gynaecology Flashcards
1
Q
In patients with hypothalamic-pituitary dysfunction, what is the typical pattern of FSH and LH?
A
FSH low, LH low
2
Q
Hyperprolactinemia caused by a pituitary adenoma is frequently associated with amenorrhea and what other symptom?
A
Galactorrhoea
3
Q
What measurement can help differentiate hypothalamic-pituitary amenorrhea from ovarian failure?
A
FSH raised with ovarian failure, low with HPO
4
Q
Primary amenorrhea is defined as the absence of menstruation after what age (with normal secondary sex characteristics)?
A
16
5
Q
Primary amenorrhea is defined as the absence of menstruation after what age (with no secondary sex characteristics)?
A
14
6
Q
In a person with primary amenorrhea and anosmia and low GnRH, LH, FSH, oestradiol, what is the most likely diagnosis?
A
Kellmann Syndrome
7
Q
What is the incidence of Kellman syndrome?
A
1/50000
8
Q
In secondary amenorrhea what test should be done first?
A
Pregnancy test
9
Q
What are the two differential diagnoses for secondary amenorrhea and raised FSH/LH in a 30 year old woman, assuming pregnancy has been excluded?
A
POI and Turners/Sawyers
10
Q
What are the features and karyotype of turners syndrome (non-mosaic)?
A
45 XO, short stature
primary or secondary amenorrhea
absent or reduced secondary sex characteristics, webbed neck
short 4th metacarpals
renal and cardiac abnormalities (coactation of aorta, horseshoe kidney)
11
Q
What are the karyotypes seen in turners mosaics?
A
45x: 46xx, 45xo; 46xy
12
Q
In turners syndrome why are streak ovaries removed surgically?
A
Risk of malignant transformation
13
Q
What therapy should be given to people with turners syndrome?
A
2 years oestrogen to achieve normal growth and development.
After 2 years 10 days of progestin each month should be added to induce a withdrawal bleeds and protect the endometrium
14
Q
Which dopamine agonist is safe in pregnancy (in the context of treating pituitary adenoma)?
A
Bromocriptine. Bromocriptine and cabergoline appear to be safe during pregnancy however bromocriptine is the most ‘tried and tested’ in this scenario.
15
Q
What % of women are able to achieve a pregnancy on dopamine agonists (assuming no other fertility problems)?
A
80%
16
Q
What % ovarian tumours (malignant and benign) are epithelial in origin?
A
70%
17
Q
What is a Brenner Tumour (transitional cell)?
A
Benign formed of bladder like cells, coffee bean nuclei, rarely transforms to squamous cell carcinoma.
18
Q
In which type of ovarian tumour are coffee bean nuclei seen?
A
Brenner Tumour (transitional cell).
19
Q
Which type of ovarian tumour are psammoma bodies seen on histology?
A
Serous cystadenoma
20
Q
Which type of ovarian tumour are pseudomyxoma peritoni seen?
A
Mucinous cyst adenoma
21
Q
Bilateral ovarian tumours are most commonly associated with which type?
A
Serous epithelial
22
Q
% bilateral mature cystic teratoma?
A
10%
23
Q
A 20 yo woman with an ovarian mass on ultrasound in keeping wither a teratoma presents with palpitations, anxiety, exopthalmous and weight loss, but has a normal thyroid examination, what is the name of the ovarian mass associated with this clinical picture?
A
Stuma ovari
24
Q
What age group to immature teratoma normally affect?
A
<20s (malignant and aggressive)
25
Raised LDH is seen in which type of ovarian tumour?
Dysgerminoma
26
What histology is seen with a dysgerminoma?
Fried egg cells, large central nuclei with lots of cytoplasm.
27
Raised bHCG is seen with which type of ovarian tumour?
Choriocarcinoma
28
Raised AFP is seen with which type of ovarian tumour?
Yolk sac (endodermal sinus) tumour
29
What histology is seen with Yolk sac (endodermal sinus) tumours?
Schiller Duval bodies
30
Name 4 types of sex cord-stroma ovarian tumours?
Granulosa, theca cell, Sertoli-leydig, fibroma
31
Ovarian fibroma is associated with which syndrome?
Miegs (ascites and hydrophroax)
32
Reinke crystals are seen in which type of ovarian tumour?
