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OBGYN > Gynecology > Flashcards

Gynecology Flashcards

1
Q

Discuss sex differentiation

A
  • sex differentiation occurs through the SRY gene on the Y chromosome
  • gene encodes for testis-determining factor -> mullerian inhibiting substance and testosterone which develop the male genital system
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2
Q

Discuss the development of the ovaries

A
  • undifferentiated until the 7th week where develops from the paraxial mesoderm in 3rd week and develop the urogenital ridge around the nephrogenic cord in 4th week
  • with no Y chromosome the indifferent gonad develop the ovary where the medullary cords degenerate, cortical cord develops (form future follicular cells) and no tunica albuginea
  • ovaries descend slightly and the suspensory ligament develops from the superior genital ligament and the round ligament develops from the inferior genital ligament (gubernaculum)
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3
Q

Discuss the formation the genital Ducts

A

Indifferent Stage
- mesonephric duct is Wolfian duct
- paramesonephric duct is muellerian duct
Absence of MIS and Testosterone
- mesonephric duct degenerates
- paramesonephric duct develops to form the uterine tube, uterus and superior aspect of the vagina
- absence of testosterone forms the external genitalia and lower 1/3 of clitoris -> 5th month the vaginal plate canalizes to form the vagina

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4
Q

Discuss the formation of the external genitalia

A

Indifferent
- 3rd week mesynchymal cells migrate around cloacal membranes to form cloacal folds -> superiorly form genital tubercle and inferiorly form the urethral and anal folds
Development of External Genitalia
- genital tubercle elongates to form the clitoris
- urethral folds do not fuse to form labia majora
- urogenital groove remains open and form the vestibule

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5
Q

List the timing of events of the endometrial and ovarian cycles

A 
Endometrial
- day 1-5 have menstruation
- day 6-13 have proliferative phase
- day 15-28 have secretory phase
Ovarian Cycle
- day 1-13 have follicular phase
- day 14 have ovulation
- day 15-28 have luteal phase
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6
Q

Describe in-detail the ovarian cycle

A

Primordial
- primordial follicle develop into primary and then secondary follicle overtime and is gonadotropin independent -> larger primary oocyte with more zona pellucida + granulosa cells proliferating forming layers around oocyte + interstitial cells form theca cells around oocyte
Follicular Phase
- increase in FSH and LH lead secondary follicle to form the Graafian follicle, where fastest primary follicle to form secondary will be chosen
- tertiary follicle begin to produce estrogen which inhibits FSH causing other follicles to die
- dominant produce more estrogen leading to LH surge
Ovulation
- LH surge lead to ovulation by increasing antral fluid and release of hydrolytic enzymes so that secondary oocyte with corona radiata are release
- completion of meiosis 1
Corpus Luteam Phase
- corpus luteum produces progesterone and estrogen
- in the absence of LH the corpus luteum will degenerate into corpus albicans
- with bHCG the corpeus luteum will continue to release progesterone until taken over by placenta at 4-5 months

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7
Q

Describe the endometrial stages

A

Menstruation
- due to low estrogen and progesterone cause shedding of the endometrium
Proliferative
- high estrogen from follicle stimular endometrial cells increase its thickness
Secretory
- with high progesterone cause endometrial hypertrophy, thickening of the spiral arteries and glycogen secretion

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8
Q

Discuss where the major hormones of menstruation are produced

A

Progesterone
- produced by granulosa, theca, interstitial and corpus lutem
- LH stimulate corpus luteum to produce
- low <2 before ovulation and >5 after
- act on hypothalamus to decrease GnRH production
Testosterone
- produced by theca, interstitial and corpus luteum
- theca cells synthesize and then pass to granulosa cells via basement membrane to produce estrogen
- in non-dominant follicle cannot convert testosterone quickly enough resulting in atresia
Estrogen
- produced by granulosa and corpus luteum
- low <50 at menstruationa nd then peak at 200 during follicular development
- inhibit GnRH release
- FSH target granulosa cells to produces estrogen and stimulate follicular growth
Activin and Inhibin
- released by granulosa cells to activate or inhibit FSH release

