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3A > Gynaecology - Fertility and contraception > Flashcards

Gynaecology - Fertility and contraception Flashcards

1
Q

Contraception for under 16s

A

Fraser criteria

  1. Understands doctor’s advice
  2. Attempted to persuade her to tell her parents
  3. Believe she will continue intercourse without contraception
  4. Physical or mental health is at risk
  5. It is in her best interests
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2
Q

Short-acting methods of contraception

A

COCP
POCP

Diaphragm/cap

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3
Q

COCP method of action

A

Inhibits ovulation

TAKES 7 DAYS!!

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4
Q

COCP advantages

A

Reversible

Decreases dysmenorrhoea
Decreases menorrhagia
Decreases acne

Protective for…

  • Endometrial cancer
  • Ovarian cancer
  • Colon cancer
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5
Q

COCP disadvantages and contraindications

A

Risks…

  • VTE
  • Breast cancer
  • Cervical cancer

Contraindications…

  • Aged > 35 + 15 cigs/day
  • BMI > 35
  • Migraine with aura
  • Previous VTE, stroke or IHD
  • Breast-feeding < 6 weeks
  • Uncontrolled HTN
  • Breast cancer or BRCA1/2
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6
Q

POCP method of action

A

Thickens cervical mucus

Decreases tubal motility - ECTOPIC RISK!!

TAKES 2 DAYS!!

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7
Q

POCP advantages / disadvantages

A

Reversible

Useful in difficult populations

  • Obese
  • Migraines
  • HTN
  • Aged > 35

Decreased oestrogen side effects

  • Nausea
  • Breast tenderness
  • Headaches

Disadvantages

  • Irregular bleeding
  • Ectropion risk
  • Ovarian cyst risk
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8
Q

Long-acting methods of contraception

A

Implant
Depo injection
IUD - Copper
IUS - Mirena - Levonogestrel

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9
Q

Implant MOA

Advantages vs disadvantages

A

Progesterone - Negative feedback - Prevents ovulation
Thickens cervical mucus

TAKES 7 DAYS

Advantages

  • Long-acting
  • Decreases menorrhagia
  • Decreases dysmenorrhoea

Disadvantages

  • Irregular bleeding
  • Minor-op
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10
Q

Depo-provera MOA

Advantages vs disadvantages

A

Progesterone - Negative feedback - Inhibits ovulation
Thickens mucus

TAKES 7 DAYS
Lasts 3 months

Advantages - 55% amenorrhoea after first year

Disadvantages

  • Not immediately reversible - Up to one year!
  • Decreased bone mineral density
  • Irregular bleeding
  • Weight gain
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11
Q

IUD MOA

Advantages vs disadvantages

A

Hostile environment for sperm
Decreases sperm motility and survival

INSTANT

Advantages

  • Long-acting
  • No need to remember to take it
  • Non-hormonal
  • Works immediately after insertion

Disadvantages

  • Menorrhagia
  • Dysmenorrhoea
  • Uterine perforation
  • Expulsion
  • Ectopic risk
  • PID in first 20 days
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12
Q

IUS method of action

Advantages vs disadvantages

A

Levonogestrel
Thickens cervical mucus
Thins endometrium

TAKES 7 DAYS

Advantages

  • Long-acting
  • Reduces menorrhagia
  • Reduces dysmenorrhoea
  • Can lead to amenorrhoea

Disadvantages

  • Irregular bleeding
  • Painful fitting
  • Ectopic
  • Expulsion
  • Perforation
  • PID in first 20 days
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13
Q

Emergency contraception methods

A

Progesterone - Within 72 hours
Levonelle - Within 72 hours

Ellaone - Ullipristal acetate - 5 days

IUD
- 5 days after intercourse
OR
- 5 days after likely ovulation date

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14
Q

Post-partum contraception

A

Required from day 21

POCP - Safe if breastfeeding

COCP

  • CI if breastfeeding < 6 weeks
  • Safe if breastfeeding - 6 weeks - 6 months

IUD - Best option!
- 48 hours PP
OR
- 4 weeks PP

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15
Q

Female sterilisation methods

A

Tubal ligation

Essure - Coil blockage in tubes

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16
Q

Tubal ligation

Advantages vs disadvantages

A

Advantages - No hormonal side effects

Disadvantages

  • Non-reversible on the NHS
  • Ectopic risk
  • Surgical procedure
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17
Q

Essure - Coil blockage

Advantages vs disadvantages

A

Advantages

  • Quick
  • Permanent

Disadvantages

  • Irreversible
  • Surgical procedure
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18
Q

Menstrual cycle days 1-4

A

Low hormone level
Endometrium shedding
HPA - Producing some FSH and LH

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19
Q

Menstrual cycle days 5-14

A

Proliferative phase
FSH and LH acting on the ovary - Follicular growth
Follicle produces oestrogen and inhibit - Negative feedback on HPA
HPA stops producing FSH and LH - Prevents further follicular growth
Oestradiol level increases - Positive feedback on HPA
HPA releases FSH and LH - Egg is released

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20
Q

Menstrual cycle days 15-28

A

Follicle releases egg and becomes corpus luteum
Corpus luteum maintained by LH - Secretes oestrogen and progesterone

No fertilisation…

  • Corpus luteum degenerates
  • No further progesterone secretion
  • No negative feedback on HPA
  • Back to square 1
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21
Q

Roles of progesterone

A

Spiral artery formation
Stromal cell enlargement
Endometrium thickening
Negative feedback on HPA

22
Q

Subfertility definition / aetiology

A

Failure to conceive after 1 year of trying

Hormonal - Amenorrhoea

Uterine

  • Congenital abnormalities
  • Polyps
  • Fibroids
  • Endometriosis
  • Infection / PID
  • Asherman’s - Intrauterine adhesions

Lifestyle - Obesity and smoking

Metabolic - Thyroid dysfunction

23
Q

Subfertility investigations

A 
FSH / LH 
Anti-Mullerian hormone - Marked of ovarian reserve 
Oestradiol
Testosterone 
Prolactin

TFTs

Triple swab

USS - Check for abnormalities

24
Q

Subfertility management

A

Treat cause!

Low FSH/LH

  • Gonadotrophins
  • Weight loss

PCOS

  • Clomiphene
  • Metformin
  • Gonadotrophins

Menopause - Egg donor required

Endometriosis - Ablation of ectopic tissue

25
Amenorrhoea types
Primary - Not started by 16 - With secondary characteristics - Not started by 14 Secondary - Stopped for 6 months
26
Amenorrhoea hypothalamic causes and investigations
Primary - Anorexia - Stress - Exercise - Kallmann's Investigations - FSH/LH
27
Amenorrhoea anterior pituitary causes and investigations
Primary - Prolactinoma Investigations - Prolactin ^^^
28
Amenorrhoea thyroid causes and investigations
Primary - Thyroid disease Investigations - TSH - T3 - T4
29
Amenorrhoea adrenal causes and investigations
Primary - Adrenal tumour - Cushing's - CAH Secondary - Adrenal tumour Investigations - Adrenal tumour - CT - Cushing's - Dexamethasone suppression test - CAH - Testosterone ^^^
30
Amenorrhoea ovarian causes and investigations
Primary - Androgen insensitivity - PCOS - Primary ovarian failure - Turner's syndrome Secondary - PCOS - Primary ovarian failure
31
Amenorrhoea genital causes and investigations
Primary - Imperforate hymen - Transverse vaginal septum Secondary - Cervical stenosis - Asherman's - Intrauterine adhesions Investigations - USS - MRI
32
PCOS aetiology / diagnostic criteria
Genetics - Family history Smoking Insulin resistance LH ^^^ Ovarian androgens ^^^ Adrenal androgens ^^^ 1. Multiple cysts on USS 2. Androgen excess 3. Irregular periods
33
PCOS presentation
Gynae... - Subfertility - Amenorrhoea - Intermenstrual bleeding - Oliguria Other... - Acne - Hirsutism - Acanthosis nigricans - Insulin resistance - Weight gain
34
PCOS investigations
``` Testosterone ^^^ LH/FSH ratio ^^^ Prolactin ^^^ TSH Pelvic USS Insulin ^^^ ```
35
PCOS management
Lifestyle advice - Weight loss Hirsutism and acne... - COCP - Spirnonlactone - Eflornithine Infertility - Clomiphene - Metformin - GnRH
36
Kallmann's syndrome
X-linked Failure of GnRH secreting neurons to migrate to hypothalamus Presentation - Anosmia - Amenorrhoea - Hypogonadism Investigations - FSH/LH - LOW
37
Angroden insensitivity aetiology and presentation
X-linked Testosterone resistance ``` Undescended testes Normal female genitalia Primary amenorrhoea Absent uterus / vagina Testosterone ^^^ ```
38
Androgen insensitivity investigations and management
Investigations - Buccal smear - Karyotype Management - Orchidectomy - Increased Ca risk - HRT
39
IVF indications / procedure
Male infertility Unexplained infertility Tubular disease Endometriosis 1. GnRH agonist + FSH every day until follicle is 18-20mm 2. hCG administration 3. Egg and sperm collection 4. Culture 5. Transfer
40
IVF risks
Ovarian hyperstimulation syndrome Ovarian cancer Multiple pregnancy Ectopic
41
Ovarian hyperstimulation syndrome aetiology
Cause - IVF RFs - Low BMI - PCOS - Young 1. bHCG ^^^ + Oestrogen ^^^ + Progesterone ^^^ 2. Increased vascular permeability 3. Fluid moves from vascular compartment into tissues
42
Ovarian hyperstimulation syndrome presentation / management
Vascular - Hypovolaemia - Thrombosis risk - Hypotension - Shock - Hypoalbuminaemia - Oliguria Tissues - Ascites - Hydrothorax - Ovarian cysts - Weight gain Management - Fluid correction - TED compression stockings - LMWH
43
Menopause definition and diagnosis
Permanent cessation of menstruation Due to loss of ovarian follicle activity 12 consecutive months of amenorrhoea Mean age - 51
44
Menopause presentation
Vasovagal - Sleep disturbance - Night sweats - Hot flushes Periods - Dysfunctional menstrual bleeding Urogynae - Vaginal dryness - Vaginal atrophy - Dyspareunia - Itching - Prolapse - Incontinence - UTI - Urinary frequency ^^^
45
Menopause long-term risks
Osteoporosis CVD Psychological effects - Dementia - Depression - Anxiety
46
Perimenopause
From the onset of symptoms TO 12 months after last period
47
Menopause investigations
Only if < 40 OR Atypical symptoms Less follicles... - FSH ^^^ - 2 measurements 4 weeks apart - Day 2-5 - AMH ^^^ Others... - TFT - LH - Oestradiol - Progesterone - DEXA
48
Menopause management
Lifestyle - Sleep hygiene - Weight loss HRT - Hysterectomy - Oestrogen - No hysterectomy - Oestrogen + Progesterone Non-HRT - Vasomotor - Fluoxetine and Citalopram - Psych - Antidepressants Contraception > 50 - Continue until 12 months after last period < 50 - Continue until 24 months after last period
49
HRT - ROA | Advantages vs disadvantages
Oral Transdermal MIRENA COIL Advantages - Reduces symptoms - Reduces osteoporosis risk Disadvantages - Breast cancer - VTE - CVD - Oestrogen only - Endometrial and ovarian cancer
50
HRT contraindications
Oestrogen responsive cancer - Breast - Endometrial - Ovarian Undiagnosed PV bleed Untreated endometrial hyperplasia
51
Premature menopause definition and causes
Menopause < 40 - A CRISIC Causes - AI disease - Chromosomal - Radiotherapy - Idiopathic - Surgery - Infection - Chemotherapy
52
Premature menopause management
1. FSH > 25 UI/L 2. 4 months amenorrhoea Oestrogen replacement - COCP Androgen replacement - Testosterone gel

3A (31 decks)

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