O&G Flashcards
1
Q
Where is oestrogen produced?
Premenopausal
Pregnancy
Post menopausal
A
- Ovaries (granulosa cells) - Placenta (during pregnancy) - Adipose tissue (postmenopausal)
2
Q
What are the functions of oestrogen?
A
- Development of secondary sexual characteristics - Regulation of the menstrual cycle - Thickens the endometrial lining - Increases bone density - Enhances clotting factors
3
Q
Where is progesterone produced?
A
- Corpus luteum (after ovulation)
- Placenta (during pregnancy)
- Adrenal glands (small amounts)
4
Q
What are the functions of progesterone?
A
- Maintains the endometrial lining for implantation - Inhibits uterine contractions during pregnancy - Thickens cervical mucus - Inhibits GnRH, LH, and FSH release
5
Q
Where is luteinising hormone (LH) produced?
A
- Anterior pituitary gland
6
Q
What are the functions of LH?
A
- Triggers ovulation - Stimulates corpus luteum formation - Stimulates theca cells to produce androgens
7
Q
Where is follicle-stimulating hormone (FSH) produced?
A
- Anterior pituitary gland
8
Q
What are the functions of FSH?
A
- Stimulates follicle development in the ovaries - Stimulates granulosa cells to convert androgens to oestrogen
9
Q
Where is gonadotropin-releasing hormone (GnRH) produced?
A
- Hypothalamus
10
Q
What are the functions of GnRH?
A
- Stimulates the anterior pituitary to release LH and FSH - Regulated by negative feedback from oestrogen and progesterone
11
Q
Where is prolactin produced?
A
- Anterior pituitary gland
12
Q
What are the functions of prolactin?
A
- Stimulates milk production - Inhibits GnRH release (suppressing ovulation during breastfeeding)
13
Q
Where is human chorionic gonadotropin (hCG) produced?
A
- Syncytiotrophoblasts of the placenta
14
Q
What are the functions of hCG?
A
- Maintains the corpus luteum in early pregnancy - Stimulates progesterone production
15
Q
Where is oxytocin produced and stored?
A
- Produced in the hypothalamus - Stored in the posterior pituitary gland
16
Q
What are the functions of oxytocin?
A
- Stimulates uterine contractions during labour - Stimulates milk ejection (let-down reflex) - Promotes bonding and social attachment
17
Q
What hormonal changes occur in menopause?
A
- Oestrogen and progesterone levels fall
- FSH and LH levels rise due to loss of negative feedback
18
Q
How do hormonal contraceptives work?
A
- Combined oral contraceptive pill: Oestrogen and progesterone inhibit FSH and LH, preventing ovulation
- Progesterone-only pill: Thickens cervical mucus and thins endometrial lining
19
Q
What is puberty?
A
- The process of physical and hormonal changes leading to sexual maturity and reproductive capability.
20
Q
What is the average age of puberty onset in females?
A
- Between 8 and 13 years.
21
Q
What is the average age of puberty onset in males?
A
- Between 9 and 14 years.
22
Q
What is the first sign of puberty in females?
A
- Breast development (thelarche).
23
Q
What is the first sign of puberty in males?
A
- Testicular enlargement.
24
Q
What are the key hormones involved in puberty?
A
- Gonadotropin-releasing hormone (GnRH)
- Luteinising hormone (LH)
- Follicle-stimulating hormone (FSH)
- Oestrogen (females) - Testosterone (males)
25
What is the role of GnRH in puberty?
- Released from the hypothalamus - Stimulates the anterior pituitary to release LH and FSH.
26
What is the role of LH and FSH in puberty?
- Stimulate the gonads to produce sex hormones (oestrogen and testosterone).
27
What are the Tanner stages?
- A classification system describing physical changes during puberty. - Divided into five stages (I–V) for breast, genital, and pubic hair development.
28
What is thelarche?
- The onset of breast development, usually the first sign of puberty in females.
29
What is pubarche?
- The appearance of pubic and axillary hair.
30
What is menarche?
- The onset of menstruation, occurring later in puberty after breast and pubic hair development.
31
What is adrenarche?
- The increase in adrenal androgen production, leading to pubic and axillary hair growth.