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9
Q

Discuss the components, mechanism and use of oral contraceptive pill

A

Component
- low dose estrogen and progestin
Mechanism
- inhibit ovulation
- change cervical mucus
- cause pseudodecidualization of endometrium to inhibit implantatation
- inhibit tubal peristalsis to prevent fertilization
Use
- start at either 1st Sunday after menses, day 1 of month or immediately
- takes 7 days before it can work
- 21/7 method where hormone free days allow for menstruation

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10
Q

List the contraindications to OCP

A
  • smoker and over age of 35
  • <6 weeks post partum if breastfeeding
  • history of VTE
  • current breast cancer
  • uncontrolled hypertension
  • ischemic heart disease
  • complicated valvular disease
  • history of stroke
  • migraine headache with aura or over 35 with migraine
  • severe diabetes or cirrhosis
  • SLE and APLA
  • thrombophilia
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11
Q

List the benefits of OCP

A

Short Term
- regulation of menstrual cycle and decreased bleeding
- decreased dysmenorrhea, acne or premenstrual syndrome
Long Term
- decrease risk of endometrial, ovarian, and colorectal cancer
- decrease risk of benign breast disease
Other
- decrease risk of PID and ectopic pregnancy
- decrease risk of ovarian cyst
- improve endometriosis

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12
Q

Discuss the contraceptive patch and vaginal ring

A
  • same as oral contraceptive where use for 3 weeks with 1 free week
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13
Q

Discuss the benefits of the progestin only pill

A 
Mechanism
- need to take pill everyday at same time and it increases cervical mucous
- still have regular menstruation
Indication
- breastfeeding women or those with previous VTE
Adverse Effects
- irregular bleeding
- worsening mood
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14
Q

Discuss the benefits of injectable progestin DMPA

A 
Mechanism
- inhibit ovulation
- thicken cervical mucous
- pseudodecidualization
Use
- injection every 3 months where have 2 week interval at mark where still effective
Contraindication
- known or suspected pregnancy
- unexplained vaginal bleeding
- current breast cancer
Adverse Effect
- 50% develop amenorrhea after 1 year and 75% after 2 years
- weight gain due to increase appetite
- decreased bone densit
- delay to fertility: require 9 months after to return
Benefit
- treat menorrhagia, dysmenorrhea and endometriosis
- treat menses related symptoms
- decrease risk of endometrial and cervical cancer
- decrease seizure
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15
Q

List the contraindications to an intra-uterine device

A 
Contraindications
- known pregnancy
- puerperal sepsis
- immediate post septic abortion
- current PID or STI
- cervical or endometrial cancer
- current breast cancer
- unexplained vaginal bleeding
- distorted uterine cavity
- malignant trophoblastic disease
Adverse Effects
- unscheduled vaginal bleeding
- pain or dysmenorrhea
- uterine perforation
- infection
- expulsion
- failure where have increased risk of ectopic
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16
Q

Discuss the benefit of copper IUD

A

Mechanism

  • foreign body reaction that lead to endometrial change that adversely affect sperm transport and inhibit sperm motility directly
  • best used for emergency contraception 7 days post
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17
Q

Discuss the benefit of a mirena (LNG-IUS) IUD

A
  • contain progesterone
  • last up to 5 years
    Mechanism
  • thicken cervical mucous
  • suppress endometrial estrogen and progestin receptor
  • inhibit ovulation
  • inhibit implantation
  • induce endometrial changes
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18
Q

Discuss the use of Plan B/Norvelo

A 
- progesterone only
Mechanism
- inhibit ovulation
- change endometrium to prevent implantation
- disrupt luteal phase
- effect on tubal transport
- does not disrupt established pregnancy
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19
Q

Discuss the approach to primary amenorrhea

A
  • failure to reach menarche (amenorrhea and no pubertal development by 14 or amenorrhea with secondary sexual characteristic by 16)
    Pelvic Examination
  • if absent uterus must assess if have sexual hair -> if yes than mullerian agenesis and if no then CAIS
  • if normal then assess bHCG
    Negative bHCG assess prolactin, TSH and FSH
    Prolactin
  • if increased require MRI head to assess for pituitary tumour
  • treat with surgery or dopamine agonist
    TSH
  • if elevated treat with thyroid replacement
    FSH Decreased
  • assess if have eating disorder, over exercise or stress
  • if no, then MRI for tumour -> if MRI negative than Kallman
    FSH Increased
  • gonadal failure so must do karyotype assessing for primary ovarain insufficiency or Turner or fragile X
    FSH Normal
  • testosterone increased than ovarian sonography for tumour
  • DHEAS high then adrenal MRI for tumour
  • if DHEAS and testosterone normal or high normal than PCOS
  • 17-OH-P increased than congenital adrenal hyperplasia
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20
Q

List the differential for secondary amenorrhea

A 
Hypothalmic
- eating disorder or stress
Pituitary
- prolactinoma
Thyroid
- hypothyroidism
Ovary
- PCOS
- primary ovarian insufficiency
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21
Q

Discuss the presentation and management of primary ovarian insufficiency

A
  • 90% are idiopathic and then Turner or chemo/radiation
    Pathophysiology
  • inadequate follicles to sustain menses due to failure tof form enough primordial follicles or accelerated loss or damage
    Presentation
  • primary or secondary amenorrhea
  • menses interal >90 days
  • oligomenorrhea
    Investigation
  • consistently high FSH and LH
  • consistently low estradiol
    Diagnosis
  • primary or secondary amenorrhea for 3 months or changes from normal for 3 months
  • high FSH >40 on 2 occassions a month apart
  • age <40
    Complications
  • increased risk of osteoporosis and atheroscleorsis
  • infertility
    Management
  • pre-puberty: increase estrogen over 2 years until breakthrough bleed -> add progesterone
  • Post-Puberty: estrogen for 1-26 and progesterone for 14-26 of cycle (OCP or patch)
  • prevent complications through lifestyle, monitoring and supplementation
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22
Q

Discuss the presentation and management of polycystic ovarian syndrome

A 
Rotterdam Diagnosis (2/3)
- oligo or anovulation
- clinical or biochemical hyperandrogenism
- polycystic ovaries (>12 follicles)
Acute Management
- menstrual irregularities with oral contraceptive
- acne with lifestyle changes
- hirsutism with spironolactone
- infertility
Surveillance
- impaired glucose tolerance (possible pathophysiology where theca cell insulin resistance lead to unopposed estrogen with elevated LH)
- endometrial hyperplasia
- hyperlipidemia
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23
Q

Discuss the signs of hyperandrogensism

A
  • hirsutism on androgen dependent areas of body
  • acne
  • clitoromegaly
  • male balding
  • obesity
  • insulin resistance
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24
Q

List the differential for abnormal uterine bleeding

A 
Structural Abnormalities (PALM)
- polyp
- adenomyosis
- leiomyoma
- malignancy
No Structural Abnormality (COEIN)
- coagulopathy
- ovulatory dysfunction
- endometrial
- iatrogenic
- not yet classified
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25
Q

Discuss the risk factors for polyp and risk factors for polyp malignancy

A 
Risk Factors
- tamoxifen
- obesity
- hormone replacement
- age
For Malignancy
- >1.5cm
- tamoxifen
- age >60
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26
Q

Discuss the diagnosis and treatment of polyps

A 
Diagnosis
- hysteroscopy
- saline infusion sonography
Treatment
- symptomatic or post-menopausal
- asymptomatic if risk for malignancy, mulitple, prolapse, infertility
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27
Q

Discuss the presentation and management of adenomyosis

A 
- are ectopic endometrial glands and stroma within myometrium resulting in enlarged uterus
Presentation
- heavy menstrual bleeding
- painful menstruation with chronic pelvic pain
- enlarged uterus
Treatment
- hysterectomy
- hormonal therapy
- ablation
- embolization
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28
Q

Discuss the presentation and management of fibroids

A
  • is growth of myometrial smooth muscle in women of reproductive age
    Presentation
  • heavy and prolonged menses
  • pelvic pain or pressure with 4 D’s (dysmenorrhea, dyspareunia, dyschezia, dysuria)
  • infertility
  • enlarged urterus
    Investigations
  • CBC for anemia
  • transvaginal ultrasound
    Treatment
  • prophylactic if causing infertility, IVF or hydronephrosis
  • hormonal therapy with OCP or menopause inducing drugs
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29
Q

List the risk factors for fibroids

A 
Increased
- African American
- early menarche
- family history
- hypertension
- obesity
- alcohol
- red meat
Decreased
- high parity
- exercise
- smoking
- healthy diet
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30
Q

Discuss the screening and treatment of coagulopathy leading to AUB

A

Screen
- heavy menstrual bleed
- one of post-partum hemorrhage, surgery related bleed, bleeding with dental work
- two of bruising, epistaxis >=1/month, frequent gum bleeding, or family history
Treatment
- No pregnancy then contraceptive method
- pregnancy then antifibrinolytic, factor replacement, dDAVP

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31
Q

List the differential for ovulatory dysfunction

A
  • eating disorders
  • stress
  • excessive exercise
  • obesity
  • endocrinopathy
32
Q

List the iatrogenic causes to AUB

A 
Pharmacotherapy
- exogenous gonadal steroids
- GnRH therapy
- antipsychotic
- corticosteroids
- anticoagulants
Medical
- IUD
Surgical
- D+C
- myomectomy 
- C-section
33
Q

List the hormone treatment principles for AUB

A

Combined estrogen and progestin
- for regular or irregular menorrhagia or irregular cycle
- progestin suppress ovulation
- estrogen support endometrium preventing breakthrough bleeding
Progestin Only
- for irregular menstrual cycle
- inhibit ovarian steroid synthesis leading to endometrial atrophy and decrease bleeding
GnRH Agonist (Lupron)
- for regular or irregular menorrhagia, shrinkage of fibroid and dysmenorrhea
- induce reversible menopause

34
Q

List the mechanism of non-hormonal treatment of AUB

A 
Iron Supplementation
NSAID
- cause vasoconstriction and reduce pain
Anti-fibrinolytics (TXA)
- inhibit plasminogen activator in order to decrease bleeding
35
Q

List the life-threatening differential for vaginal bleeding

A 
Early pregnancy: ectopic or spontaneous abortion
Late pregnancy: abruption or previa
Post-partum: PPH
Ovary: torsion or rupture of cyst
Uterus: severe menorrhagia
Trauma
Infection: PID or salpingitis
Malignancy
36
Q

Discuss the presentation and management of an ectopic pregnancy

A 
Presentation
- pelvic pain
- vaginal bleeding
- palpable adnexal mass
- peritoneal signs
Investigation
- postive bHCG that is not doubling every 48hrs
- trans-vaginal ultrasound show ectopic or no pregnancy intra-uterine pregnancy with bHCG >1500
Management
- surgery if complicated
- medical abortion if not complicated
37
Q

Discuss the presentation and management of ruptured ovarian cyst

A 
Presentation
- pelvic pain
- vaginal bleeding
- nausea and vomiting
- tenderness to palpation
- peritoneal signs
Investigations
- negative bHCG
- ultrasound show free fluid in pelvis
Management
- uncomplicated get conservative with possible fluid resuscitation 
- surgical for source control if unstable or deteriorating
38
Q

Discuss the presentation and management of ovarian torsion

A 
Presentation
- pelvic pain
- vaginal bleeding
- fever, nausea and vomiting
- palpable mass
Investigations
- negative bHCG
- ultrasound show enlarged ovary/mass/peripheral follicles or no doppler flow
Management
- immediate surgery with possible salpingooophorectomy
39
Q

