Gynaecology Flashcards
Symptoms of uterine fibroids?
Asymptomatic
- Menorrhagia
- Lower abdominal pain (cramps or pressure) or dysmenorrhea
- Urinary changes - increased frequency
- Subfertility
- Bloating
Investigations for uterine fibroids
Transvaginal & transabdominal Ultrasound
Management of uterine fibroids?
symptomatic (1+2, 1) & surgical (4)
Symptomatic - levonorgestrel releasing IUS +- COCP and tranexamic acid
GnRH agonist can reduce size short term
Surgical management = myomectomy, uterine artery embolization, endometrial ablation, hysterectomy
Risk factors for uterine fibroids?
- Afrocarribean women,
- Older age
- Obesity
- Early menstruation
- Family history
Complications of uterine fibroids?
- Compression of adjacent organs - pain, constipation, urine changes (freq and retention) and hydronephrosis
- Infertility
- Complicates pregnancy: malpresentation, pre-term, miscarriage, pain
- Torsion of a pedunculated fibroid
- Haemorrhage
Investigations for endometrial cancer?
Transvaginal Ultrasound and if more than 4mm thickness, do pipelle biopsy (best) or during hysteroscopy
Management for endometrial cancer?
Total abdominal hysterectomy with bilateral salpingo-oophorectomy.
Risk factors for endometrial cancer? [10]
Oestrogen exposure so:
- early menarche & late menopause & nulliparity
- Older
- Tamoxifen or HRT
- T2DM + obesity
- Polycystic ovarian syndrome (PCOS)
- Granulosa-theca tumour (@ kids)
Differentials for menorrhagia? [9]
- Dysfunctional uterine bleeding or anovulatory cycle
- Endometrial polyps, hyperplasia or cancer.
- Fibroids & adenomyosis
- Normal copper coils
- Hypothyroidism
- Clotting abnormalities (warfarin, Von Willebrand)
- Pelvic inflammatory disease
Investigations for heavy bleeding?
Bedsides: Obs, abdominal and vaginal examination
Bloods: FBC (anaemia), coag studies, TFTs
Imaging: transabdominal/vaginal ultrasound or hysteroscopy
Management for heavy bleeding? (standard)
Levonorgestrel IUS then:
Hormonal: COCP or POPs (norethisterone) GnRH analogues (buserelin or leprorelin)
Non-hormonal: Tranexamic Acid or NSAIDs (mefenamic acid, ibuprofen or naproxen)
Surgical: Endometrial ablation –> hysterectomy
How does NSAID [1] and Tranexamic Acid work [1] ?
NSAID: inhibits prostaglandin
T.Acid: inhibits fibrinolysis
What is Meig’s Syndrome?
Fibroma (benign ovarian tumour) w ascites and pleural effusion.
Commonest type of ovarian cyst?
Follicular Cyst
Cyst associated w intraperitoneal bleeding?
Corpus luteum cyst
Most common cyst in women under 30?
Dermoid cyst (teratoma)
If a woman is fat and has PCOS what management could u offer to help w infertility?
Weight loss first then clomifene with or without metformin
Causes of intertility by groups?
1) Anovulation: PCOS, Ovarian Failure, Hyperprolactinaemia, thyroid dysfunction, hypothalamic hypogonadism
2) Male factor: idiopathic, varicocele, antibodies …
3) Tubal factors: endometriosis, infection, surgery
4) Others: fibroid
Investigations to check infertility:
Bloods: Serum progestogen (for ovulation), FSH & LH, TSH, testosterone and prolactin
Others: Laparoscopy and dye, hysterosalpingogram.
Features of PCOS?
Infertility problems Amenorrhoea or oligomenorrhoea Hirsutism and acne (due to androgens) Obesity Acanthosis Nigricans (due to insulin resistance)
Investigations for PCOS?
- Raised LH:FSH ratio
- Normal/Raised prolactin
- Normal/Raised testosterone
Imaging: pelvic ultrasound (multiple cyst on ovaries)
What are the managements for these causes of infertility?
a) PCOS
b) Hyperprolactinaemia
c) Hypogonadism
d) Tubal problems
e) Male factor
a) PCOS - Weight loss, Clomifene (1st) and Metformin. Maybe gonadotrophin.
b) Hyperprolactinaemia: bromocriptine or cabergoline
c) Hypogonadism: restore weight then gonadotrophin
d) Tubal: Laparoscopic surgery if endometriosis, IVF if severe.
e) Male: intrauterine insemination, IVF with or without sperm injection, donor insemination
