Gynaecology Presentations Flashcards
What acute conditions can lead to pelvic pain?
Dysmenorrhoea Mittelschmerz Ectopic pregnancy UTI Appendicitis PID Ovarian torsion Miscarriage
What chronic conditions can lead to pelvic pain?
Endometriosis IBS Ovarian cyst Urogenital prolapse Adhesions Psychological issues
What investigations would you request for pelvic pain?
Pregnancy test MSU High vaginal swabs USS Laparoscopy
How is cyclical pain managed?
Trial of COCP or GnRH agonist for period of 3-6 months
Diagnostic laparoscopy
Pain management team
What are the causes of post-coital bleeding?
50% - no cause
33% - cervical ectropion (more common if COCP)
Cervicitis, cervical cancer, polyps, trauma
What are some causes of inter-menstrual bleeding?
Physiological - spotting can happen around ovulation Pregnancy related - ectopic Cervicitis due to infection Cervical ectropion Polyps - cervical or endometrial Uterine fibroids/cancer Missed OCP
How would you investigate abnormal vaginal bleeding?
Speculum examination Cervical smear and HPV Pregnancy test High vaginal swabs TV USS Cervical biopsy Colposcopy
How is post menopausal bleeding defined?
Vaginal bleeding after 12 months of amenorrhoea in women of menopausal age or in younger women with early menopause or primary ovarian failure
What must you do in primary care if a patient comes in with postmenopausal bleeding?
Confirm bleeding is vaginal Risk factors - endometrial cancer Full menstrual history Gynae and abdo exam FBC, urine dip (haematuria), CA-125
If worrying - 2 week wait referral
What are the common causes of postmenopausal bleeding?
Use of HRT
Vaginal atrophy
They don’t exclude cancer so need investigating
What happens in secondary care if a woman is referred via 2 week wait for postmenopausal bleeding?
Transvaginal USS - endometrial thickness >5mm = higher chance of cancer
Endometrial biopsy - during hysteroscopy or by pipelle biopsy
What are some other causes of postmenopausal bleeding?
Simple endometrial hyperplasia Endometrial cancer Bleeding disorders Trauma Polyps Cervical, ovarian or vaginal cancer
What differentials may you consider if a woman presents with a labial or vulval mass?
Bartholin’s cyst/abscess
Vulval cancer - 90% = squamous cell carcinoma
Other cysts - sebaceous, scene’s duct, mucous
Bartholin gland carcinoma - rare
Bartholin’s benign tumour - adenoma and nodular hyperplasia (rare)
Other solid masses - fibroma, lipoma, leiomyoma
What is the initial imaging modality for ovarian masses?
Ultrasound
What can an ultrasound of an ovarian mass tell you about it?
Whether cyst is
Simple - unilocular, more likely to be physiological or benign
Complex - multilocular - more likely to be malignant