Discuss the presentation and management of pelvic inflammatory disease

A 
Pathophysiology
- infection of upper genital tract by STI
Presentation
- prior STI or sexual activity
- pelvic pain during or after menses 
- vaginal discharge or bleeding
- fever
- dysuria
- cervical motion tenderness
Investigations
- positive culture
- abscess
Management
- ceftriaxone 250mg IM + doxycyline 100mg BID for 14 days
40
Q

Discuss the presentation of Chronic Pelvic Pain Syndrome

A 
Pathophysiology
- idiopathic spasm of pelvic floor muscle
Presentation
- pain out of proportion
- dyspareunia
- vaginismus
41
Q

Discuss the presentation of vestibulitis vulvodynia syndrome

A

Presentation

  • vulvar discomfort
  • superficial dyspareunia
  • perineal burning
  • erythema of Bartholine opening and hymen
  • tenderness to Q-tip probe
42
Q

Discuss the presentation of pelvic congestion syndrome

A
  • pelvic pain varicosities
    Presentation
  • dull achin pain in pelvis made worse by standing
  • ultrasound with pelvic varicosities
43
Q

Discuss the cervical screening

A
  • begin screening at 21 if ever sexually active and repeat every 3 years
  • if never, can wait until sexually active
  • stop at 70 if have 3 previous normal results
44
Q

List the different pap test results

A

ASC-US: atypical squamous cell of undetermined significance
ASC-H: atypical squamous cell that cannot exclude high grade lesion
LSIL: low grade squamous intraepithelial lesion
HSIL: high grade squamous intraepithelial lesion
Squamous cell carcinoma

45
Q

List the follow up testing for pap test results

A 
ASC-US <30
- repeat every 6 months x2 -> if abnormal then colposcopy
ASC-US >30 with HPV testing
- if positive then colposcop
- if negative then repeat PAP in 1 year
- if no HPV than same as <30
LSIL
- colposcopy or repeat PAP at 6 months
HSIL/ASC-H/AGC
- colposcopy
46
Q

Discuss the use of colposcopy

A 
Diagnosis
- uses acetic acid to turn white the areas of dysplasia which can be biopsied
- if nothing than do transition zone
Management
- CIN 1 than repeat PAP at 12 months
- CIN 2 or 3 perform LEEP excision
47
Q

Discuss the presentation and management of bacterial vaginosis

A
  • most common cause of increase discharge
  • increase risk of acquiring STI
    Amsel’s criteria (3/4):
  • thin white discharge
  • pH >4,5
  • positive Whiff test: fishy odor when alkali is added
  • clue cells
    Management
  • flagyl 500mg PO BID for 7 days
  • do not need to treat partner
48
Q

Discuss the presentation and management of vulvovaginal candidiasis

A
  • 2nd most common with 75% having at least one episode
    Risk Factors
  • uncontrolled diabetes or system antibiotic use
  • immunocompromised
  • high estrogen level (pregnancy, obesity, OCP)
    Presentation
  • thick, white clumpy discharge
  • vulval itch with erythema and satellite lesions
    Investigation
  • pH litmus paper <4.5
  • vaginal KOH swab show yeast with hyphae and spores
    Management
  • fluconazole 150mg PO
  • topical cream for 3 days if uncomplicated and 7 if complicated (topic preferred only if pregnant)
49
Q

Discuss the presentation and management of trichomoniasis

A 
- symptoms one week after contact
Presentation
- yellow-green, frothy malodorous discharge with pruritis and dyspareunia 
- strawberry cervix
Investigation
- motile flagellated organism
Management
- treat even if asymptomatic with flagyl 2g PO single or 500mg PID x7
50
Q

Discuss the presentation and management of post menopausal atrophic vaginitis

A 
- low estrogen leading to atrophy of the vagina
Presentation
- yellow vaginal discharge
- dry and irritation of vagina
- dyspareunia
- vaginal petechiae
Management
- vaginal estrogen applied for life
51
Q

List the female risk factors for infertility

A
  • age >35
  • low or high body mass
  • history of oligo/amenorrhea, PID or endometriosis
  • previous pelvic surgery
  • previous chemotherapy
52
Q

List the male risk factors for infertility

A
  • age >40
  • cryptochordism
  • previous surgery or chemotherapy
  • recreational drug use
53
Q

Discuss the inter-relationship between infertility and sexual dysfunction

A
  • sexual dysfunction when health, relationship or idea regarding sex cause problems with function (desire, arousal, orgasm) -> leads to infertility which contributes to worsening dysfuncion
  • for men most common is erectile dysfunction
  • for women it is low desire/arousal, dyspareunia or difficulty reaching orgasm
54
Q

List the indications for further testing with infertility

A
  • female age <35 and have attempted for 1yr of unprotected and frequent (2-3x per fertile window)
  • female age >35 or specific history after 6 months of attempt
55
Q

List the investigations for infertility

A
  • assessment of ovulation by history and serum progesterone 7 days prior to expected period
  • ovarian reserve testing by FSH, estradiol, and ultrasound
  • uterus and uterine tube anatomy by saline infusion sonogram
  • semen analysis
  • TSH
56
Q

Discuss the methods for assessing ovulation

A

History
- should have ovulation 14 days before expected period if regular
- have signs of molimina
Basal Body Testing
- increase by 0.3-0.5 2-3 days after ovulation
LH Surge
- can measure LH surge at ovulation
Luteal Phase Serum Progesteron
- assessment of progesterone 7 days before expected period

57
Q

How do you confirm low ovarian reserve

A
  • measure FSH and estradiol on day 3 of menstrual cycle along with pelvic ultrasound for follicles
  • high FSH and low estradiol suggest low reserve along with low follicle count
58
Q

Discuss methods for assessment of tubal patency

A

Hysterosalpingogram
- dye put into uterus to assess patency of tubes
- due 2-3 days after menses to avoid clot and pregnancy
Saline Infusion Sonogram
- infusion of saline into uterus to assess patency
Laproscopy
- gold standard
- indication: abnormal hystersalpingogram, endometriosis, previous ectopic or surgery, previous ruptured appendicitis, abnormal pelvic exam, PID

59
Q

List the normal semen findings

A
  • volume >1.5mL
  • pH >7.2
  • sperm concentration >15million
  • > 40% progressive motility
  • > 4% normal
60
Q

Discuss the management for ovulation dysfunction infertility

A 
Hypogonodotropic hypogonadism
- weight gain
- GnRH or FSH injections
- IVF
Normogonodotropic normoestrogen (PCOS)
- weight loss
- clomiphene citrate which is selective estrogen receptor modulator to increase FSH
- metformin for insulin sensitization
- FSH injection
- IVF
Hypergonodatropic hypogonadism (POF)
- IVF
- donor
- adoption
61
Q

Discuss management of male infertility

A
  • lifestyle modification: avoid heat, limit caffeine, stop alcohol, smoking, drugs
  • abnormal sperm get GnRH
  • abnormal sperm function get IVF
  • obstruction require IVF
62
Q

Discuss the methods of treatment for induction

A 
Ovulation Induction
- add selective estrogen receptor modulator or FSH to act as antagonist at hypothalamus to increase FSH
Superovulation
- induce 2-4 eggs and then intra-uterine insemination 
- daily FSH injections
Intrauterine Insemination
- male sperm washed and placement in uterus
IVF
- tubal obstruction
- severe endometriosis
- low sperm count
- PCOS
- failed SO
- donor egg needed
- age >40`
63
Q

Discuss the procedure of IVF

A
  • FSH stimulate egg production which is aspirated by needle
  • inseminated with sperm
  • fertilized egg inserted into uterus
  • <38 1-2 eggs inserted and >42 then 5
64
Q

List the red flags for domestic abuse

A 
Being Abused
Situational
- planning on leaving or recent termination
- pregnancy
Demographics
- <30
- low SES
Physical or mental disability
Past History

Abuser

  • history of aggression
  • low SES or unemployment
  • substance use
65
Q

List the risk factors for pelvic organ prolapse

A
  • age
  • pregnancy
  • obesity
  • previous surgery
  • hypo-estrogen
  • connective tissue disorder
  • smoking
66
Q

Discuss the presentation and management of pelvic organ prolapse

A 
Pathophysiology
- weakness in pelvic floor lead to prolapse of vaginal walls along with organs surrounding
Presentation
- fullness, pressure or bulge from vagina
- urinary incontinence
- constipation
- vaginal bleeding or discharge
Investigations
- urodynamics
Management
- pelvic floor exercises and estrogen replacement
- pessary
- surgery
67
Q

Discuss the grading of pelvic organ prolapse

A 
Grade 1
- prolapse descending to upper 1/3 of vagina
Grade 2
- prolapse descending to mid vagina
Grade 3
- prolapse descending to hymenal ring
Grade 4
- prolapse past hymenal ring
68
Q

Discuss the different causes of obsterical fistuals

A 
Obstetric
- due to prolonged, obstructed labor without timely intervention
Iatrogenic
- pelvic surgery or radiotherapy lead to injury
Local disease Causing Inflammation
- local inflammatory disease
- IBD
- local cancer
69
Q

Discuss the presentation and management of pelvic fistula

A

Presentation
- recurrent vaginitis and irritation
- vesicovaginal: uncontrolled leakage of urine with recurrent UTI
- rectovaginal: leakage of stool and flatus from vagina
Management
- vesico: small get catheter in order to heal or large get surgical repair
- recto: surgical repair

70
Q

What is the definition of menopause

A
  • 12 months of amenorrhea typically occuring between 45-55
  • peri-menopause is transition period of altered hormones that leads up to and last for 1 year after
  • is the shortenin of cycles with greater time in between
71
Q

Discuss some of the physiologic changes with menopause

A
  • narrowing of thermoneutral zone leading to regulatory response of sweating or shivering
  • low estrogen lead to atrophy of vagina and bladder incontinence
  • low estrogen lead to dyslipidemia, increase plaque and vasodilation
72
Q

Discuss the clinical symptoms of menopause

A
  • vasomotor: hot flashes and night sweats
  • poor memory and concentration
  • depression and sleep disturbance
  • vaginal dryness and increased urinary frequency
  • decreased libido
  • fatigue and myalgia

Increased Risk of

  • osteoporosis
  • cardiovascular disease
  • colorectal cancer
73
Q

Discuss the conservative management of menopause

A
  • reduce core body temperature
  • avoid triggers such as alcohol, warm environment and drinks
  • regular exercise and weight loss
  • smoking cessation
74
Q

List the indications and contraindications for hormone therayp

A 
Indications
- menopausal symptoms that negatively impact quality of life within 3-5 years of menopause for a max of 5 years
- those with premature ovarian failure should be used until 50 for cardioprotective benefits
Contraindication
- cardiovascular disease
- breast or endometrial cancer
- venous thromboembolism
- acute liver disease
75
Q

List the option for medical therapy of menopause

A
  • lower dose than OCP, so have lower risk
  • have both estrogen and use progesterone if have uterus
  • transdermal better as bypass liver so lower risk of DVT

Types

  • oral conjugated equine estrogen
  • oral esterase
  • transdermal estradiol
  • oral micronized progesterone
  • progestin
76
Q

Discuss the use of vaginal estrogen therapy

A
  • first line for vaginal atrophy without vasomotor symptoms
  • reduced risk of complications of HT
  • require lifelong therapy
77
Q

List the histological findings of endometriosis

A

> =2 of

  • endometrial epithelium
  • endometrial gland
  • endometrial stroma
  • hemosiderin-laden macrophage

OBGYN (4 decks)

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