxiety, low self-esteem
Sleep apnoea
98
Q

What are the signs of PCOS?

A 
Hirsutism 
Male pattern balding/alopecia 
Obesity 
Acanthosis nigrans 
Occasionally clitoromegaly 
Increased muscle mass 
Deep voice
99
Q

What is the diagnostic criteria for PCOS?

A

ROTTERDAM CRITERIA: 2 of the 3 following:
Polycystic ovaries (>/= 12 peripheral follicles or increased ovarian volume >10cm3)
Oligo-ovulation or anovulation
Clinical and/or biochemical signs of hyperandrogenism

100
Q

What is the differential diagnosis for PCOS?

A 
Thyroid disorder 
Hyperprolactinaemia 
Cushing's syndrome 
Acromegaly 
Side effects from medication 
Late-onset congenital adrenal hyperplasia 
Androgen-secreting ovarian or adrenal tumours 
Ovarian hyperthecosis
101
Q

What are the investigations for PCOS?

A

Pelvic USS

Total testosterone, free testosterone, LH, TFTs, fasting glucose and lipids, sex hormone-binding globulin

102
Q

What is the management for PCOS?

A

Counselling on long-term effects
Weight control and exercise
Low GI diet
If not wanting to conceive: COCP, co-cyprindrol, metformin, eflornithine, orlistat
If wishing to conceive: clomifene, metformin, laparoscopic ovarian drilling

103
Q

What is Asherman Syndrome?

A

A rare, acquired condition of the uterus resulting in intrauterine adhesions

104
Q

What are some risk factors for Asherman syndrome?

A 
Myomectomy
LSCS
Infections 
Age
Genital TB
Repeated D&amp;C or over-vigorous D&amp;C
Obesity
105
Q

What are the symptoms of Asherman syndrome?

A

Decrease in flow and duration of bleeding
Oligomenorrhoea
Pain during menstruation and ovulation
Infertility

106
Q

What investigations would you perform for Asherman syndrome?

A

Hysteroscopy
HSG
Sonohysterography - USS pelvis when uterus is filled with sterile fluid

107
Q

What is the management for Asherman syndrome?

A

Adhesiolysis and follow up tests to ensure adhesions haven’t returned

108
Q

What is the prognosis for Asherman syndrome?

A

Extent of adhesion formation is critical

Mild-moderate adhesions can usually be treated with success

109
Q

What are prolactinomas?

A

Benign, prolactin-producing tumours of the pituitary gland.
Microadenomas are the most common (90%)
Macroadenomas are rare (>10 mm in size) approx 10%
Can also have giant pituitary adenomas (>40mm) and malignant prolactinomas (vary rare)

110
Q

What are the symptoms of prolactinomas?

A 
Amenorrhoea
Oligomenorrhoea 
Anovulatory cycles 
Galactorrhoea 
Infertility 
Hirsutism 
Reduced libido
111
Q

What are the signs of prolactinomas?

A

Bitemporal hemianopia as a result of compression of the optic chiasm
Cranial nerve palsies

112
Q

What investigations would you perform for prolactinomas?

A

TFTs, bhCG, basal serum prolactin
Visual field testing
Pituitary imaging preferably MRI
Assessment of pituitary function

113
Q

What is the management for prolactinomas?

A

Treat with dopamine agonists: cabergoline, bromocriptine, quinagolide
Surgery
Radiotherapy - rarely used

114
Q

What are the complications of prolactinomas?

A

Osteoporosis, reduced fertility (erectile dysfunction and infertility in men)

115
Q

What is the aetiology of PID?

A

Often polymicrobial, can be caused by genital mycoplasmas, endogenous vaginal flora, aerobic streptococci, mycobacterium tuberculosis and STIs e.g. Chlamydia trachomatis and Neisseria gonorrhoeae

116
Q

What are the risk factors for PID?

A

Risk factors for acquiring STIs
Having had an IUCD fitted in the last 20 days
Termination of pregnancy

117
Q

What are the symptoms of PID?

A

Bilateral lower abdominal pain
Deep dyspareunia
Abnormal vaginal bleeding
Vaginal or cervical purulent discharge

118
Q

What are the signs of PID?

A

Lower abdominal tenderness
Mucopurulent discharge and cervicitis on speculum
Cervical motion tenderness and adnexal tenderness on bimanual examination
Fever >38C

119
Q

What investigations would you perform for PID?

A 
bhCG
Cervical and endocervical swabs
ESR or CRP 
Endometrial biopsy
USS
Diagnostic laparoscopy 
Urinalysis and urine culture
120
Q

What is the management of PID?

A

Mild-moderate disease: primary care/outpatients
Severe disease: inpatient for IVABx
Moxifloxacin is 1st line
Doxycycline as an empirical treatment for male partners
Refer to GUM clinic for full work up

121
Q

What are the complications associated with PID?

A 
Infertility
Ectopic pregnancy 
Perihepatitis 
Tubo-ovarian abscess 
Reactive arthritis
122
Q

What is primary amenorrhoea?

A

Amenorrhoea in a patient who has never had a period.
Investigate in 14 year old girls with no breast development or 15 year old girls with breast development.
The most common cause is late puberty. Consider genetic karyotyping for Turner’s syndrome or testicular feminisation. True primary amenorrhoea is caused by congenital absence/undeveloped uterus or ovaries

123
Q

What is secondary amenorrhoea?

A

Amenorrhoea in patients who previously had periods.

124
Q

What are the causes of secondary amenorrhoea?

A 
Emotional distress
Weight loss
Low BMI
Excessive exercise 
Systemic disease 
Hyperthyroidism 
Drug-induced (contraceptives, antipsychotics, long term opiates)
Early menopause 
PCOS
Pituitary tumour 
Pituitary necrosis
125
Q

What are the investigations for secondary amenorrhoea?

A 
FSH (increased in premature menopause)
Testosterone (increased in PCOS)
LH (increased in PCOS)
TFTs 
bhCG (could be pregnant!)
USS
Prolactin
126
Q

What is the management of secondary amenorrhoea?

A

Treatment depends on the cause

Phase 3A (9 decks)

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