32
What is spermarche?
- The first ejaculation, marking reproductive maturity in males.
33
What factors influence the timing of puberty?
- Genetics (strongest influence) - Nutrition and body weight - Chronic illness or endocrine disorders - Environmental factors
34
What is precocious puberty?
- Puberty onset before age 8 in females or 9 in males.
35
What are the causes of precocious puberty?
- Idiopathic (most common)
- - Central (gonadotropin-dependent, e.g. brain tumours)
- - Peripheral (gonadotropin-independent, e.g. ovarian/testicular tumours, congenital adrenal hyperplasia)
36
What is delayed puberty?
- Absence of puberty signs by age 13 in females or 14 in males.
37
What are the causes of delayed puberty?
- Constitutional delay (most common) - Chronic illness (e.g. cystic fibrosis, inflammatory bowel disease) - Hypogonadotropic hypogonadism (e.g. Kallmann syndrome) - Hypergonadotropic hypogonadism (e.g. Turner or Klinefelter syndrome)
38
What is constitutional delay of puberty?
- A normal variant where puberty is delayed but eventually progresses. - Often familial.
39
How is delayed puberty managed?
- Treat underlying cause if present - Reassurance if constitutional delay - Hormonal therapy (e.g. oestrogen or testosterone) in some cases
40
What is the placenta?
- A temporary organ that develops during pregnancy. - Provides oxygen, nutrients, and waste removal for the fetus.
41
What are the main functions of the placenta?
- Gas exchange - Nutrient transfer - Waste elimination - Hormone production - Immune protection
42
What nutrients are transferred across the placenta?
- Glucose (via facilitated diffusion) - Amino acids - Fatty acids - Vitamins and minerals
43
How does the placenta eliminate fetal waste?
- Metabolic waste (CO₂, urea, bilirubin) diffuses into maternal circulation for excretion.
44
What hormones are produced by the placenta?
- Human chorionic gonadotropin (hCG)
- Progesterone - Oestrogen
- Human placental lactogen (hPL)
45
What is the role of hCG?
- Maintains the corpus luteum in early pregnancy. - Supports progesterone production.
46
What is the role of progesterone in pregnancy?
- Maintains the endometrium. - Inhibits uterine contractions. - Supports fetal development.
47
What is the role of oestrogen in pregnancy?
- Stimulates uterine growth. - Prepares breasts for lactation. - Increases blood flow to the placenta.
48
What is the role of human placental lactogen (hPL)?
- Promotes maternal insulin resistance. - Increases glucose availability for the fetus. - Supports breast development.
49
How does the placenta provide immune protection?
- Transfers maternal IgG antibodies to the fetus. - Provides passive immunity.
50
Which infections cross the placenta?
rubella, CMV, toxoplasmosis can cross and cause congenital disease.
51
What is placental insufficiency?
- Inadequate placental function leading to fetal growth restriction and hypoxia.
52
What factors can cause placental insufficiency?
- Hypertension - Pre-eclampsia - Smoking - Diabetes - Placental abruption
53
What is placental abruption?
- Premature separation of the placenta from the uterine wall. - Can cause bleeding, fetal distress, or stillbirth.
54
What is placenta praevia?
- Low-lying placenta covering the cervix. - Can cause painless vaginal bleeding in pregnancy.
55
What happens during the follicular phase?
- Starts on day 1 of menstruation and lasts until ovulation. - FSH stimulates follicle growth in the ovary. - Maturing follicles produce oestrogen. - Oestrogen thickens the endometrium.
56
What triggers ovulation?
- A surge in LH levels, usually around day 14 of a 28-day cycle.
57
What happens during ovulation?
- The dominant follicle releases a mature egg (ovum) into the fallopian tube. - This is the most fertile phase of the cycle.
58
What happens during the luteal phase?
- The ruptured follicle forms the corpus luteum, which secretes progesterone.
- Progesterone stabilises the endometrium for potential implantation.
- If no pregnancy occurs, the corpus luteum degenerates, progesterone falls, and menstruation begins.
59
What happens if fertilisation occurs?
