Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSRA Content > Gynaecology Conditions 1 > Flashcards

Gynaecology Conditions 1 Flashcards

1
Q

Define abnormal uterine bleeding?

A

 Any bleeding that is either:
• Abnormal in volume (excessive duration or heavy)
• Irregularity, timing (delayed or frequently)
• Non-menstrual bleeding – IMB, PCB, PMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define amenorrhoea?

A

 Absence of menstruation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define primary amenorrhoea? When to suspect it?

A

 Failure to start menstruating
 Suspect and assess when girls have not established menstruation by age of 13 (if no secondary sexual characteristics) or 15 (if normal secondary sexual characteristics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of primary amenorrhoea?

A
  • Often due to late puberty (familial)
  • May be pregnant
  • Structural abnormalities of external/internal genitalia
  • Hypothalamic-Pituitary-Ovarian causes (common)
  • Hyperprolactinaemia
  • Ovarian causes:
  • Uterine causes:
  • Turner’s syndrome or androgen insensitivity syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What causes HPO problems in primary amenorrhoea?

A

o Stress, emotions, exams, increased exercise, weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of hyperprolactinaemia in primary amenorrhoea?

A

o May have galactorrhoea
o Thyroid problems
o Renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Causes of ovarian failure in primary amenorrhoea?

A

o PCOS

o Ovarian insufficiency/failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Causes of uterine causes of primary amenorrhoea?

A

o Pregnant
o Asherman’s syndrome (uterine adhesions after D&C)
o Post-pill amenorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define secondary amenorrhoea?

A

 Previous normal menstruation but stops for 3-6 months or more, 6-12 months in women with irregular periods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes of secondary amenorrhoea?

A
  • Physiological
  • Hypothalamic-Pituitary-Ovarian causes (common):
  • Hyperprolactinaemia
  • Ovarian causes:
  • Uterine causes:
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Physiological causes of secondary amenorrhoea?

A

o Pregnancy
o Menopause
o During lactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

HPO causes of secondary amenorrhoea?

A

o Stress, emotions, exams, professional athletes, increased exercise, weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hyperprolactinaemia causes of secondary amenorrhoea?

A

o May have galactorrhoea
o Thyroid problems
o Renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ovarian causes of secondary amenorrhoea?

A

o PCOS
o Ovarian insufficiency/failure
 Secondary to chemotherapy, radiotherapy or surgery
 Genetic disorders – Turner’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Uterine causes of secondary amenorrhoea?

A

o Asherman’s syndrome (uterine adhesions after D&C)

o Post-pill amenorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Tests in amenorrhoea?

A

 BhCG to exclude pregnancy
 Serum free androgen index (PCOS)
 FSH/LH (low if HP axis cause)
• If FSH>20IU/L – premature menopause – karyotyping
 Prolactin (Increased by stress, hypothyroidism, prolactinomas, metoclopramide)
• If >1000IU/L – MRI scan
 TFTs
 Testosterone levels
• >5nmol/L indicate androgen secreting tumour or late-onset CAH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment of amenorrhoea?

A

 Related to cause

 Refer to secondary care for specialist investigations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Treatment of amenorrhoea if mild HPO malformation?

A

o Medroxyprogesterone acetate (10mg/24h for 10 days) challenge will stimulate endometrium production and cause period
o Reassurance and diet advice, stress management
o Psychiatric help if depression indicated
o Still use contraception as ovulation may occur at any time
o Clomifene – restores period in mild cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Treatment of amenorrhoea if shut-down HPO malformation?

A

o Stimulation by gonadotrophin-releasing hormone (goserelin)
o Used in specialist fertility clinics only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Treatment of amenorrhoea if premature ovarian failure?

A

 Premature ovarian failure needs HRT and pregnancy can be achieved using IVF or oocyte donation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Complications of amenorrhoea?

A 
	Osteoporosis
•	May need Vit D and Ca supplements
•	Offer HRT or COCP if needed
	CVD
	Infertility
	Psychological stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Define olgimenorrhoea? Most common cause?

A

o Menses occurring less frequently than every 35 days
o More common in extremes of reproductive life
o Common cause is PCOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Define menorrhagia? How common?

A

o Excessive menstrual blood loss which interferes with QoL, social or emotional life
o Defined as >80ml/cycle but impossible to measure
o 30% of women report heavy periods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Causes of menorrhagia?

A

 Dysfunctional uterine bleeding (DUB)
 Anovulatory cycles
 IUCD
 Pathological causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Dysfunction uterine bleeding causing menorrhagia?

A
  • No pathology, 40-60%

* Diagnosis of exclusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Anovulatory cycles causing menorrhagia?

A

• Extreme reproductive life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Pathological reasons causing menorrhagia?

A

Polyp
Adenomyosis
Leiomyoma
Malignancy

Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not classified
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Iatrogenic reasons causing menorrhagia?

A

 IUCD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Key history pieces in menorrhagia history?

A

 Note cycle bleeding and length
• Heavy, prolonged vaginal bleeding
 Change in volume (clots, floods, etc)
 Worsening impact on life – school, work, home, sexual
 Enquire about other symptoms: premenstrual syndrome, IMB, PCB, dyspareunia, pelvic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Signs in menorrhagia?

A 
	Anaemia
	Abdomen exam
•	Masses
	Ensure smear up to date
	Inspect cervix and take swabs if needed
	If indicated bimanual examination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Investigations in menorrhagia?

A 
	Pregnancy test
	Bloods – FBC, (TFTs, clotting (if indicated))
	Smear if due & STI screen
	USS
	Hysteroscopy
	Endometrial sampling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When to refer to secondary care in menorrhagia? Investigations?

A

• Criteria
o Persistent IMB
o Symptoms failed to improve on medical management
o Women >45 with heavy bleeding, endometrial pathology
o Abnormal examination
o Risk factors for endometrial cancer
• TVUS and hysteroscopy if abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

1st line medical management of menorrhagia?

A

Mirena IUS
 Release levonorgestrel – leading to atrophy of endometrium
 Reduces bleeding and 30% amenorrhoeic at 12 months
 SE – irregular bleeding for 1st 4-6 months and progestogenic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

2nd line medical management of menorrhagia?

A

NSAIDs (mefenamic acid)
 Taken during days of bleeding

Tranexamic Acid
 Useful in those trying to conceive as non-hormonal
 CI – thromboembolic disease

COCP
 Effective but think CIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

3rd line medical management of menorrhagia?

A

Progestogens
 Medroxyprogesterone acetate (IM every 12 weeks)
 Norethiserone PO (Used short-term to stop heavy bleeding)

GnRH rarely used, only in secondary care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

When to use surgical management of menorrhagia?

A

2 drugs tried and failed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Surgical management of menorrhagia? When performed? SE?

A

Endometrial ablation
o 1st line, if uterus is <10 weeks of gestation on palpation
o Removing the full thickness of endometrium with superficial myometrium and basal glands using diathermy/thermal balloon
o Performed with hysteroscopy
o SE – bleeding, infection, uterine perforation, vaginal discharge, infertility
o Need contraception post-operation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Alternative surgical managements and when performed?

A

Uterine Artery Embolisation or Myomectomy
o If uterus is >10 weeks in size or fibrois >3cm, retain ferility

Hysterectomy
o Women not wishing to retain fertility, who have fibroids >3cm
o Vaginal hysterectomy preferred, may need abdominal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Define dysmenorrhoea? How common?

A

o Low anterior pelvic pain, occurring with periods

o 50% women complain of moderate pain, 12% of severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Pathology of dysmenorrhoea?

A

 Imbalance of prostaglandins and leukotrienes in menstrual fluid which produces vasoconstriction and uterine contractions
 May be responsible for diarrhoea, nausea and headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Description of primary dysmenorrhoea?

A
  • Pain without organ pathology
  • Often starts with onset of ovulatory cycles
  • Pain begins with period and last 2-3 days
42
Q

Description of secondary causes of dysmenorrhoea? What are they?

A 
•	Pelvic pathology
o	Years after onset of menstruation
o	Precede start of period by several days and may last throughout period
o	Associated dysparenunia
o	Caused by:
	Endometriosis
	PID
	Fibroids
	Adhesions
	IUCD
43
Q

Symptoms of dysmenorrhoea?

A

 Crampy pain with ache in groin or back
 Worse in first few days (primary)
 Constant through period (secondary), deep dysparenunia

44
Q

Investigations in dysmenorrhoea?

A

 Abdominal/Vaginal exam
 Speculum and may need swabs/smear if due
 If mass – pelvic USS

45
Q

General advice in dysmenorrhoea?

A
  • Stop smoking
  • TENS may help
  • Tea may help
  • Abdominal/back massage and lying down
46
Q

Pharmacological management in dysmenorrhoea?

A 
•	NSAIDs (mefenamic acid) during menstruation
•	Paracetamol
•	If not wanting to conceive:
o	COCP
o	POP
o	Depot medroxyprogesterone acetate
o	Mirena IUS
47
Q

Surgical management in dysmenorrhoea?

A

• If women completed family – hysterectomy in severe, refractory cases

48
Q

Define IMB?

A

o Vaginal bleeding (other than postcoital) at any time during menstrual cycle other than normal menstruation

49
Q

Causes of IMB?

A 
	Cervical polyps
	Ectropion
	Fibroids
	Carcinoma
	Cervicitis/Vaginitis
	IUCD
	Hormonal contraception
•	May get breakthrough bleeding when starting
	Chlamydia
	Pregnancy related
50
Q

Assessment of IMB?

A

o Symptom that needs further investigations
o Assessment
 Take menstrual, gynaecological, sexual history (obstetric if indicated)
 Abdominal and PV exam

51
Q

Investigations in IMB?

A 
	Exclude pregnancy and STIs
•	Pregnancy test
•	Infection screen (chlamydia and gonorrhoea)
	Smear if overdue
	Bloods
•	FBC, clotting, TFT, FSH/LH
	TVUS if structural abnormality thought of
	Biopsy
52
Q

Referral in IMB?

A

 Abnormal cervix (2 week wait)

 Cervical polyp, pelvic mass, high risk of endometrial cancer (FHx, prolonged cycles, tamoxifen), >45 with IMB

53
Q

Management of IMB?

A 
	Depends on cause
	If cancer suspected
•	Urgent referral for investigation
	Infection
•	Abx depending on disease and organism
•	Contact tracing and treatment of sexual partners
54
Q

Hormonal contraception changes in management of IMB?

A

• Common in 1st 3 months after starting contraception
• May need speculum examination if >3 months
o Women >45 need biopsy
• COCP
o Stick with pill for 3 months, use pill with dose of ethinylestradiol to provide cycle control
o Different COCP may be tried
• POP
o Different POP tired
• PO implants/depot/IUS
o First line – COCP for up to 3 months continuously or in usual cycle regimen – repeat as often as needed

55
Q

Management of cervical ectropions, polyps and fibroids in IMB?

A

 Cervical Ectropion’s
• May resolve if COCP stopped or following pregnancy
• Thermal cautery or silver nitrate if needed
 Cervical polyps
• Avulsed and sent for histology
 Fibroids
• Small removed hysterscopically
• Uterine artery embolization
• Large – drugs, vascular embolization or surgery

56
Q

Define PCB? How common?

A
  • Postcoital bleeding
    o Non-menstrual bleeding through vagina immediately after sexual intercourse
    o Around 5% women experience PCB
57
Q

Causes of PCB?

A 
	Infection
	Cervical ectropion
	Cervical/Endometrial polyps
	Vaginal/Cervical cancer
	Sexual abuse
	Atrophic change
58
Q

Assessment of PCB?

A

 Take menstrual, gynaecological, sexual history (obstetric if indicated)
 Abdominal and PV exam

59
Q

Investigations in PCB?

A 
	Exclude pregnancy and STIs
•	Pregnancy test
•	Infection screen (chlamydia and gonorrhoea)
	Smear if overdue
	Bloods
•	FBC, clotting, TFT, FSH/LH
	TVUS if structural abnormality thought of
	Biopsy
	Persistent PCB needs colposcopy
60
Q

When to refer PCB?

A

 Abnormal cervix (2 week wait)

 Cervical polyp, pelvic mass, high risk of endometrial cancer (FHx, prolonged cycles, tamoxifen), no cause of PCB

61
Q

Management of PCB?

A 
	Depends on cause
	If cancer suspected
•	Urgent referral for investigation
	Infection
•	Abx depending on disease and organism
•	Contact tracing and treatment of sexual partners
62
Q

Management of cervical ectropions, polyps and fibroids in PCB?

A

 Cervical Ectropion’s
• May resolve if COCP stopped or following pregnancy
• Thermal cautery or silver nitrate if needed
 Cervical polyps
• Avulsed and sent for histology
 Fibroids
• Small removed hysterscopically
• Uterine artery embolization
• Large – drugs, vascular embolization or surgery

63
Q

Hormonal management in PCB?

A

• Common in 1st 3 months after starting contraception
• May need speculum examination if >3 months
o Women >45 need biopsy
• COCP
o Stick with pill for 3 months, use pill with dose of ethinylestradiol to provide cycle control
o Different COCP may be tried
• POP
o Different POP tired
• PO implants/depot/IUS
o First line – COCP for up to 3 months continuously or in usual cycle regimen – repeat as often as needed

64
Q

Define premenstrual syndrome?

A

o Distressing physical, behavioural and psychological symptoms, in the absence of organic or underlying psychiatric disease
o Recurs during the luteal phase of each menstrual (ovarian) cycle and which disappears or significantly regresses by the end of menstruation

65
Q

How common is PMS?

A
  • 80% have mild or moderate PMS

- 5% have severe PMS

66
Q

Pathology of PMS?

A
  • Suggestion abnormal response to normal progesterone excursions
  • Affects GABA receptors
  • Neurons in PMS preferentially metabolise progesterone into pregnenolone (heightens anxiety) rather than allopregnanolone (anxiolytic)
67
Q

Risk factors for PMS?

A

o FHx of PMS
o High BMI
o Stress
o Traumatic events

68
Q

Symptoms of PMS?

A
  • Mood swings
  • Irritability
  • Depression
  • Stress/Tension
  • Bloating and breast tenderness
  • Headache
  • GI upset
69
Q

Classifying moderate PMS?

A

o Severe PMS involves disruption of interpersonal/work relationships or interference with normal activities

70
Q

DSM-IV criteria for severe PMS?

A

o >5 symptoms present for most of the luteal phase and absence of symptoms post menses (at least one symptom must be from the first 4):
 Markedly depressed mood, feelings of hopelessness or self-deprecation.
 Marked anxiety, tension (being ‘on edge’)
 Marked affective lability (e.g. feeling suddenly sad or tearful)
 Persistent and marked anger/irritability/increased conflicts.

 Decreased interest in usual activities.
 Subjective sense of difficulty in concentrating.
 Lethargy, easy fatigability/lack of energy.
 Marked change in appetite, overeating or specific food cravings.
 Hypersomnia or insomnia
 Subjective sense of being overwhelmed or out of control.
 Other physical symptoms (breast tenderness or swelling, headaches, joint or muscle pain, a sense of ;bloating;, weight gain).

71
Q

Investigations in PMS?

A

• Exclude underlying organic/psychiatric causes
o BP, pulse, thyroid and breast examination
• Symptoms diary filled in over 2 cycles (2-3 months)

72
Q

General measures in PMS?

A

• Improve Healthy Diet
o Less fat, sugar, salt, caffeine and alcohol.
o Regular, frequent small balanced meals rich in complex carbohydrates
• Increase exercise
• Stop smoking
• Schedule stressful tasks to better half of month if needed
• Stress reduction
o Relaxation techniques
o Yoga
o Meditation
o Breathing techniques

73
Q

1st line management in moderate PMS?

A

• COCP (Yasmin, good if wanting contraception too)
o Used cyclically or continuously
• Cognitive behavioural therapy.
• Simple analgesia for pain if needed

74
Q

1st line management in severe PMS?

A

• COCP (Yasmin, good if wanting contraception too)
o Used cyclically or continuously
• Cognitive behavioural therapy.
• Simple analgesia for pain if needed
• SSRI (fluoxetine/sertraline/citalopram)
o Continuous or just for luteal phase of menstruation
o Give 3 months, if benefit then continue for 6-12 months

75
Q

Secondary care medical management of PMS?

A
  • Progesterone or progestogens used alone.
  • Antidepressants other than SSRIs
  • Alprazolam.
  • Diuretics
  • Danazol
  • Transdermal oestrogen
  • GnRH analogues +/- addback HRT
76
Q

Complementary therapies in PMS treatment?

A

o Vitamin B6, calcium and vitamin D, magnesium, evening primrose oil

77
Q

Surgical management of PMS?

A
  • Hysterectomy including oophorectomy with oestrogen-only HRT, last resort for severe PMS
78
Q

Define PCOS?

A

o Hyperandrogenism, oligomenorrhoea and polycystic ovaries on US without other causes of polycystic ovaries

79
Q

How common is PCOS?

A

• Most common endocrine disorder in women:

  • Prevalence = 10% of women at childbearing age.
  • Responsible for ~80% of anovulatory subfertility
80
Q

Pathology of PCOS?

A
  • Excess androgens
  • Androgens are steroid hormones (e.g. testosterone) that stimulates or controls the development and maintenance of male characteristics
    Insulin resistance leads to hyperinsulinemia
81
Q

Effect of excess androgens in PCOS?

A

o Hypersecretion of LH (increased frequency and amplitude of LH pulses).
o LH stimulates androgen secretion from ovarian thecal cells

82
Q

Effect of steroid hormones in PCOS?

A

o Increased androgens in the ovary disrupt folliculogenesis lead to excess small ovarian follicles (hence the cysts) and irregular/absent ovulation.
o Increased peripheral androgens cause hirsutism (acne/body hair).

83
Q

Effect of insulin resistance in PCOS?

A

Hyperinsulinaemia
o Reduced sex hormone binding globulin (SHBG) in liver so increased free testosterone
o Increased androgen production

84
Q

When do symptoms commonly present in PCOS?

A

• Often present in peripubertal period – mid-20s

85
Q

Symptoms of PCOS?

A

o Asymptomatic
o Oligomenorrhoea (irregular periods, <9 per year) or amenorrhoea (no periods)
o Signs of hyperaldosteronism: acne, hirsutism, alopecia.
o Obesity
o Psychological: mood swings, depression, anxiety
o Sub/infertility
o Recurrent miscarriage

86
Q

Sings of PCOS?

A

o Male-pattern baldness, alopecia
o Obesity (usually central)
o Acanthosis nigricans (areas of increased velvety skin pigmentation which occur in the axillae and other flexures)
o Clitoromegaly, increased muscle mass, deep voice - severe

87
Q

Long term complications of PCOS?

A
  • Obesity, insulin resistance and dyslipidaemia risk factors for IHD.
  • Higher rate of T2DM, GDM
  • Long periods of secondary amenorrhea (unopposed oestrogen) risk factor for endometrial hyperplasia and carcinoma
88
Q

Investigations performed in PCOS?

