Gynaecology Flashcards
What are red flags for menorrhagia?
Weight loss
Recent onset
Dysuria
Painful sex
Under which circumstances would you fast-track for endometrial biopsy?
- > 10mm endometrial thickness (<5mm post-menopause)
- > 45
- Resent onset
- IMB
- Unresponsive to treatment
What is a 2nd line medical management for menorrhagia?
- Tranexamic acid taken during menstruation only
- NSAIDs - Mefanemic acid - inhibit prostaglandin synthesis
What is a 3rd line medical management option for menorrhagia
Progestogens - unsuitable for conception
What is the surgical management for menorrhagia?
- Endometrial ablation
- Hysterectomy
What is a uterine artery embolisation for?
Menorrhagia due to fibroids
Can retain uterus and avoid surgery
What is the medical management for irregular/IMB?
IUS
COCP
Progestogens
What is the management of ectropions?
Freeze via cryotherapy
How can you manage painful periods?
NSAIDs - Mefanamic acid/Ibuprofen
COCP
Mirena coil
What can cause primary amenorrhoea?
- Turner’s
- Congenital adrenal hyperplasia, congenital malformations of the Genital tract
What can cause secondary amenorrhea?
- PCOS
- Hyperprolactinaemia
- Thyrotoxicosis
- Asherman’s syndrome
- Hypothalamic Hypogonadism
What investigations would be necessary for amenorrhoea?
- Pregnancy
- TFTs
- Gonadotrophins - high = ovarian, low = hypothalamic
- Prolactin
- Androgen levels
- Oestrodiol
What is required for a diagnosis of PCOS?
Two or more of:
- Amenorrhoea
- Clinical/biochemical hirsuitism
- Polycystic ovaries on USS - >8 cysts <10mm in size
What blood tests would you perform to test for PCOS?
- FSH - normal
- Prolactin - rule out hyperprolactinaemia
- Testosterone - raised
- LH - often raised
- TSH
What are 3 causes of premature menopause?
- Turner’s/Fragile X
- Hypothyroid, Addison’s, myaesthena gravis
- Galacgosaemia
What infections can cause premature menopause
- TB
- Mumps
- Malaria
- Varicella
What is tibolone?
Synthetic steroid with weak oestrogenic, progestogenic and androgenic effects used to treat menopause:
- Vasomator, psychological + libido Sx
- Conserves bone mass and reduces risk of vertebral fracture
What are the risks from taking HRT
- Endometrial cancer
- Breast cancer
- VTE in 1st year (4x risk 1-6mnths, 3x risk 7-12mnths)
What type of HRT is indicated for hysterectomy?
Oestrogen only for hysterectomy
Oestrogen + progestogen for those wihtout
At what side endometrial thickness would post-menopausal bleeding indicate an endometrial biopsy?
> 3mm or >5mm if on HRT
What is adenomyosis?
Ectopic implantation of endometrial tissue deep inside myometrium
What 3 investigations would be necessary for endometriosis suspection?
- TVUSS - gross endometriosis/chocolate cysts
- Laparoscopy - peritoneal/biopsy
- MRI - Presence of adenomyosis in bladder/bowel etc
What is the medical management for endometriosis?
- COCP or GnRH - mimic pregnancy/menopause
- Progestogen
What is the surgical management for endometriosis?
- Endometrial ablation
- Hysterectomy –> HRT for post-menopausal SE
If someone is wanting to conceive and has endometriosis, what might be the best option?
Endometrial ablation
Which ovarian cyst is most likely to induce endometrial carcinoma?
Thecoma - benign oestrogen secreting tumours
If someone has CN I what is the management?
Follow-up in 6months for cytology
What is Radical Trachelectomy?
Removal of 80% cervix and vagina - preserves fertility
What is the management for Stage I endometrial cancer?
Laparoscopic hysterectomy + salpngectomy
Which gene is most likely to cause ovarian cancer?
BRCA1 then BRCA2 then HNPCC
What risk factors increase the risk of vulval cancers?
HPV in younger women
Lichen planus in older women
What are the legal requirements for a termination of pregnancy?
- Risk to woman’s life
- Risk to her physical/mental health
- Risk to existing children - physical/mental
- Foetus will be handicapped
When is a medical abortion indicated?
Up to 21 weeks
What is the medical management for abortion?
Mifepriston then misprostol 48hours later
What are the options for surgical management of abortion?
- Vacuum aspiration up to 14 weeks
- Dilatation and evacuation 14-24 weeks
What are the risks of an abortion?
- Infection
- Cervical trauma
- Failure - 1%
- Haemorrhage/perforated uterus = very rare
What causes infertility with regards to ovulation problems?
Disruption of LH surge/system with high/low BMI + thyroid abnormalities
What causes infertility with regards to Tubual blockage?
PID complication
Endometriosis - scarring/adhesions
What causes infertility with regards to Endometrial factors?
Prevent implantation of embryo
Fibroids, polyps, adhesions
Surgical resection may improve
What drug is used to induce ovulation?
Clomiphene citrate
Increases FSH and ovary stimulation to produce more follicles
What is ovarian drilling?
Passing an electrical current through the ovary to induce ovulation
How is ovulation induced for IVF?
Injection of hCG
What is the success rate for IVF?
30% if less than 35
What is the success rate of intrauterine insemination?
15-20%
What would you expect to see on examination of a woman with urinary incontinence?
Cystocele/urethrethrocele
Palpation of abdomen to exclude distended bladder
What conservative management is there for urinary incontinence?
- Lose weight
- Smoking - chronic cough
- Increase pelvic muscle strength - physio
- Cones - inserted into vagina and held - strengthen
What medical management is there for urinary incontinence
Dulexitine - Serotonin and noradreanline reuptake inhibitor
What are the side effects of Dulexitine?
Dry mouth
Dyspepsia
Drowsiness
What surgical management of incontinence are there?
Mid-urethral sling - tension free vaginal tape placed under urethra to prevent leakage when coughing
What can you use to measure contractions on filling and provocation in suspected detrusor overactivity?
- Cystometry
What conservative measures are there for urge incontinence?
- Avoid caffeine
- Reduce fluid intake
- Time voiding and systemic delay in voiding - resist sensation of urgency and form a timetable
What medical management is there for urge incontinence
- Oxybutynin - suppress detrusor by blocking muscarinic receptors
- Oestrogens - post-menopausal women to improve atrophy, dryness and irritation
- Botulinum toxin - blocks neurotransmission and injected cystoscopically