Steroli-Leydig (pink rod like structures in cytoplasm
33
Which marker is raised in granulosa cell tumours?
Inhibin B
34
Granulosa cell tumours have which feature seen on histology?
Call-exner bodies (granulosa cells around eosinic fluid)
35
Thecoma tumours produce which marker?
Oestradiol
36
A 65 year old woman presents with increased weight and irregular post menopausal bleeding. Bloods show a raised oestradiol level and ultrasound shows a complex ovarian mass. Which type of ovarian tumour is this likely to be?
Thecoma (theca cell)
37
A 30 year old woman presents with rapid increase in acne and a deepening over her voice. Bloods show a raised testosterone and ultrasound an ovarian mass, which type of ovarian tumour is this likely to be?
Sertoli-Leydig (usually benign, can be hormonally active)
38
If signet cell rings are seen on histology of an ovarian mass which type of ovarian tumour is this likely to be?
Krukenberg (GI malignancy, metastasis to ovaries, usually bilateral)
39
Risk factors for ovarian cancer?
No pregnancies, infertility, early menarche, late menopause, endometriosis, PCOS, smoking. (reduced cycle # = protective)
40
Investigations for suspected ovarian cancer?
TV USS, bloods (LDH, bHCG, AFP, inhibin B, ca125), MRI to clarify/plan surgery, CT if staging, histology only way to dx completely.
41
A pregnant woman is found to have bilateral ovarian cysts on her dating USS, which ovarian tumours are these likely to be?
Theca-lutein
42
A 35 year old woman has an ultrasound for non-visible threads for her IUD. A 32x33x34mm simple cyst is seen on the right ovary, the scan is otherwise normal and the IUD correctly sited, and she is usually fit an well. What follow up does the she need?
<5cm, no further USS required, usually functional in nature (previous guidelines said <3cm reassure and NFA).
43
A 35 year old woman has an ultrasound for non-visible threads for her IUD. A 50x60x55mm simple cyst is seen on the right ovary, the scan is otherwise normal and the IUD correctly sited, and she is usually fit an well. What follow up does she need?
Rescan 12/52
44
A 35 year old woman has an ultrasound for non-visible threads for her IUD. A 50x60x55mm simple cyst is seen on the right ovary, the scan is otherwise normal and the IUD correctly sited, and she is usually fit an well. She was reassured and given a repeat uss 3/12 later the cyst measures 55x60x60mm and remains simple, she is asymptomatic. What investigations, if any would you do?
Ca125.
45
A 35 year old woman has an ultrasound for non-visible threads for her IUD. A 50x60x55mm simple cyst is seen on the right ovary, the scan is otherwise normal and the IUD correctly sited, and she is usually fit an well. She was reassured and given a repeat uss 3/12 later the cyst measures 55x60x60mm and remains simple, she is asymptomatic.Ca125 is 20. What follow up if any does she require?
Surgical options should be discussed as increasing in size and at risk of torsion.
46
A 35 year old woman has an ultrasound for non-visible threads for her IUD. A 50x60x55mm simple cyst is seen on the right ovary, the scan is otherwise normal and the IUD correctly sited, and she is usually fit an well. She was reassured and given a repeat uss 3/12 later the cyst measures 50x60x55mm and remains simple. Does she need any further investigations?
Ca125
47
A 27 year old woman has an ultrasound for non-visible threads for her IUD. A 50x60x55mm simple cyst is seen on the right ovary, the scan is otherwise normal and the IUD correctly sited, and she is usually fit an well. She was reassured and given a repeat uss 3/12 later the cyst measures 50x60x55mm and remains simple. Ca125 is 20. Does she require any further follow up?
Annual USS.
48
A 36 year old woman has an ultrasound for non-visible threads for her IUD. A 50x60x55mm simple cyst is seen on the right ovary, the scan is otherwise normal and the IUD correctly sited, and she is usually fit an well. She was reassured and given a repeat uss 3/12 later the cyst measures 55x60x60mm and remains simple, she is asymptomatic. Ca125 is 41. What follow up if any does she require?
2WW gynae referral.
