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Phase 3a Medicine - Women's Health > Gynaecology > Flashcards

Gynaecology Flashcards

1
Q

Define:

a. menorrhagia
b. IMB
c. Primary amenorrhoea
d. Secondary amenorrhoea
e. Oligomenorrhoea
f. Dysmenorrhoea

A

a. heavy menstrual bleeding.
b. intermenstrual bleeding - bleeding between periods.
c. no menstrual cycle has occurred by age 16 in the presence of secondary sexual characteristics or by 13/14 in the absence of secondary sexual characteristics.
d. menstrual cycle was present but then stops for at least 6 months.
e. infrequent periods (>35 days for >6 months.)
f. painful periods.

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2
Q

List the types of FGM.

A

Type 1 - Clitoridectomy: partial or total removal of the clitoris.
Type 2 - Excision: partial or total removal of clitoris and labia minora +/- majora.
Type 3 - Infibulation: narrowing of vaginal orifice with creation of covering seal by vutting and repositioning labia minora and/or majora +/- excision of clitoris.
Type 4 - All other harmful procedures for non-medical purposes.

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3
Q

List 5 gynaecological and 5 obstetric complications of FGM.

A 
Gynae
1. Dyspareunia (painful sex.)
2. Sexual dysfunction with anorgasmia.
3. Chronic pain.
4. Keloid scar formation,
5. PTSD.
Obs
1. Increased risk for need of C-section.
2. Increased risk of PPH.
3. Extended hospital stay.
4. Fear of childbirth.
5. Increased risk for needing episiotomy.
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4
Q

List 3 causes of acute and 3 causes of chronic pelvic pain with a gynaecological source.

A

Chronic:

  • Endometriosis
  • Adenomyosis
  • Ovulation pain

Acute:

  • Ectopic pregnancy
  • Pelvic inflammatory disease.
  • Ovarian cyst torsion.
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5
Q

Define endometriosis

A

Endometrial tissue growing elsewhere than the uterus.

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6
Q

What is an endometrioma?

A

a collection of endometrial tissue which bleeds and forms a cyst –> aka chocolate cyst.

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7
Q

What is the classic triad of endometriosis?

A
  • Dysmenorrhoea.
  • Dyspareunia.
  • Infertiltiy.
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8
Q

What investigations would you carry out for endometriosis?

A
  • Regular CA125 bloods.
  • USS to show endometriomas.
  • MRI if needed, for deep sighted endometriosis.
  • Diagnostic laparoscopy.
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9
Q

What is the management for pain in endometriosis?

A

Simple analgesic.

Mefenamic acid with tranexamic acid.

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10
Q

What is the treatment for endometriosis?

A

1st line –> oral contraceptive pill or GnRH agonists.
2nd line –> progesterone therapy; depo-provera or Mirena coil.
3rd line –> laparoscopy with excision/ablation, and dye flush to check tubal patency.

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11
Q

What is the normal pattern of female puberty?

A

Telarche (breast development), pubarche (pubic hair), menarche.

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12
Q

What are the causes and investigations for delayed puberty?

A
  • Anorexia nervosa.
  • Genetically delayed puberty.
  • Baseline FBC, bone profile and alk phosp for anorexia.
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13
Q

Define precocious puberty.

A

Appearance of physical and hormonal signs of pubertal development below the age of 8 in girls and 9 in boys.

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14
Q

What are the 2 different types of precious puberty and what causes them?

A

Central: gonadotrophin-dependent, entire HPG axis matures early.

Pseudo-puberty: gonadotrophin-independent, due to autonomous production of testesterone e.g. from congenital adrenal hyperplasia or tumours of the adrenals/ovaries.

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15
Q

Define adenomyosis.

A

Presence of endometrial tissue in the myometrium.

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16
Q

What are the three theories of how endometriosis occurs?

A
  • Sampson’s theory: retrograde menstruation causes it.
  • Halban’s theory: lesions of endometriosis established by haematogenous or lymphogenous spread.
  • Meyer’s theory: undifferentiated cells of the peritoneum become endometrial cells.
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17
Q

What is the difference in presentation with endometriosis and adenomyosis?

A

Adenoymosis presents when older and multiparous.

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18
Q

Define fibroids.

A

Benign uterine tumours of smooth muscle, called leiomyoma.

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19
Q

What is the epidemiology of fibroids.

A

30% of women over 30 have them.

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20
Q

What are the different types of fibroids?

A
  • Pedunculated.
  • Subserosal.
  • Intramural.
  • Submucosal.
  • Intracavitary.
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21
Q

What is the treatment for fibroids?

A

Myomectomy - surgical removal of fibroids.

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22
Q

Define heavy menstrual bleeding.

A

Menstrual loss that is subjectively excessive to the patient, interfering with her quality of life.

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23
Q

Clinically, what is considered as normal menstrual loss?

A

60-80ml.

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24
Q

What are the pathological causes of heavy menstrual bleeding?

A

Uterine fibroids.
Uterine polyps.
More rarely: adenomyosis/endometriosis
Can occasionally be: thyroid, clotting or drug related.

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25
Q

What investigations would you carry put for heavy menstrual bleeding?

A
  • Full blood count, clotting studies, TFTs if any evidence of thyroid disease.
  • Transvaginal ultrasound.
  • Endometrial biopsy.
  • Hysteroscopy.
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26
Q

What are the treatments for heavy menstrual bleeding?

A
  • 1st line (if not trying to concieve): Mirena coil.
  • 2nd line: antifibrinolytics (tranexamic acid,) NSAIDs (mefenamic acid,) COCP.
  • 3rd line: progestagens e.g. Depo-Provera, GnRH agonists.
  • Surgical: hyteroscopic ablation/polyp removal, hysterectomy.
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27
Q

Define primary amenorrhoea.

A

No menses by age 16 in presence of secondary sexual characteristics, or by 14 in the absence of any secondary sexual characteristics.

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28
Q

Define secondary amenorrhoea.

A

Menstruation but then cessation of menses for at least 6 months.

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29
Q

Define oligomenorrhoea.

A

Menses more than 35 days apart (a cycle length of >35 days.)

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30
Q

List the physiological causes of amenorrhoea.

A
  • Pregnancy.
  • Post-menopause.
  • During lactation.
  • Pregnancy.
  • Pre-puberty.
31
Q

List the iatrogenic causes of amenorrhoea.

A
  • Hormonal treatment e.g. Mirena coil.
  • Some anti-emetics.
  • Some anti-psychotics (by increasing prolactin levels.)
32
Q

List the hypothalamic causes of amenorrhoea.

A
  • Hypogonadotropic hypogonadism.

- Kellmann syndrome.

33
Q

What happens to FSH, LH and oestrogen levels in hypogonadotropic hypogonadism?

A

FSH, LH and oestrogen are all low.

34
Q

What is the other defining feature of Kallmann sydrome?

A

Impaired or absent sense of smell.

35
Q

List the pituitary causes of amenorrhoea.

A
  • Hyperprolactinaemia.

- Sheehan’s sydrome.

36
Q

What is Sheehan syndrome?

A

When the pituitary gland chemically shuts down after a massive postpartum haemorrhage.

37
Q

Why does hyperprolactinaemia cause amenorrhoea?

A

Increases prolactin levels inhibit GnRH and so means low FH, LSH and oestrogen.

38
Q

What are the causes of hyperprolactinaemia?

A

Pituitary hyperplasia or benign adenoma of pituitary gland.

39
Q

What are the non-gonadal endocrine causes of amenorrhoea?

A
  • Hyper or hypothyroidism.

- Congenital adrenal hyperplasia.

40
Q

List the ovarian causes of amenorrhoea.

A
  • Polycystic ovarian syndrome.

- Premature ovarian insufficiency.

41
Q

List the congenital/genetic causes of amenorrhoea.

A
  • Turner’s syndrome.
  • Gonadal dysgenesis.
  • Androgen insensitivity syndrome.
  • Constitutional delay.
42
Q

What type of obstructions can cause primary amenorrhoea?

A
  • Imperforate hymen.

- Transverse vaginal septum.

43
Q

What type of obstructions can cause secondary amenorrhoea?

A
  • Asherman’s syndrome.

- Cervical stenosis.

44
Q

List the relevant investigations for amenorrhoea.

A
  • Pregnancy test.
  • Gonadotrophin (FSH and LH) levels.
  • Oestrogen levels.
  • Prolactin levels.
  • Thyroid function tests.
  • Pelvic USS.
  • Progesterone and progesterone-oestrogen challenge.
45
Q

What do low FSH and LH levels indicate in amenorrhoea?

A

That it is a hypothalamic cause because decreased GnRH from the hypothalamus has caused the low FSH and LH.

46
Q

What do high

FSH and LH levels indicate in amenorrhoea?

