Gynaecology: Management Flashcards
Adenomyosis
endometrial tissue inside the myometrium
Adenomyosis management
No contraception
- tranexamic acid - reduce bleeding
- mefenamic acid- reduce pain & bleeding
Contraception
- Mirena coil (1st line)
- COCP
- POP
androgen insensitivity syndrome
cells unable to respond to androgen hormones due to a lack of androgen receptors
X-linked recessive genetic condition
Androgen insensitivy syndrome management
MDT
- bilateral orchidectomy to avoid testicular tumours
- oestrogen therapy
- vaginal dilator/ surgery
Asherman’s syndrome
adhesions forming within the uterus. following damage
Asherman’s syndrome management
dissect adhesions during hysteroscopy (gold stand investigation)
reoccurrence of adhesions after treatment is common
Atrophic vaginitis
dryness and atrophy of the vaginal mucosa related to a lack of oestrogen
atrophic vaginitis management
vaginal lubricants for dryness
- Sylk, replens
topical oestrogen
- estriol cream, pessary, tablet, ring
contraindications of topical oestrogen
breast cancer, angina, venous thromboembolism
Bartholin’s Cyst & Abscess
Blockaage of Bartholin’s glands causing them to swell and become tender.
If cysts become infection they lead to an abscess
Most common cause: e.coli
Bartholin’s Cyst Management
Good hygiene
Analgesia
Warm compresses
Possibly biopsy if vulval malignancy needs to be excluded
Bartholin’s Abscess
Antibiotics
Surgical Interventions
- Word catheter
- Marsupilisation
Cervical ectropion
Columnar epithelium of the Endocervical has extended out to the ectocervix
Cervical ectropion management
Normally no management required
Problematic bleeding
- Cauterisation of ectropion using silver nitrate or cold coagulation during colposcopy
endometriosis
ectopic endometrial tissue outside of the uterus
endometriosis management
Hormonal management options
- COCP, POP, Depot, implant, Mirena coil
Gold standard diagnosis: laparoscopic surgery
Laparoscopic surgery to excise/ablate endometrial tissue and remove adhesions
Hysterectomy (final surgical option)
fibroids
benign tumours of smooth muscle of the uterus
fibroids management
<3cm
- Mirena coil (1st line)
- Symptomatic management: NSAIDs & tranexamic acid
Smaller fibroids + heavy menstrual bleeding
- endometrial ablation
- resection of submucosal fibroids
- hysteroscopy
>3cm [referral to gynaecologist - investigation & management) -Symptomatic management -Uterine artery embolisation -Myomectomy -hysterectomy
Red degeneration of fibroids
Ischaemia, infarction and necrosis of fibroid due to disrupted blood supply
red degeneration of fibroids: management
Supportive: rest, fluids, analgesia
heavy menstrual bleeding management
Try to identify and treat aetiology
No contraception
- Tranexamic acid (reduce bleeding)
- Mefenamic acid (reduce pain & bleeding)
Contraception
- Mirena Coil
- COCP
- Cyclical Oral progestogens
lichen sclerosus
chronic inflammatory skin condition that presents with patches of shiny, ‘porcelain-white’ skin
Lichen sclerosus management
Potent topical steroids
- clobetasol propionate
Regular use of emollients
Contraception methods- women approaching menopause
Barrier methods
Mirena/ copper coil
Progesterone Only Pill
Progesterone Implant
COCP can be used up to 50y/o if no other contraindications but is a UKMEC2
Management of perimenopausal symptoms
HRT
Testosterone- treat reduced libido
Vaginal oestrogen- for vaginal dryness & atrophy
Vaginal moisturisers
nabothian cysts
fluid-filled cysts on the surface of the cervix
nabothian cysts management
No treatment required
If diagnosis uncertain
-refer for colposcopy
types of ovarian cysts
function cysts serous cyst adenoma mutinous cyst adenoma endometrioma dermoid cysts/ germ cell tumours sex-cord stromal tumours
Ovarian cyst management
Possible ovarian cancer
- complex cysts or raised CA125
- two week wait referral to gynae oncology specialist
Possible dermoid cyst
- referral to gynaecologist for further investigation & consideration of surgery
Simple ovarian cysts
- <5cm: resolve within 3 cycles
- 5-7cm: routine referral to gynae & yearly US
- > 7cm- consider MRI/surgical evaluation
Cysts in postmenopausal women
- Correlation with CA125 & referral to gynaecologist
- Raised CA125’ two-week wait suspected cancer referral
- Simple cysts ,5cm & normal CA125: US every 4-6mths
Persistent/ Enlarging cysts
- Surgical evaluation
- Removal of cyst (ovarian cystectomy)
Meig’s Syndrome
benign ovarian tumour (ovarian fibroma) with pleural effusion and ascites
meig’s Syndrome management
Removal of tumour
ovarian torsion
ovary twists in relation to surrounding connective tissue, Fallopian tube and blood supply
-Gynae emergency
Cn be visualised as whirlpool sign on pelvic US
ovarian torsion management
Definitive diagnosis: Laparoscopic surgery
Detorsion (un-twist ovary & fix it in place)
Oophorectomy (remove affected ovary)
pelvic organ prolapse
descent of pelvic organs into the vagin
Uterine prolapse: uterus descends into vagina
Vault prolapse: top of vagina descends
Rectocele: rectum prolapses forward into vagina
Cystocele: bladder prolapse backward into vagina
Pelvic organ prolapse management
Conservative
- physio
- weight loss
- lifestyle changes
- vaginal oestrogen cream
Vaginal Pessary
Surgery (definitive option)
Polycystic Ovarian Syndrome
Common condition causing metabolic and reproductive problems in women
Characteristic features of multiple ovarian cysts, infertility, oligomenorrhoea, hyperandrogegism and insulin resistance
PCOS management
weight loss
reducing risk of endometrial cancer
- Mirena coil
- Induce withdrawal bleed every 3-4 months (cyclical progestogens or COCP)
Manage infertility
- Clomifene
- Laparoscopic ovarian drillin
- IVF
Managing hirsutism
- weight loss
- co-cyprindiol (COCP)
- topical eflornithine
Management of acne
- COCP -first line for acne in PCOS (co-cyprindiol)
- Retinoid.
Premature ovarian insufficiency
menopause before the age of 40 years.
Characterised by hypergonadotropin hypogonadism
[Raised LH and FSH. Low estradiol levels}
Premature ovarian insufficiency management
HRT
- traditional hormone replacement therapy
- COCP
Contraception is still recommended as small risk of pregnancy
Increased risk of VTE with HRT in women <50.
Can be reduced by using transdermal methods (patches)
premenstrual syndrome
psychological, emotional and physical symptoms that occur during luteal phase of menstrual cycle
PMS management
healthy lifestyle changes
COCP
- recommended COCPs contain drosperidone (i.e Yasmin)
SSRI antidepressants
CBT
Cyclical breast pain
-danazole & tamoxifen
physical symptoms (breast. swelling, water retention, bloating) -Spironolactonw
Primary amenorrhoea
Not starting menstruation
- by 13 when there is no other evidence of puberty
- by 15 when there is other signs of puberty
primary amenorrhoea management
Establish and treat underling cause
Hypogonadotropic Hypogonadism
(Hypopituitarism or Kallman Syndrome)
- Pulsatile GnRH (induces fertility)
- COCP (induce regular menstruation
Ovarian Aetiology (PCOS, damage/ absence of ovaries) -COCP
Secondary amenorrhoea
no menstruation for .3months after previous regular menstrual periods
Secondary amenorrhoea management
Establish and treat underlying cause
Possible causes -pregnancy -Menopause & premature ovarian failure -Hormonal Contraception -Hypothalamic or pituitary pathology Ovarian causes (PCOS) -Uterine pathology (Ashermans Syndrome) -Thyroid pathology - Hyperprolactinaemia
Urinary incontinence
loss of control of urination
Types
- Urge incontinence
- stress incontinence
- mixed incontinence
- overflow incontinence
urinary incontinence management
Stress Incontinence Avoid caffeine, diuretics, overfilling bladder Restrict fluid intake Weight loss Pelvic floor exercises Surgery
urge Incontinence
- bladder retraining
- anticholinergics (oxybutynin, tolterodine)
- Miragebron
- Invasive procedures
Overactive Bladder Invasive management
- botulinum type A injection
- percutaneous sacral nerve stimulation
- augmentation cystoplasty