49
A 35 year old woman has an ultrasound for non-visible threads for her IUD. A 50x60x55mm simple cyst is seen on the right ovary, the scan is otherwise normal and the IUD correctly sited, and she is usually fit and well. She was reassured and given a repeat uss 3/12 later the cyst measures 55x60x60mm and has become multilocular, she is asymptomatic. Ca125 is 36. What follow up if any does she require?
2ww gynae referral (raised C125, size and complex features on uss)
50
A 38 year old woman has an ultrasound for non-visible threads for her IUD. A 50x80x72mm simple cyst is seen on the right ovary, the scan is otherwise normal and the IUD correctly sited, and she is usually fit an well. What follow up if any does she require?
Ca125, if normal routine gynae referral ?surgery as risk of torsion. Ca125 raised 2ww gynae referral.
51
A 23 year old with history of HMB and dysmenorrhea with perimenstrual dyscexia and urinary symptoms. She is overwise fit and well, menarche was aged 12, periods are regular and 7/28. They have gradually become more painful over time. You suspect endometriosis and discuss her management options, what are her management options?
Information giving, hormonal management (CHC if not contraindicated, progestin only treatment otherwise or IUS), analgesia (NSAIDs best evidence), ultrasound to assess for other causes of pelvic pain and to look for endometriosis, diagnostic laparoscopy +/- treatment to endometriosis if found.
52
A 23 year old with history of HMB and dysmenorrhea with perimenstrual dyscexia and urinary symptoms. She is overwise fit and well, menarche was aged 12, periods are regular and 7/28. They have gradually become more painful over time. You suspect endometriosis and discuss her management options and she elects for CHC, you request an ultrasound and list her for diagnostic laparoscopy +/- treatment to endometriosis if found. USS returns with a 2x3x2cm ground glass ovarian mass, in keeping with endometrioma, and Ca125 is normal, what follow up is required of the endometrioma?
>3cm repeat USS 12/12, if unchanged no further f/u, if increasing in size refer to gynae to consider surgery.
53
23 year old with history of HMB and dysmenorrhea with perimenstrual dyscexia and urinary symptoms. She is overwise fit and well, menarche was aged 12, periods are regular and 7/28. They have gradually become more painful over time. You suspect endometriosis and discuss her management options and she elects for CHC, you request an ultrasound and list her for diagnostic laparoscopy +/- treatment to endometriosis if found. USS returns with a 50x52x40mm ground glass ovarian mass, in keeping with endometrioma, and Ca125 is normal, what follow up is required of the endometrioma?
Refer to gynae to consider surgery. Risk of torsion and growth, impact on fertility
54
A 23 year old with history of HMB and dysmenorrhea with perimenstrual dyscexia and urinary symptoms. She is overwise fit and well, menarche was aged 12, periods are regular and 7/28. They have gradually become more painful over time. You suspect endometriosis and discuss her management options and she elects for CHC, you request an ultrasound and list her for diagnostic laparoscopy +/- treatment to endometriosis if found. USS returns with a 2x2x2cm ground glass ovarian mass, in keeping with endometrioma, and Ca125 is normal, what follow up is required of the endometrioma?
Reassurance <3cm
| Some schools of though suggest annual surveillance as may grow by 1cm/year esp if not on progestins
55
A 45 presents with bloating, tiredness and feeling of early satiety, she is normally fit and well. Her GP investigated with routine bloods, and ultrasound. A multilocular cysts with 5 papilary structures and colour flow noted was found on the right adnexa. Her Ca125 is 55.
What is her RMI score?
RMI = menopausal state (1 for pre, 3 for post) x malignant features on USS x ca125 value. 55x1x2 = 110
56
What RMI figure should be referred to a secondary/tertiary centre for care?
>200
57
What is the 5 year survival rate for epitheial ovarian tumours at stage 1/2/3/4?
```
1= 80-90%
2 = 70%
3 = 40%
4 = 17%
```
58
BRCA 1 carriers have what % risk of ovarian cancer by age 85?
40-60%
59
BRCA 2 carriers have what % risk of ovarian cancer by late age?
16-27%
60
What measure to detect and prevent ovarian cancer are recommended for BRCA carriers?
6/12 USS and ca125 until BSO once family complete.
61
BRCA is found on which chromosome?