A 
o	Bloods:
	Total testosterone (normal or slightly raised)
	Free testosterone (may be raised if >5nmol/L – exclude androgen-secreting tumours and CAH – 17-hydroxyprogesterone)
	SHBG (normal or low in PCOS)
	LH (elevated) &amp; FSH (normal)
	TFTs
	Prolactin
	Lipids
•	To exclude a prolactinoma
o	Ovarian USS
o	Screen for diabetes
o	BMI
89
Q

What is the criteria for PCOS?

A

Rotterdam criteria for diagnosing PCOS:
- Requires the presence of 2 out of 3 of:
• Polycystic ovaries on US
• 12 or more follicles or ovarian volume >10 on USS
• Oligo-ovulation or anovulation
• Clinical/biochemical features of hyperandrogenism
 Acne, excess body hair, alopecia
 Raised serum testosterone

90
Q

DDx of PCOS?

A
  • Thyroid dysfunction
  • Hyperprolactinaemia
  • Late-onset CAH
  • Androgen secreting tumours
  • Cushing’s syndrome
91
Q

General management of PCOS?

A 
o	Weight loss
o	Diet 
o	Exercise
o	Stop smoking
o	Sleep apnoea advice
•	Psychological support
92
Q

If not planning pregnancy, management of PCOS?

A 
o	Improving insulin resistance:
	Metformin (not licensed so risks and benefits weighed up)
o	Ensuring withdrawal bleeds every 3-4 months: (reduces endometrial cancer risk)
	COCP cyclical
	IUS
	If not taking pill (norethisterone 5mg TDS PO for 10 days)
o	Hirsutism
	Co-cyprindol 2mg/d
	Waxing, shaving
	Eflornithine facial cream
	Spironolactone
•	Avoid in pregnancy, teratogenic
93
Q

If presenting with subfertility and wanting to conceive, management of PCOS?

A 
o	Clomifene citrate
	Induces ovulation
	Use for <6 cycles
	Need US monitoring
o	Metformin added on
o	Laparoscopic Ovarian Drilling
	Needlepoint diathermy in 4 places per ovary to reduce steroid production
	When clomifene not working
94
Q

Complications of PCOS?

A
  • Infertility
  • Endometrial hyperplasia and cancer
  • CVD risk
  • T2DM – screening offered if obese, FHx, >40
  • GDM – screen in pregnancy 24-28 weeks
95
Q

Define post-menopausal bleeding?

A
  • Bleeding occurring >1 year after last period where menopause can be expected
96
Q

What is post-menopausal bleeding considered to be?

A
  • Considered endometrial carcinoma until proven otherwise (10%)
97
Q

Management of post-menopausal bleeding?

A

Referral to gynaecologist within 2 weeks Investigations for endometrial carcinoma
o TVUS (shows endometrial thickening >4mm)
o Biopsy as out-patient (Pipelle method - side-opening cannula with vacuum sucks biopsy) or hysteroscopy with biopsy
o If cancer – need CT/MRI

98
Q

Other causes of post-menopausal bleeding?

A
  • Vaginitis (atrophic commonly)
  • Foreign bodies (pessaries)
  • Carcinoma of cervix or vulva
  • Endometrial/cervical polyps
  • Oestrogen withdrawal (HRT)
99
Q

How is atrophic vaginitis treated?

A

lubricants/moisturisers and HRT or topical oestrogen

100
Q

What is functional/chronic pelvic pain?

A

Intermittent or constant pelvic pain >6 months with no pathological cause

101
Q

Common conditions associated with chronic pelvic pain?

A

IBS and interstitial cystitis

Sexual/Physical abuse

102
Q

Management of chronic pelvic pain?

A

Address psychological/social issues
Trial of OCP, GnRH analogue for 3-6 months, Mirena IUS
Antispasmodics, analgesics, pain clinic
Laparoscopy

MSRA Content (87 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions