Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Gynae (Owen) > Menstrual problems > Flashcards

Menstrual problems Flashcards

1
Q

Management of premenstrual syndrome

A

Mild
- lifestyle- exercise, small meals 2-3 hours apart, stop smoking alcohol
Moderate
- COCP
Severe
- SSRI for luteal phase or continuous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Presentation of premenstrual syndrome

A

Physical
- bloating
- breast pain
Emotional
- anxiety
- mood changes
- fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What causes mittelschmerz

A

In ovulation a small amount of fluid is released

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a cervical ectropion

A

Increased oestrogen levels can cause the transformation zone to move down into the ectocervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Symptoms of cervical ectropion

A

Post coital bleeding from trauma to cervix (columnar cells more fragile than squamous)
Dyspareunia
Increase in discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does cervical ectropion appear

A

Reddening around the cervical OS
This is the shifting of transformation zone where columnar cells are visible which are red

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of cervical ectropion

A

Ablation if very troublesome symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management of menorrhagia

A

Do they want contraception?
Yes
1st line- LNG-IUS
2nd line- COCP
3rd line- injection or implantable progestogen
NO
Do they have painful periods?
YES
Mefanemic acid
NO
Tranexamic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When suspect PCOS

A

Amenorrhoea, oligomenorrhoea, infertility
Signs of acne, hirsutism
Acanthosis nigricans
FHx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is acanthosis nigricans

A

Dry rough skin with pigmented appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is PCOS diagnosed in adults versus adolescents

A

Adults- rotterdam criteria
2 of
- amenorrhoea/infertility
- signs of hyperandrogenism (including just elevated testosterone)
- presence of cysts (over 12 measuring over 2mm or ovary size of over 10ml)

Adolescents
- hyperandrogenism and amenorrhoea required
If do not meet criteria then described as “at risk”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Most common cause of dysmenorrhoea

A

Primary dysmenorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pathophysiology of PCOS

A

Production of LH greatly increased causing excess androstenedione which enters the blood and is converted to oestrone which inhibits LH surge. As such ovulation does not occur meaning that dominant follicle either degenerates or becomes a cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is thought to cause anterior production of LH production in PCOS

A

Presence of hyperinsulinaemia causes proliferation of theca cells as they have insulin receptors. LH production increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Consequences of high androstenedione

A

Hrisutism
Male pattern baldness
Acne

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where does acanthosis nigricans develop

A

Folds of neck, groin and underarms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What bloods tests do you do in PCOS

A

Sex hormone binding globulin
Free androgen index
Total testosterone
LH
FSH
Prolactin and thyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What can happen to prolactin in PCOS

A

Slightly raised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is sex hormone binding globulin

A

Protein in the blood which binds to testosterone primarily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is sex hormone binding globulin in PCOS

A

Low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the free androgen index

A

(100x testosterone)/ SHBG
This is a measure of total free testosterone essentially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What happens to free androgen index PCOS

A

Raised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Important things to screen for in PCOS

A

Wellbeing
Sleep apnoea
CVD risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Who with PCOS should be offered OGTT

A

BMI over 25
Not overweight but other risk factors like fhx
Non white

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Who gets an annual OGTT with PCOS
Impaired fasting glucose Impaired glucose tolerance
26
What should PCOS people have annually
Weight monitoring BP checks
27
How to manage amenorrhoea in PCOS
If prolonged amenorrhoea (1 in 3 months) then prescribe cyclical progestogen for 14 days to induce a withdrawal bleed and then refer for TVUSS If over 10mm get sampling If normal then offer either low dose COC, cyclical progestogen or LNG-IUS depending on whether wants withdrawal bleeds or has acne etc If does not wish to have any of these then refer to specialist where will be offered USS every 6-12 months Weight loss also useful
28
Management of acne in PCOS
First line is COCP- co-cyprindiol If needed follow acne pathway Healthy lifestyle
29
Management of hirsutism in PCOS
Healthy lifestyle Discuss methods of hair reduction- waxing and removal
30
Management of infertility in PCOS
Healthy lifestyle- stop smoking and lose weight especially when overweight Refer to specialist where can prescribe 1st line clomifene and then add metformin or use first line when overweight Second line includes- gonadotrophins, Pulsatile GNRH and ovarian drilling
31
MOA of clomifene
Occupies oestrogen receptors in brain without activating them which stimulates GNRH release and ultimately FSH
32
Inheritance of androgen insensitivty syndrome
X-linked
33
Investigations for androgen insensitivty syndrome
Karyotyping- 46 XY Testosterone levels very high
34
When suspect androgen insensitivty syndrome
Amenorrhoea Breast development as can get conversion of testosterone to oestrogen No pubic hair anywhere Groin swellings which are undescended testicles
35
Management of androgen insensitivity syndrome
Counselling that should raise as a girl Bilateral orchidectomy Oestrogen therapy
36
Causes of secondary dysmenorrhoea
Endometriosis Adenomyosis PID Fibroids Cu IUD
37
Difference in pain for secondary dysmenorrhoea
Can start a few days before
38
Pain in dysmenorrhoea
Starts within a few hours of period and can radiate to back or down thighs
39
Management of pain in primary dysmenorrhoea
Mefanemic acid and paracetamol 2nd line COCP 3rd line can use POP or Mirena
40
Complications of PCOS
Endometrial cancer Stroke CVD Infertility OSA
41
How many periods aim in PCOS for per year
3 to reduce Ca risk
42
What happens to PCOS patients when do IVF
OHSS
43
What happens to the majority of secondary oocytes in ovaries
Undergo atresia not from ovulation
44
When is prime time to assess levels of hormones
Day 2-5 of menstrual cycle
45
Why do you want to lose weight in PCOS
Adipose tissue synthesises oestrogen which can adds to oestrogen levels in blood
46
How does PCOS appear on USS
Pearl sign Sagging of ovaries
47
What are signs of extremely high testosterone in women
Deep voice Virilisation Cliterol hypertrophy Rapidly progressing hirsutism
48
Problem of using accutane in PCOS treatment
It is teratogenic so must be on contraception
49
Why give COCP in PCOS
Increases SHBG
50
If presenting with menorrhagia what are first line investigations
Clotting screen FBC
51
What type of drugs are tranexamic
Antifibrinolytic
52
How is primary amenorrhoea defined
Failure to menstruate by 15 with secondary sexual characteristics Failure to menstruate by 13 without secondary sexual characteristics
53
What are spiral arteries
What supply the endometrium Proliferate in the luteal phase
54
What is most common cause of primary amenorrhoea
Turners
55
What is second most common cause of primary amenorrhoea
Mullerian agenesis
56
What is included in mullerian duct system
Uterus, cervix and upper 2/3 of vagina
57
What is virilisation
When females develop male sexual characteristics
58
What does cause of primary amenorrhoea depend on
Development of secondary sexual characteristics such as breasts
59
Causes of priary amenorrhoea where development of secondary sexual characteristics
Endocrine - CAH - high prolactin - thyroid dysfunction - cushings Androgen insensitivty (testosterone produced which can be converted to oestrogen) Genitourinary dysfunction - imperforate hymen - mullerian agenesis - transverse septum
60
What is imperforate hymen
The hymen is memebrane which is partially closed in the vagina If imperforate then completely occludes the vagina
61
How does imperforate hymen present
Amenorrhoea with regular painful periods- eventually get abdo distention and discomfort from where uterus and cervix fill with blood. Can also get urinary retention
62
What is investigation for imperforate hymen
Abdo USS - shows haematocolpos and haematometra
63
What is management of imperforate hymen
Incision under anaesthesia Then evacuation of uterus and cervix
64
Causes of haematocolpos and haematometra
Imperforate hymen Transverse septum
65
What is a transverse septum
When have tissue sitting across whole of vaginal canal
66
Amenorrhoea with impaired sense of smell
Kallman
67
Causes of primary amenorrhoea without secondary sexual characterstics
Constituional Turners Hypothalamic-pituitary dysfunction - stress (mental and physical) - weight loss - kallmans
68
What causes functional hypothalamic amenorrhoea
Excess exercise
69
What defines secondary amenorrhoea
Absence of menstruation for 3-6 months after regular menses Absence of menstruation for 6-12 months after oligomenhorrhoea
70
How does mullerian agenesis present
Dyspareunia Agenesis
71
What does amenorhhoea with very little pubic har suggest
Androgen insensitivity
72
Signs on examination of haematocolpos
Parting of labia may reveal blue bulging membrane Abdominal mass
73
If have examinaed the breasts when can next measure prolactin
48 hours
74
Examinations for amenorrhoea
BMI Inspection of whole body - hirsutism - acne - striae - buffalo hump - galactorrhoea - lack of pubic hair - abdominal mass Test visual fields
75
Investigations for primary amenorrhoea
TSH FSH/LH Prolactin Testosterone TVUSS
76
What looking for in TVUSS for primary amenorrhoea
Streak ovaries Lack of uterus/ovaries
77
What do if prolactin 500-1000 Primary amenorrhoea investigation
Repeat
78
What can cause mild hyperprolactinaemia
Drugs - anti-psychotics - SSRI - anti-emetics metoclopramide Stress PCOS Renal impairment (can go as high as 2000) Thyroid dysfunction
79
How to interpret testosterone levels in primary amenorrhoea investigation
Normal- less than 2.5 2.5-5- PCOS Over 5- CAH, Cushings, testosterone tumour, AIS
80
What level of prolactin warrants an MRI
Over 1000
81
Most common cause of hyperprolactinaemia in primary care
Stress or drugs
82
When does normal referral for primary amenorrhoea get changed
If present younger than 13 or 15 but - growth retardation - 5 years post thelarche and no menses - thyroid cause suggested - androgen excess - galactorrhoea
83
Who to refer to for amenorrhoea
Gynaecologist most of time Endocrinologist if hyperandrogenism, hyperprolactinaemia or thyroid causes suggested
84
How to manage amenorrhoea caused by excess exercise, weight loss or stress
Refer all to endocrinologist to rule out pituitary tumour If ruled out Excess exercise- reduce exercise and refer to sports physician if possible Stress- manage stress Weight loss- dietician or relevant services if ED
85
When do you consider osteoporosis prophylaxis for amenorrhoea
Over 12 months
86
When refer to gynae for secondary amenorrhoea
POI in under 40 Recent uterine or cervical surgery suggesting asherman or endometritis Infertility
87
What is asherman syndrome
Amenorrhoea caused by recent uterine procedure or severe uterine infection which may have lead to adhesions meaning no functional endometrium
88
Causes of endometritis
Recent rupture of membranes IUD insertion Hysteroscopy and biopsy Cervical curettage PID C-section
89
When manage osteoporosis risk in amenorrhoea
POI under 40 Hypothalamic hypogonadism High prolactin
90
How manage osteoporosis risk in amenorrhoea
Lifestyle- stop smoking and lose weight Vit d levels HRT considered if amenorrhoea over 12 months - if functional hypothalamic give for 12 months and then stop for 6 months to see if menses return
91
How manage osteoporosis risk in secondary amenorrhoea if caused by functional hypothalamic amenorrhoea
Give for 12 months and then stop for 6 months to see if menses return
92
How to daignose asherman syndrome
Hysteroscopy
93
What is seen on vaginal examination of imperforate hymen
Bulging membrane
94
What are gonadotorphin levels in prolactinaemia
Low FSH and LH
95
If present with galactorrhoea and amenorrhoea what do
Exclude thyroid causes and renal dysfunction Then MRI
96
What is vulvodynia
Presence of pain in vaginal/vulvar region for 3 months with no identifiable cause
97
Difference between unprovoked and provoked vulvodynia
Unprovoked- present most of time without identifiable trigger Provoked- has identifiable trigger like speculum or sex
98
What is most common cause of discharge in a prepubescent girl
Vulvovaginitis
99
What causes vulvovaginitis in a prepubescent girl
Due to low oestrogen the vaginal mucosa is very thin meaning susceptible to infections
100
Management of vulvovaginitis
Good hygiene Wear cotton undergarments
101
If have hyperprolactinaemia causing amenorrhoea what are first investigations
Rule out other causes Hypothyroidism CKD
102
What is it called if somenoe has AIS
Male intersex
103
Management plan if unprovoked vulvodynia
First line- amitryptylline Second line- gabapentin or pregabalin
104
What is premenstrual dysmorphic syndrome
A severe form of premenstrual syndrome whereby exhibit only the psychological symptoms of PMS without the physical
105
Investigation for pre menstrual syndrome
Symptom diary for 2 cycles
106
What is average size of dominant follicle
2cm
107
What produces the oestrogen near ovulation
Dominant follicle
108
What determines a cycle length
How long it takes to produce a dominant follicle Luteal phase is fixed 14 days in everyone
109
If a fundus at umbilicus is 20 weeks what is it coming out of pelvis
12 weeks
110
What type of drug is mefanemic acid
Prostaglandin inhibitors
111
How to treat asherman syndrome
Hysteroscopy with adhesiolysis Postoperative systemic oestrogen
112
What defines primary dysmenorrhoea
It occurs within 1 year of menache
113
In PMS, how give the COCP
Omit pill free period
114
What is best drug for dysmenorrhoea if dont want to take a pill every day
Mefanemic acid as can be given as a short course
115
Cause of menopause with liver problems, joint pain and diabetes
Haemochromatosis
116
What must do before TVUSS in PCOS amenorrhoea assessment
Give progesterone for 14 days to induce bleed
117
What is given to reduce endometrial cancer risk in PCOS
Low dose COCP Cyclical progesterone every 14 days in 3 months
118
How does a post hysterectomy bladder injury present
Anuria Pain Blood in urine

Gynae (Owen) (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions