Gynaecology Flashcards
Disorders of sex development (DSD):
Was established to describe congenital conditions with atypical development of chromosomal, gonadal or anatomic sex.
Delayed puberty (in girls)
Is usually diagnosed if there is no breast tissue by the age of 13 and subsequently no onset of menstruation by 15-16 years of age.
The timing of puberty is highly genetic but can be delayed due to:
Very low levels of body fat (athletes, malnourished, eating disorders)
May also occur with hypogonadism
- Ovaries are damaged/not developing correctly
- Problem with parts of the brain involved with puberty
Medical conditions/treatments that can lead to hypogonadism
Conditions: - Hypothyroidism - Diabetes Mellitus - Cystic fibrosis Treatments: - Chemotherapy - Radiotherapy
Beside the psychosocial impact of delayed puberty, another risk is:
Inadequate skeletal growth and mineralisation
Treatment for delayed puberty depends on the cause, but the goal is:
Development of secondary sex characteristics and fertility
Bone growth and mineralisation
Precocious puberty:
Starting puberty before what is considered as normal.
Early onset puberty can cause initial growth spurt to cause tall stature, however:
Rapid bone maturation can cause linear growth spurt to cease too early, resulting in short adult stature.
Central or complete/true precocious puberty:
If the cause can be traced to the hypothalamus or pituitary gland.
Causes can include:
Damage to inhibitory mechanisms of the brain
Brain tumours
Secondary sex characteristics can be induced by exogenous sex steroids, this is referred to as:
Peripheral/pseudo precocious puberty.
Polycystic Ovarian Disease (PCOS)
Is a hormonal disorder common among women of reproductive age.
Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels.
The exact cause is unknown.
Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as T2DM and heart disease.
Signs and symptoms of PCOS
Vary, and a diagnosis is made if two of the following signs are present:
- Irregular periods. Infrequent, irregular or prolonged menstrual cycles.
- Excess androgen. Elevated levels of male hormone may result in physical signs like male-pattern baldness, excess body/facial hair, severe acne.
- Polycystic ovaries. Enlarged, containing follicles that surround the ovaries and turn into multiple cysts and fail to release eggs.
Although the exact cause is unknown, some causes may be:
- Excess insulin might increase androgen production, causing difficulty with ovulation.
- Low grade inflammation
(Research has shown women with PCOS have low-grade inflammation that stimulates polycystic ovaries to produce androgens. Can lead to heart and blood vessel problems. - Hereditary
- Excess androgens
Complications:
Infertility Gestational diabetes Miscarriage or premature birth Metabolic syndrome T2DM Sleep apnoea Depression/anxiety Endometrial cancer Abnormal uterine bleeding
Endometrial/uterine polyps
Growths attached to the inner wall of the uterus that extend into the uterine cavity or overgrowth of cells in the lining of the endometrium.
Not usually cancerous although can be
Most common in post-menopausal women.
S&S = irregular menstrual bleeding.
Endometriosis:
A disease of reproductive aged women characterised by the presence of endometrial tissue outside the uterine cavity and commonly associated with pelvic pain and infertility.
Aetiology:
No definitive aetiology but several hypothesis regarding how endometriotic lesions occur.
1 being retrograde menstruation, however, this is more common can endometriosis so other factors may determine is. (hormonal, inflammatory and immunologic)
Presentation:
Varies between women and can result in inter-menstrual bleeding, painful periods, painful intercourse, painful defecation and painful urination.
Diagnosis:
Only possible with laparoscopy
Management:
Primary:
Surgically remove lesions
NSAIDS
Low-dose oral contraceptive
Secondary: (if primary doesn’t work within 3 months)
GnRH or androgens to reduce pain from severe to moderate
Endometritis:
An acute inflammation of the uterine lining that is normally due to an infection as a result of a PID, STI’s, retained products.
If untreated, can lead to infertility.
Signs and symptoms:
Fever
Purulent vaginal discharge
Lower abdominal pain
treated with antibiotics
Cervical cancer:
Growth of abnormal cells in the lining of the cervix, most commonly squamous cell carcinoma (80%)
73% 5 year survival rate
Most common signs:
Heavier menstrual bleeding Bleeding between periods Excessive tiredness Unusual vaginal discharge Leg pain, swelling, low back pain
Causes:
Almost all cases are caused by persistent infection with some high risk types of Human Papilloma Virus (HPV) (biggest risk factor whereby 8/10 women will become infected with at some time in their lives.)
Vaginal cancer:
Cancer that starts in the vagina and should not be confused with cancer that spreads to the vagina.
One of the rarest forms of cancer affecting female reproductive system.
Signs:
Align with cervical cancer signs but may include a lump in the vagina.
Risk factors:
A precancerous condition known as ‘vaginal intraepithelial neoplasia (VIN) that often has no symptoms.
HPV
STI’s can lead to development of VIN
Tobacco smoking doubles risk of vaginal cancer.
Vulvar cancer:
External female genitals, most commonly the labia minora, majora and perineum.
Symptoms:
Itching, burning, soreness of vulva.
Lump, swelling or wart-like growth
Thickened, raised skin patches
Risk factors:
VIN and HPV
HIV
Organ transplant
Treated with surgery then radiation
Uterine/endometrial cancer:
Endometrial cancers begin in the lining of the uterus and account for 75% of all cases.
Uterine sarcoma’s development in the myometrium and is rarer.
Most common gynaecological cancer in Australia
Risk factors:
Postmenopausal Endometrial hyperplasia Never having children Family Hx Taking tamoxifen to treat breast cancer
Most common treatment:
Hysterectomy, chemotherapy and radiation
Urinary tract infection (UTI)
Usually caused by bacteria and affects part of the urinary system (kidneys, bladder, ureters and the urethra)
Treatment includes antibiotics.
Utero vaginal prolapse
Lump the size of a small egg protruding from vagina.
Management of prolapse:
Depends on the degree, however, topical oestrogen cream can decrease discomfort
Some patients can use a ring pessary