A

That the cause is premature ovarian insufficiency because FSH normally stimulates oestrogen production, but when the ovaries do not respond to this, as in POI, more FSH has to be produced, hence levels are high.

47
Q

Describe the progesterone challenge and what the results mean.

A
  • Patient is given progesterone, then stopped. Should have a withdrawal bleed.
  • If she bleeds this means oestrogen levels are okay, but she does not ovulate.
  • If she does not, this means either that she doesn’t have enough oestrogen or that there is an outflow obstruction.
  • Then do an oestrogen-progesterone challenge to see if she bleeds after being given oestrogen. If so it means she does not have oestrogen due to either a hypothalamic cause (low FSH and LH) or ovarian cause (high FSH.)
  • If she does not bleed, it is due to an obstruction.
48
Q

How do you treat annovulation?

A

Using Clomid.

49
Q

What is the management for hypogonadotropic hypogonadism?

A
  • Treat the stress or anxiety or anorexia nervosa, reduce exercise and restore weight.
50
Q

What is the management for premature ovarian insufficiency and when should it be used until?

A

Oestrogen replacement therapy such as HRT or COCP until average age of menopause (51.)

51
Q

What is the management for hyperprolactinaemia?

A

Imagine to visualise tumour, then dopamine agonist such as Bromocriptine, or surgery.

52
Q

What is the management for PCOS?

A
  • COCP.
  • Metformin.
  • Diet and lifestyle advice.
53
Q

What is the management for hyperthyroidism?

A

Carbimazole.

54
Q

What is the management for hypothyroidism?

A

Levothyroxine.

55
Q

When should osteoporosis risk be assessed in amenorrhoea and why?

A

In conditions with low oestrogen so any hypothalamic cause or in hyperprolactinaemia.

56
Q

Define secondary premature ovarian insufficiency.

A

Menopause occurring in woman <40 years.

57
Q

Define primary premature ovarian insufficiency.

A

Menses have never started due to ovarian insufficiency.

58
Q

List the natural causes of POI.

A
  • Mainly idiopathic.
  • Chromosomal abnormalities.
  • FSH receptor gene polymorphism.
  • Autoimmune disease.
59
Q

List the iatrogenic cuases of POI.

A
  • Surgery.
  • Chemotherapy,
  • Radiotherapy.
60
Q

What is needed for a diagnosis of POI?

A
  • 2 separate FSH levels more than 4 weeks apart wirh 4 months or amenorrhoea.
61
Q

Define menopause.

A

Cessation of menstruation.

62
Q

What is the average age of menopause?

A

51 years.

63
Q

How is normal menopause diagnosed, what should be avoided?

A

Diagnosed after 12 months of amenorrhoea. Avoid using FSH levels.

64
Q

Define perimenopause and what it is characterised by.

A

The period leading up to menopause characterised by classic symptoms of ireegular periods, hot flushes, mood swings and urogenital atrophy causing vaginal dryness.

65
Q

What are the long-term effects of menopause.

A

Osteoporosis.
Cardiovascular disease.
Dementia if early menopause.

66
Q

Outline the management of menopause.

A
  • Hormonal: HRT with oestrogen (+/- progesterone) replacement. i.e. Mirena coil.
  • Non-hormonal: Clonidine, SSRIs, gabapentin.
  • Non-pharmaceutical: CBT.
67
Q

What are the risks of HRT?

A
  • Breast cancer if using oestrogen and progesterone HRT.
  • VTE.
  • Cardiovascular disease if started in women >60 years.
  • Stroke with oral HRT.
68
Q

List contraceptive types that have user failure.

A
  • Combined oral contraceptive pill.
  • Contraceptive patch.
  • Progesterone only pill.
  • Barrier methods.
  • Natural family planning.
  • Lactational amenorrhoea method.
69
Q

List contraceptive types that do not have user failure.

A
  • Contraceptive injection.
  • Contraceptive implant.
  • IUD.
  • IUS.
  • Sterilisation.
70
Q

List the long-acting reversible contraceptives.

A
  • Contraceptive injection.
  • Contraceptive implant.
  • IUD.
  • IUS.
71
Q

Which contraception methods can be started immediately after miscarriage or abortion?

A 
COCP <24 weeks.
Patches <20 weeks.
POP <24 weeks.
Injections.
IUS.
72
Q

Name 2 types of hormonal emergency contraception and which hormone they use.

A

Progesterone - Levonelle and ellaOne.

73
Q

Name a non-hormonal emergency contraceptive.

A

IUD.

Phase 3a Medicine - Women's Health (2 decks)

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