17
62
A 69 year old woman has an episode of PMB, her GP requests an ultrasound to assess, the endometrial thickness is 2mm and she is reassured and advised to report any further bleeding to her GP, however on the USS a 9x8x7mm simple cyst was noted on the left ovary. What follow up is needed?
Nil <1cm.
63
A 69 year old woman has an episode of PMB, her GP requests an ultrasound to assess, the endometrial thickness is 2mm and she is reassured and advised to report any further bleeding to her GP, however on the USS a 15x20x20mm simple cyst was noted on the left ovary. What follow up is needed?
Ca125, if raised 2WW referral, if normal 6/12 USS and Ca125.
64
A 69 year old woman has an episode of PMB, her GP requests an ultrasound to assess, the endometrial thickness is 2mm and she is reassured and advised to report any further bleeding to her GP, however on the USS a 15x20x20mm simple cyst was noted on the left ovary, ca125 was 20 and a repeat USS was organised for 6/12, it shows a 15x20x20mm simple cyst. She is asymptomatic.
What follow up is needed?
Ca125 now and again 6/12 ca125 and USS (total 1 year surveillance) then discharge if no change and ca125 normal.
65
A 69 year old woman has an episode of PMB, her GP requests an ultrasound to assess, the endometrial thickness is 2mm and she is reassured and advised to report any further bleeding to her GP, however on the USS a 15x20x20mm simple cyst was noted on the left ovary, ca125 was 41. She is asymptomatic. What follow up is needed?
Urgent gynae referral from community care.
In gynae….RMI is 123, the cyst is small with IOTA benign so repeat uss and ca125 4-6/12.
Resolved - discharge
Unchanged - uss and ca125 4-6/12 and if still unchanged discharge.
Increased size/complexity - intervention.
66
A 69 year old woman has an episode of PMB, her GP requests an ultrasound to assess, the endometrial thickness is 2mm and she is reassured and advised to report any further bleeding to her GP, however on the USS a 15x20x20mm simple cyst was noted on the left ovary, ca125 was 20 and a repeat USS was organised for 6/12, it shows a 25x20x20mm simple cyst, repeat ca125 is 25. She is asymptomatic. What follow up is needed?
Routine gynae o/p to discuss surgery
67
A 69 year old woman has an episode of PMB, her GP requests an ultrasound to assess, the endometrial thickness is 2mm and she is reassured and advised to report any further bleeding to her GP, however on the USS a 15x20x20mm simple cyst was noted on the left ovary, ca125 was 20 and a repeat USS was organised for 6/12, it shows a 25x20x20mm simple cyst, repeat ca125 is 38. What follow up is needed?
2WW referral.
| In gynae; increased size and ca125 - consider intervention
68
A 69 year old woman has an episode of PMB, her GP requests an ultrasound to assess, the endometrial thickness is 2mm and she is reassured and advised to report any further bleeding to her GP, however on the USS a 15x20x20mm simple cyst was noted on the left ovary, ca125 was 41. What follow up is needed?
2W referral.
69
A 69 year old woman has an episode of PMB, her GP requests an ultrasound to assess, the endometrial thickness is 2mm and she is reassured and advised to report any further bleeding to her GP, however on the USS a multilocular cyst on the right ovary measuring 50x20x65 mm, ca125 is 20, what follow up is needed?
2ww gynae
Tumour markers
Gynae oncology MDT
70
A 69 year old woman has an episode of PMB, her GP requests an ultrasound to assess, the endometrial thickness is 2mm and she is reassured and advised to report any further bleeding to her GP, however on the USS a multilocular cyst on the right ovary, ca125 is 50, what follow up is needed?
2WW referral.
71
A 69 year old woman has an episode of PMB, her GP requests an ultrasound to assess, the endometrial thickness is 2mm and she is reassured and advised to report any further bleeding to her GP, however on the USS multilocular left ovarian mass, with colour flow and solid components, what follow up is needed?
2WW referral and ca125, LDH, AFP, HCG
72
What stage is considered advanced disease in ovarian cancer?
>1c
73
What % of cervical cancer has high risk HPV DNA present?
99.7%
74
Which types of HPV are associated with 70% of cervical cancer?
16&18
75
What is the dose schedule for HPV vaccine in >15yo?
3 doses
| 0/1/4-6 months, ideally within 12/12 but don’t restart if longer.
76
What is the dose schedule for HPV vaccine in <15yo?
2 doses 6-24/12 apart.
77
When should a 60 year old return for her next routine cervical screening?
5years (this will be her final one)
78
At what age does cervical screening interval move from being 3 yearly to 5 yearly?
50
79
What % of cervical screening are HPV -ve?
87%
80
If a cervical screening returns high risk HPV +ve and the cytology is negative what will follow up be?
smear 12/12
9/100 smears
(persistent HPV on 2nd smear refer colp)
81
If a cervical screening returns high risk HPV +ve and the cytology is positive what will follow up be?
Colp
| 4/100 smears.
82
Follow up after colp?
2 x yearly smears.
83
How many turns of the cytobrush are you meant to do in a routine smear?
5 x clockwise turns.
84
Risk factors for cervical cancer?
Smoking, multiple partners, young age first sex, low socioeconomic group, CHC, HIV/immunosuppressed, not attending screening.
85
How long after delivery does a woman need to wait to attend her smear?
12 weeks
86
CIN 1 treatment?
6/12 colp and watchful waiting
87
CIN 2 treatment?
LETTZ & 6/12 colp
88
CIN 3 treatment?
LETTZ & 6/12 colp
89
Stage 1a2 treatment (cx cancer)?
hysterectomy and lymph node biopsy
90
Stage 0 & 1a1 treatment (cx cancer)?
cone biopsy/LETTZ
91
Stage 1b1- 2a treatment (cx cancer)?
Radical hysterectomy and lymph nodes and radiotherapy
92
Stage 2b+ treatment (cx cancer)?
Inoperable palliative therapies (chemo/radio)
93
Causes of AUB?
```
Structural PALM (polyp, adenomyosis, leiomyoma, malignancy)
non-structural COIEN coagulopathy, ovulatory disorder, iatrogenic, endometrial, not classified.
```
94
Causes of ovulatory disorders leading to AUB?
PCOS, thyroid function, congenital adrenal hyperplasia, raised prolactin, cushings
95
Define IMB?
Bleeding between clearly defined cycles
96
Define PCB?
Bleeding during or after sex
97
How long is chronic in the context of AUB?
6/12
98
Define PMB?
PVB >12/12 after the LMP if over 50 24/12 if under 50.
99
Volume of blood loss considered excessive?
>80ml in reality it’s if the patient says it’s excessive.
100
Evaluation of HMB and initial mx?
Hx and examination, exclude pregnancy, FBC/TFTs, STI screen, smears up to date. If all NAD reasonable to try medical therapy 3-6/12, if fails USS, if USS NAD 2nd line medical therapy, if fails ablation or hysterectomy.
101
1st line medical therapy for HMB if no pathology suspected or USS NAD?
Enquire about family plans, if wishing to conceive no hormones - TXA/NSAIDS, otherwise IUS or oral progestins either contraception or not depending on need or CHC.
102
Evaluation of IMB and initial mx?
Hx and examination, exclude pregnancy, FBC/TFTs, STI screen, smears up to date, USS, endometrial biopsy if risks for endometrial hyperplasia.
Treat according to cause, if all Ix NAD reasonable to try medical therapy 3-6/12,
if fails USS, if USS NAD 2nd line medical therapy,
if fails hysteroscopy and consider ablation or hysterectomy. Enquire about family plans, if wishing to conceive no hormones
103
Treatment of endometrial polyp?
Hysteroscopic polypectomy or conservative mx
104
Reasons to Hysteroscopic polypectomy?
>1cm, symptomatic, post menopausal (increased risk of malignancy)
105
Causes of PMB?
```
Atrophic vaginitis 60-80%,
Trauma (eg pessary),
HRT,
endometrial polyp,
hyperplasia 5-10%,
endometrial carcinoma 10%,
rarely oestrogen secreting tumours (theca cell/granulosa cell)
```
106
Risk factors for endometrial carcinoma?
>45 yo, obesity, nullip, unopposed oestreogen, tamoxifen, PCOS (chronic anovulation), diabetes, family hx.
107
Risk of malignancy for endometrial hyperplasia without atypia?
<5%
108
Risk of malignancy for endometrial hyperplasia with atypia?
