Lecture 20: Clinical gynaecology

Question 1

What is clinical Gynaecology?

Answer 1

• Issues of discomfort and/or disease of the female genital tract.
• Prevention of disease eg; cervical screening.
• Reproduction and contraception.

Question 2

Cervical Screening is?

Answer 2

One of the most effective screening tests in reducing the incidence and mortality from cervical cancer. By 60-80%!!

HPV is the underlying cause, a vaccine has been introduced.

Question 3

IVF??

Answer 3

>5mill babies born by IVF

1. Stimulate via hormones the female ovaries so lots of follicles/eggs mature.
2. Puncture via abdominal wall, takes eggs our and mix in vitro with sperm
3. Find the best fertilised eggs, place them back in the womb

Question 4

The founding of the first contraceptive pill was?

Answer 4

Pincus was initially shut down, but at the same time Djerassi synthesized progestogen, and they together synthesized the first contraceptive pill, that was on the market in 1960.

Question 5

What is the major breakthrough in womens reproductive health??

Answer 5

The Oral contraceptive Pill.
Currently used by >100 mill women.

Women could decide if/when they wanted to get pregnant!!!

Question 6

What kind of things do you see in terms of womens health in the community and/or emergency health system?

Answer 6

heavy menstrual bleeding

Abnormal cervical smears

Early pregnancy complication

Lower abdo pain

Question 7

Gynaecologic History taking

Answer 7

1. What’s the presenting complaint?
   - onset, duration, course, severity
   - impact on life
2. Specific complaint related history (exclude pregnancy)
   - cervical smear, sexual health etc

Question 8

Gynacaelogical Examination

Answer 8

1. General Abdominal Examination
2. Pelvic Examination-Speculum &bimanual

Question 9

What is a speculum examination?

Answer 9

-Because in normal circumstances vaginal walls have collapsed, but speculum allows us to expand the walls and clearly view the cervix

Question 10

Gynacaelogical Investigations

Answer 10

• Urine (pregnancy)
• Cervical smear
• Vaginal Swabs
• Biopsy (pipelle)

Question 11

Uterine Fibroids are? Symptoms?

Answer 11

Very common cause of menstrual bleeding, benign SM tumor from uterine myometrium.

Symptoms: abnormal bleeding, pelvic discomfort, no pain

Question 12

Uterine Fibroid Treatment?

Answer 12

Don’t treat unless the symptoms are really bad. If treatment is required, use drugs (eg NSAIDS) or surgery can be done.

These can grow in different places, eg; bladder

Question 13

Causes of Heavy menstrual bleeding?

Answer 13

Structural: Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia (PALM)

Non-Structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified (COEIN)

Question 14

Treatment for Acute HMB

Answer 14

Progestogens (high dose/ 10 days)

or Tranexamic acid

Question 15

Progestogens action on the Endometrium

Answer 15

• Stops the oestorgen induced growth of the endometrium
• Stabilizes endometrial Vasculature
• Initiates the clotting cascade
• inhibits matrix metallo proteinase activity

Question 16

How does Tranexamic Acid work?

Answer 16

Anti-fibronlytic that prevents plasminogen activation. Little bit of anti-coagulation at the level of the uterus, restoring blanace of coagulating and anti-coagulating products.

Question 17

What is Endometrial Ablation and when do we do it?

Answer 17

• Minor procedure, whole inner womb lining taken out
• Short recovery
• 80% satisfaction
• 25% repeat procedure

Only done if after 3 months medical management has failed!!

Question 18

Types of Incontinence

Answer 18

..

Question 20

Dysmenorrhea

Answer 20

Pain during menstrual cycle

45-72% in menarche +3years

39% use analgenics

Question 21

Endometriosis stats and associated pain types

Answer 21

1 in 10 women

Most painful condition, functional extra-uterine endometrium, only way to diagnose is a painful invasive procedure.

Dysmenorrhoea, dyspareunia, dyschezia (pain on opening bowels), dysuria

Question 22

Dyspareunia

Answer 22

pain during sex

Question 24

Endometriosis treatment?

Answer 24

1. Pain management
2. Hormones
3. Surgery

But is is a chronic condition and will carry on within reproductive lifespan.