Lecture 19: Clinical gynaecology Flashcards
At point does gynaecology health become important?
Its important across all her lifespan
Hospital and community settings for womans health issues are very different
What does clinical gynaecology involve?
- Education i.e whats normal, what to expect
- Prevention (Smear)
- Diagnosis and treatment of disease
- Managing symptoms
- Bening and malignant pathologies
When you have a young female come into a GP clinic, what are some things worth asking?
Note different ages have different needs
- Sexually active?
- Explore need for contraception
- Educate regarding family planning and sexual health
- Screen for family violence
- Offer cervical smear and self swabs for STI screen
What are some long acting reversible contraception options? discuss benefits
LARCs
- Effective, reversible, long lasting contraception
- Do not rely on patient compliance
- Failure less than 1%
- Cost effective
Methods:
- Subdermal contraceptive implant i.e jadelle, copper IUD, hormonal IUD, DEPO (lasts only 3 months tho)
Why cervical smear?
- Cervical cancer caused by HPV
- Slow progressive change over ten years
- Smear detects precancerous cervical change
- 20-69 y/o that are sexually active are invited to smear every 3 years
Note will be changing to HPV screening
Where does cervical cancer occur?
Majority of cancer developed within the transformative zone
= Area of maturing epithelium b/w current squamocolumnar junction and the original squamous epithelium
Describe the smear test:
- Use of speculum to visualise the cervix
- Cytobroom to sample cells from transformative zone
- 36 year Pacific woman sees GP with heavy periods lasting 10 days with ‘flooding’
- Menarche age 12, always had heavy periods, worse last 2 years, no IMB/PCB, no pelvic pain
- Feeling tired and exhausted
- Wants to get pregnant
- Normal smear history
How do you proceed with her tiredness?
•Screen and treat anaemia
- Iron deficiency anaemia confirmed (Hb 92, ferritin 6)
Treat : oral iron or iron infusion
- 36 year Pacific woman sees GP with heavy periods lasting 10 days with ‘flooding’
- Menarche age 12, always had heavy periods, worse last 2 years, no IMB/PCB, no pelvic pain
- Feeling tired and exhausted
- Wants to get pregnant
- Normal smear history
How do you exclude other pathologies?
Exclude pathology
- Normal gynaecological exam
- Normal pelvic ultrasound
- Normal endometrial sampling
- Negative pregnancy test
- 36 year Pacific woman sees GP with heavy periods lasting 10 days with ‘flooding’
- Menarche age 12, always had heavy periods, worse last 2 years, no IMB/PCB, no pelvic pain
- Feeling tired and exhausted
- Wants to get pregnant
- Normal smear history
What pre-pregnancy advice do you give?
•Pre-pregnancy advice
- Start folic acid and iodine, stop smoking
- BMI into healthy range if not already
How do you perform a gynae exam?
Abdo palpation - Pelvic masses i.e pregnancy, tumour
Speculum examination - Visualise cervix, swabs/STI screen, smear if indicated
Bimanual examination (fingers in vagina, push down on uterus) - uterine size and position, mobility and tenderness, adnexal masses (tubes)
How is pelvic ultrasound performed and what does it diagnose?
- Transvaginal or transabdo
- Visualise cervix, uterus, adnexae
- Diagnosis of polyps, fibroids, ovarian cysts, pelvic abscesses
What are the treatments for heavy menstural bleeding?
- Depends on age, fertility plans, choice i.e hormones (contraceptives) or surgery i.e hysterectomy or endometrial ablation
- Can manage with NSADIS and/or tranexamic acid to allow for pregnancy
What does tranexamic acid do?
- Tranexamic acid binds to plasminogen
- Blocks interaction of plasminogen with fibrin
- Prevents dissolution of fibrin clot
Write some notes on endometrial ablation:
- Day case procedure
- Short recovery time
- 2/3rds women satisfied
- 1/3rds require repeat procedure or hysterectomy
Insert probe into uterus and ablation of the endometrium