Simple 10-25%, complex 30-50%
109
Histological features of atypia?
hyperchromic enlarged nuclei, enlarged epithelial cells, increased nuclei to cytoplasm ratio
110
% regression of hyperplasia without atypia?
90%
111
Follow up for hyperplasia without atypia?
6 monthly EB x 2, if at high risk of hyperplasia or oral progestins (instead of IUS) should have annual EB.
112
Treatment of endometrial hyperplasia with atypia?
Hysterectomy (BSO if peri/post menopausal, otherwise consider ovarian preservation vs ovarian cancer risk)
113
Follow up of endometrial hyperplasia with atypia NOT having hysterectomy?
3/12 EB until 2 x negative then 6-12/12 EB until hysterectomy.
114
Follow up of endometrial polyp with atypia on histology?
Hysteroscopy and EB.
115
75% of endometrial carcinoma are which type?
Endometrioid adenocarcinoma
116
Practical classification of endometrial carcinoma is what?
Type 1 and Type 2
117
Type 1 endometrial carcinoma features?
80-90% all cases, low grade, hormone driven, good prognosis, peri/post menopausal, endometrioid adenocardcinoma.
118
Type 2 endometrial carcinoma features?
10-20% of all cases, clear cell or uterine papillaryserous, older women, high grade, poorer prognosis.
119
Treatment options for recurrence of endometrial cancer?
if not had radiotherapy, use it, otherwise surgery.
120
Most recurrences of endometrial carcinoma happen in what timeframe?
<36/12
121
Stage 1 endometrial carcinoma where?
Confined to uterine body/fundus
122
Location of stage 2 endometrial carcinoma?
Cervix
123
Location of stage 3a/b endometrial carcinoma?
3a ovary, 3b vaginal, 3c lymph node
124
Location of stage 4a/b endometrial carcinoma?
4a bladder/bowel, 4b liver.
125
If a patient with endometrial carcinoma is unfit for surgery what treatment options are there?
Radiotherapy – 50-60% 5 year survival
| Hormonal treatment with progestins not proven but ~20% response
126
Causes of HMB?
20-30% fibroid, Polyp 5-10%, adenomyosis 5%, endometriosis 5%
127
Risk factors for fibroids?
Afro Caribbean, increasing age
128
Types of fibroid and FIGO classification?
```
Pedunculated submucosal (grade 0),
submucosal (grade 1 >50% submucosal, grade 2 <50% submucosal), intramural (grade 3/4),
subserosal (grade 6)
pedunculated subserosal (grade 7),
other eg cervical (grade 8)
```
129
How much do fibroids grown per year on average?
1cm
130
Treatment options for fibroids?
Depends on size, number and fertility plans, and symptoms. <3cm hormones. >3cm hormones but more likely to need procedural management.
131
Complications of fibroids?
```
Calcification
hyaline degradation (painful/enlarged)
red degradation (in pregnancy necrosis)
infection (abscess)
sarcomatous change (0.2% risk)
Torsion of pedunculated fibroids
prolapse of cervical fibroids.
```
132
Medical treatment options for fibroids?
Progestins (IUS/oral/ CHC), TXA/NSAIDS (won’t prevent growth), GnRH analogues, myomectomy, hysterectomy
133
2nd line treatment of fibroids?
Hysteroscopic myomectomy +/- endometrial ablation +/- IUS.
134
3rd line treatment of fibroids if wishing to preserve fertility?
Uterine artery embolization (70-90% improvement in symptoms, 20-30% retreatment needed) or abdominal myomectomy (80% improvement, 20% need further treatment in 2-5 years)
135
Miscarriage risk with uterine artery embolization?
7 x baseline
136
2nd/3rd line treatment of fibroids if family complete?
Hysterectomy +/- BSO.
137
Ulipristal acetate is a pharmacological option for the treatment of fibroids?
No, licence withdrawn following liver injury.
138
What pharmacological treatment should be consider before Hysterectomy +/- BSO for fibroids?
3-4/12 GnRH analogues (60% volume reduction)
139
What changes to the endometrium can tamoxifen cause?
Subendometrial cysts – look identical to endometrial ca on scan.
140
PVB on tamoxifen warrants what management?
EB and USS (ideally hysteroscopy too)
141
Mechanism of action of tamoxifen?
Selective oestrogen receptor modulator (antioestrogenic in the breast, but oestrogenic in the endometrium)
142
Tamoxifen effect on endometrial cancer risk?
Doubles risk
143
Features of primary dysmenorrhea?
Within 6-12 of menarche, 24-72hrs pain at onset of bleeding (not before), effects 90% teens (15% severe enough to miss school)
144
Treatment options for primary dysmenorrhea?
Lifestyle – exercise/stop smoking, tens machine, NSAIDs, weak opioids, hormones! – CHC/POP/IUS/Depo/NET or provera.
145
How long does primary dysmenorrhea take to resolve typically?
<2 years
146
Menorrhagia in adolescents – spontaneous remission%?
90%
147
Ix for menorrhagia?
FBC/TFTs, in teens 20% will have underlying coagulopathy (if fhx or hx of bruising and bleeding consider screening), STI screen, consider USS and hormone profile if persists.
148
% women of reproductive age with endometriosis?
10%
149
Average time to diagnosis with endometriosis?
7 years
150
Infertility % for women with endometriosis?
30-50%
151
Having a first degree female relative with endometriosis increased risk by what factor?
X6
152
Symptoms of endometriosis?
Dysmenorrhea, dyspareunia, cyclical abdo pain, changes to bowel/bladder around period, infertility
153
% women with endometriosis who have an endometrioma?
20-40%
154
Endometriosis is associated with increased risk of what cancer?
Clear cell, low grade serious and endometroid invasive ovarian cancer.
155
Medical treatment options for endometriosis?
Info, analgesia, hormones (CHC/POP/Depo/IUS), GnRH analogues 3/12 then add back if for longer.
156
Surgical tx for endometriosis?
Laparoscopy and to endo, hysterectomy and BSO, with HRT, removal of endometrioma.
157
What is adenomyosis?
Deposits of endometrium within the myometrium (same sx, ix and tx as endo).
158
Prevalence of PCOS in uk?
5-15%
159
Polycystic ovaries are seen on USS in as may as what % women?
33% but PCO is not diagnostic without the hyperandrogenism/oligo or amenorrhea.
160
Risks in pregnancy of PCOS?
Gestational diabetes, preterm birth, pre-eclampsia
161
% risk of multiple pregnancy with clomifene?
11%
162
PCOS management?
Lifestyle – weight optimisation, 3-4 withdrawal bleeds/year if oligo/amenorrhea. If risk factors for diabetes or >40yo oral glucose tolerance test (if impaired should be annual repeat), metformin limited evidence good for weight loss, helps fertility (use contraception if not planning)
163
What % of women with PCOS have fertility problems?
75%
164
A woman presents with vulval pain, for a few months. She has a low risk sexual hx and is sterilised. On examination she has several a well demarcated areas that are raised and slightly purple. She also has irritation in her mouth and you see white lacey patches in the oral cavity.
What is the likely dx and what at the mouth lesions called
Lichen planus
| Wickham striae
165
A woman 60 presents with vulval itch, for a few months. She has a low risk sexual hx and is sterilised. On examination she has loss of pigmentation of the clitoris and vulva, extending to the anus. The clitoris is flattened. What is the likely diagnosis?
Lichen sclerosis
166
management of lichen sclerosis
Emollitions and clobetasol, daily for a month, then alturnate das for a months, then 2 x weekly, r/v after 3/12, if not improved refer to vulval clinic/biopsy. If improved annual f/u in primary care.
167
malignant transformation of lichen sclerosis
upto 5% risk of malignant transformation
168
Features of lichen planus on vulva
purple polygonal papules or erosive, can extend into vestibule/vaginal.
Wickham striae
169
A woman presents with vulval itch, she is 32yo, using pop for contraception and has a RMP for 5 years. She is fit and well but suffers with OCD and anxiety. No allergies or skin conditions.
On examination you find a thickened labia majora and signs of excoriation what is the likely diagnosis
lichen simplex
170
Treatment of lichen simplex
Info, break itch/scratch cycle
| Emollients and steroids.
171
What is the peak age for VIN
35-49yo
| Smokers and immunosuppressed = risk factors.
