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YEAR 5 SPECIALTIES KEY INFO > INTRO TO GYNAE: Dysmenorrhoea, Menorrhagia, Dyspareunia, IMB, PCB, Amenorrhoea > Flashcards

INTRO TO GYNAE: Dysmenorrhoea, Menorrhagia, Dyspareunia, IMB, PCB, Amenorrhoea Flashcards

1
Q

What are RFs for primary dysmenorrhoea?

A
  • early age at menarche
  • heavy menstrual flow
  • nulliparty
  • FHx of dysmenorrhoea
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2
Q

What can cause secondary dysmenorrhoea?

A
  • endometriosis
  • adenomyosis
  • fibroids
  • PID
  • IUD insertion

Should always exclude these before diagnosing primary dysmenorrhoea

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3
Q

How is primary dysmenorrhoea identified and treated?

A

FEATURES = pain before or within a few hrs of period starting, lower abdominal pain radiating to back or thighs, assoc. w/vomiting, nausea, diarrhoea, fatigue, irritability, dizziness, headache

Rx = NSAIDs, COCP

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4
Q

What is endometriosis?

A

Endometrial tissue found outside uterine cavity

Sx = secondary dysmenorrhoea, deep dyspareunia, subfertility, urinary sx

O/E reduced organ mobility, tender nodularity in posterior vaginal fornix, visible vaginal endometriotic lesions

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5
Q

How is endometriosis investigated and managed?

A

IX = laparoscopy

MX =
1. NSAIDs/paracetamol
2. COCP/POP
3. GnRH analogues, surgery

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6
Q

What is adenomyosis?

A

Endometrial tissue found in myometrium

Sx = secondary dysmenorrhoea, menorrhagia, enlarge, boggy uterus

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7
Q

How is adenomyosis investigated and treated?

A

IX = TVUSS or MRI

MX =
1. NSAIDs/paracetamol/tranexamic acid
2. GnRH agonists
3. Uterine artery embolisation
4. Definitive = hysterectomy

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8
Q

What is dysfunctional uterine bleeding?

A

Menorrhagia in the absence of underlying pathology

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9
Q

What are underlying causes of menorrhagia?

A

Fibroids, hypothyroidism, IUD, PID, bleeding disorders

Unless there is underlying pathology, mx = reduce bleeding

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10
Q

How is menorrhagia investigated and managed?

A

IX = FBC, TVUSS etc.

MX =
No contraception needed - tranexamic acid, mefenamic acid

Contraception needed - Mirena coil, COCP, long-acting progestogens e.g. Depo-Provera

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11
Q

What are fibroids and how are they investigated?

A

Benign smooth muscle tumours of the uterus

SX = menorrhagia, bulky related sx, subfertility

IX = TVUSS

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12
Q

How are fibroids managed?

A

Asx = nil

Sx = LNG-IUS, NSAIDs, tranexamic acid, COCP, oral/injectable progestogen

Shrinking fibroids =
- GnRH agonists
- myomectomy, ablation, hysterectomy, uterine artery embolisation

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13
Q

What is candidiasis?

A

Vaginal infection due to Candida albicans

Sx = cottage cheese discharge, superficial dyspareunia, dysuria, itch

Ix = clinical diagnosis

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14
Q

What are RFs for candida?

A

DM, drugs (abx, steroids), pregnancy, immunosuppression

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15
Q

How is candida managed?

A

PO fluconazole
If CI then clotrimazole pessary (e.g. in pregnancy)

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16
Q

Summarise atrophic vaginitis

A

Thinning and drying of the vaginal walls​

Features:​
Vaginal dryness, dyspareunia, occasional spotting​

Ix: Speculum – pale and dry vaginal wall ​

Mx: ​
Vaginal lubricants and moisturisers​
Topical oestrogen cream​

17
Q

Summarise CIN

A

CIN: abnormal changes of cells that line cervix​

Mild/moderate dyskaryosis​

CIN 1: 1/3 of depth of surface of cervix​

CIN 2: 2/3 of depth of surface of cervix​

CIN 3: whole thickness of surface of cervix​

Mx (for CIN 2/3):​
- LLETZ​
- Cone biopsy​

18
Q

Summarise cervical cancer features and investigation?

A

Highest incidence in people aged 25-29 years old​

2 types, SCC (80%), adenocarcinoma (20%)​

Risk factors:​
HPV, smoking, HIV, early first intercourse, many sexual partners, high parity, lower socioeconomic status, COCP​

Features:​
Abnormal vaginal bleeding (PCB, IMB, PMB), vaginal discharge​

Ix: Screening programme​

19
Q

What is the cervical cancer screening system?

A

HPV first system:​
- 25-49 years: 3-yearly screening​
- 50-64 years: 5-yearly screening​
- Delayed until 3 months post-partum​
- Can opt out if never sexually active​

Negative HPV – return to normal recall​

Positive HPV – check cytology​
- Normal = repeat in 12 months​
- Abnormal = colposcopy, then management​

Inadequate sample – repeat in 3 months ​

20
Q

What is endometrial hyperplasia?

A

Abnormal proliferation of endometrium ​

Types:​

  • simple​
  • complex​
  • simple atypical​
  • simple complex​

Features:​
Abnormal vaginal bleeding (e.g. IMB)​

21
Q

How is endometrial hyperplasia managed?

A

Management without atypia:​
- Oral or local intrauterine (LNG-IUS) progestogens for 6 months​
- Continuous progestogens for women who decline the LNG-IUS​
- Hysterectomy​
- Bilateral salpingo-oophorectomy should be added for postmenopausal women​

Management with atypia:​
- Laparoscopic total hysterectomy​
- Bilateral salpingo-oophorectomy should be added for postmenopausal women​

22
Q

Summarise endometrial cancer

A

Usually seen in post-menopausal women​

Good prognosis due to early detection​

Risk factors:​
Excess oestrogen​

Features:​
Postmenopausal bleeding or intermenstrual bleeding​

Ix: ​
Suspected cancer pathway if:​
>=55 years old with post menopausal bleeding​
TVUSS​
Hysteroscopy with endometrial biopsy​

Mx: ​
Surgery​

23
Q

What is cervical ectropion?

A

Transformation zone: area between the native and unaffected columnar epithelium of the endocervical canal and native squamous epithelium ​

Squamo-columnar junction: abrupt change from columnar cells to squamous cells (changes with time)​

Location depends on:​
Age​
Hormonal status​
Birth trauma​
Contraceptives ​
Pregnancy​

24
Q

Summarise cervical ectropion

A

Larger area of columnar epithelium present on the ectocervix​

Caused by elevated oestrogen levels​

Features:​
Vaginal discharge, PCB​

Ix: speculum​

Mx: ​
Asymptomatic: no treatment​
Symptomatic: cauterization with silver nitrate or cold coagulation​

25
Q

Summarise amenorrhoea investigations and management

A

Primary: absence of periods by 15 years old with normal secondary sexual characteristics OR​ absence of periods by 13 years old with no secondary sexual characteristics
​
Secondary: absent period for 3 to 6 months in women with previous normal and regular menses OR absent period for 6 to 12 months in women with previous oligomenorrhoea​

Investigations:​
Exclude pregnancy – urinary or serum b-HCG​
Bloods – FBC, U&Es, coeliac screen, TFTs​
Special bloods – gonadotrophins, prolactin, androgen levels, oestradiol​

Management:​

Primary:​
Investigate and treat any underlying cause​
Potentially HRT (e.g. Turner’s)​

Secondary:​
Exclude pregnancy, lactation, menopause​
Treat underlying cause​

YEAR 5 SPECIALTIES KEY INFO (16 decks)

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