- The embryo secretes human chorionic gonadotropin (hCG). - hCG maintains the corpus luteum, keeping progesterone levels high to sustain pregnancy.
60
What is the function of the corpus luteum?
- A temporary endocrine structure that produces progesterone to support early pregnancy.
61
Why does menstruation occur?
- If no pregnancy occurs, progesterone levels drop. - The endometrial lining sheds, resulting in menstrual bleeding.
62
What is the normal blood loss during menstruation?
- 30–80 mL.
63
What is menorrhagia?
- Heavy menstrual bleeding exceeding 80 mL per cycle.
64
What is oligomenorrhoea?
- Infrequent menstrual cycles (intervals >35 days).
65
What is amenorrhoea?
- Absence of menstruation for >6 months (secondary) or failure to start menstruation (primary).
66
What are the three stages of labour?
- First stage: Cervical dilation and effacement. - Second stage: Expulsion of the fetus. - Third stage: Delivery of the placenta.
67
What happens during the first stage of labour?
- Early phase: Regular contractions and cervical effacement. - Active phase: Rapid cervical dilation (≥4 cm). - Transition phase: Intense contractions and complete dilation (10 cm).
68
What are the signs of the first stage of labour?
- Regular, painful contractions. - Cervical dilation and effacement. - Loss of mucus plug and possible rupture of membranes.
69
What are the stages of the first stage of labour?
- Latent phase: Cervix dilates from 0–4 cm.
- Active phase: Cervix dilates from 4–10 cm.
70
What happens during the second stage of labour?
- Expulsion of the fetus. - Full cervical dilation (10 cm). - Mother pushes with contractions to deliver the baby.
71
What are the signs of the second stage of labour?
- Strong urges to push. - Crowning (baby’s head visible at the vaginal opening).
72
What happens during the third stage of labour?
- Delivery of the placenta. - Contractions continue to help expel the placenta.
73
What are the signs of the third stage of labour?
- Gush of blood. - Umbilical cord lengthens. - Uterine contraction and firming of the uterus.
74
What is the management of the first stage of labour?
- Pain relief (e.g., epidural, analgesics).
- Monitoring of fetal heart rate.
- Cervical checks to assess dilation.
75
What is the management of the second stage of labour?
- Support during pushing.
- Perineal support to prevent tearing. - Episiotomy if necessary.
- Monitoring of fetal heart rate.
76
What is the management of the third stage of labour?
- Active management: Oxytocin administration to prevent postpartum hemorrhage.
- Controlled cord traction to deliver the placenta.
77
What are the signs of obstructed labour?
- Prolonged labour (over 12-18 hours).
- Failure of cervical dilation.
- Fetal distress.
78
What is the definition of prolonged labour?
- Latent phase >20 hours, active phase >12 hours for primigravidas.
- Latent phase >14 hours, active phase >8 hours for multigravidas.
79
What is the management of obstructed labour?
- Caesarean section (C-section) if vaginal delivery is not possible.
80
What are the possible complications during labour?
- Fetal distress. - Shoulder dystocia. - Postpartum hemorrhage. - Uterine rupture.
81
What is fetal distress during labour?
- Abnormal fetal heart rate (bradycardia or tachycardia).
- Lack of variability or decelerations.
82
What is shoulder dystocia?
- Difficulty delivering the fetal shoulders after the head is born. - Requires specific manoeuvres (e.g., McRoberts maneuver).
83
What is postpartum hemorrhage?
- Blood loss >500 mL after vaginal birth or >1000 mL after caesarean section.
- Can be caused by uterine atony, retained placenta, or trauma.
84
What are the risk factors for postpartum hemorrhage?
- Multiple gestations.
- Prolonged labour or rapid delivery.
- Previous PPH.
- Uterine atony.
85
What is the management of postpartum hemorrhage?
- Uterotonic drugs (e.g., **oxytocin**).
- Manual removal of placenta if retained.
- Surgical interventions (e.g., curettage, hysterectomy).
86
What is uterine rupture during labour?
- A tear in the uterine wall, often at the site of a previous caesarean section.
- Can lead to fetal and maternal distress.
87
What is the role of the fetal heart rate monitoring during labour?
- To assess fetal well-being. - Continuous monitoring helps detect signs of fetal distress early.
88
What is cervical cancer?
The most common female malignancy in younger females (<45), heavily associated with HPV infection.
89
What are the most common histological types of cervical cancer?
Squamous cell carcinoma (80%) and adenocarcinoma.
90
Which HPV types are associated with cervical cancer?
HPV 16, 18, 33 (not HPV 6 and 11, which are linked to genital warts).
91
Why is the HPV vaccine offered to both boys and girls before sexual activity?
To reduce HPV transmission and prevent HPV-associated cancers, including cervical cancer.
92
What are the risk factors for cervical cancer?
- HPV infection (**16,18,33**)
- COCP use
- Smoking
- HIV
- Increased sexual activity (early first intercourse, multiple partners, high parity)
- Lower socioeconomic
93
What are the clinical features of cervical cancer?
- Abnormal PV bleeding (post-coital or intermenstrual)
- Pelvic pain
- Dyspareunia
94
What might be found on examination in cervical cancer?
Abnormal vaginal discharge
95
What is the UK cervical cancer screening schedule?
- 25-49 years → Every 3 years
- 50-64 --> 5 years
- 65+ → Only if abnormal previous results
96
How should cervical screening be delayed in pregnancy?
Smear tests should be delayed 3 months postpartum.
97
What happens if an inadequate smear test is taken?
- Repeat in 3 months
- If 2 inadequate results → Refer for colposcopy
98
How is HPV screening interpreted?
- HPV-negative → No cytology, normal recall schedule
- HPV-positive → Cytology performed
99
What happens if cytology is abnormal in an HPV-positive smear?
Refer for colposcopy (includes borderline, low/moderate/severe dyskaryosis, and worse).
100
What happens if cytology is normal in an HPV-positive smear?
- 1st repeat smear in 12 months
- If now HPV-negative → Normal recall schedule
- If still HPV-positive, repeat again at 24 months
- If HPV-positive at 24 months → Refer for colposcopy
101
What is CIN (Cervical Intraepithelial Neoplasia)?
A pre-malignant dysplasia of cervical cells, found on colposcopy (not smear test).
102
How is CIN classified?
- CIN 1 – Mild dysplasia
-CIN 2 - Moderate dysplasia
-CIN 3 - Severe dysplasia
103
What is the FIGO staging of cervical cancer?
- Stage 1 – Confined to cervix
- Stage 2 - invades uterus or upper vagina
- Stage 3 - invades pelvic wall or lower vagina
- Stage 4 - invades bladder, rectum, or beyond pelvis
104
What is the management of CIN and early cervical cancer?
CIN or early Stage 1A → Cone biopsy or LLETZ (large loop excision of transformation zone)
105
What is the management for Stage 1-2 cervical cancer?
Radical hysterectomy with removal of local lymph nodes.
106
What is the management for Stage 3 to early Stage 4 cervical cancer?
Chemotherapy and radiotherapy.
107
How is advanced Stage 4 cervical cancer managed?
Chemotherapy and radiotherapy, with possible palliative care or pelvic exenteration surgery.
108
What is ovarian cancer?
5th most common female malignancy, often asymptomatic and non-specific, leading to poor prognosis.
109
What are the main classifications/types of ovarian cancer?
* Epithelial (90%) – most common subtype is serous (80%)
* Germ cell tumours (AFP & HCG markers)
* Sex cord-stromal tumours
* Krukenberg tumour (GI metastasis with signet ring cells).
110
What genetic mutations are associated with ovarian cancer?
BRCA1/BRCA2 genes.
111
What factors increase the risk of ovarian cancer?
Increased ovulations (early menarche, late menopause, nulliparity), age 60+, obesity, genetics (BRCA1/2).
112
What contraceptive is protective against ovarian cancer?
COCP (combined oral contraceptive pill).
113
What are the key clinical features of ovarian cancer?
Bloating, abdominal/pelvic pain, urinary symptoms (urgency), GI changes.
114
For ovarian When should an urgent 2WW referral be made?
If an abdominal/pelvic mass or ascites is found.
115
What is the first-line investigation for suspected ovarian cancer?
CA125 blood test – if >35, proceed to urgent abdominal/pelvic USS.
116
What is the next step if an ovarian mass is found on imaging?
Calculate the Risk of Malignancy Index (RMI) and consider diagnostic laparotomy.
117
What is the prognosis of ovarian cancer?
Poor prognosis, with an overall 5-year survival <50%.
118
What is the management of ovarian cancer?
MDT approach with surgery, chemotherapy, and radiotherapy.
119
What is endometrial cancer, and who is most commonly affected?
A cancer of the endometrium, most common in postmenopausal women (75% of cases).
120
How does COCP affect endometrial cancer risk?
COCP is protective.
121
What are the main risk factors for endometrial cancer?
- Obesity
-DM
-Nulliparity
-Early menarche
-Late menopause
-PCOS
-Unopposed oestrogen therapy
-HNPCC
-Tamoxifen
122
What is the most common presenting complaint in endometrial cancer?
Postmenopausal vaginal bleeding (bleeding >12 months after menopause).
123
Is endometrial cancer typically painful?
No, it is normally not painful.
124
What are the main differential diagnoses for postmenopausal vaginal bleeding?
- Atrophic vaginitis
-Endometrial hyperplasia
-Endometrial/cervical polyps
125
What is the first-line investigation for postmenopausal bleeding in women >55?
Urgent 2WW referral for transvaginal ultrasound (TVUSS).
126
What TVUSS finding suggests endometrial cancer?
Endometrial thickness >4mm.
127
What is the next step if TVUSS is suspicious for endometrial cancer?
Hysteroscopy with endometrial biopsy.
128
What is the mainstay of treatment for endometrial cancer?
Surgical management via:
-Total abdo hysterectomy
-Bilateral salingoophorectomy
+/- post op radiotherapy
129
What is the most common type of vulval cancer?
Squamous cell carcinoma (80%).
130
What are the key risk factors for vulval cancer?
- Age >65
-HPV
-Immunosuppresion
131
How does vulval cancer typically present?
- Lump/ulcer in the labia, which may be itchy
-Inguinal lymphadenopathy
132
What is the management for vulval cancer?
MDT approach with surgery, chemotherapy, and/or radiotherapy.
133
What is Pelvic Inflammatory Disease (PID)?
Infection and inflammation of the female pelvic organs (uterus, fallopian tubes, ovaries, and surrounding peritoneum).
134
What causes PID?
Ascending cervical infection, commonly caused by Chlamydia trachomatis, Neisseria gonorrhoeae, or Mycoplasma.
135
What are the clinical features of PID?
- PC: Low abdominal pain, menstrual irregularity, dyspareunia, dysuria.
- O/E: Cervical excitation (tender on palpation), fever, discharge.
136
What investigations are done for PID?
- High vaginal swab (often negative)
- Chlamydia/Gonorrhea screen
137
What is the treatment for PID?
- Option 1: Oral ofloxacin + oral metronidazole
- Option 2: IM ceftriaxone + oral doxycycline + oral metronidazole
138
What are the complications of PID?
- Infertility (10-20% after 1 episode)
-Ectopic
- Chronic pain
- Perihepatitis (Fitz-Hugh Curtis Syndrome - RUQ pain)
139
What is Vulvovaginal Candidiasis?
A very common vaginal yeast infection, also known as Thrush.
140
What causes Vulvovaginal Candidiasis?
Most commonly caused by Candida albicans (80%), but other Candida species can also be responsible.
141
What are the risk factors for Vulvovaginal Candidiasis?
- Diabetes (DM)
- Antibiotics and steroids
- Pregnancy
- Immunosuppression (HIV)
142
What are the clinical features of Vulvovaginal Candidiasis?
- PC: Vulvitis with superficial dysuria and dyspareunia.
- O/E: Non-offensive, white curdy discharge (cottage cheese), vulval erythema.
143
How is Vulvovaginal Candidiasis diagnosed?
Primarily clinical diagnosis.
High Vaginal Swab if unsure
For recurrent cases (4+ episodes/year), consider testing for diabetes (bG).
144
What is the treatment for Vulvovaginal Candidiasis?
- Non-pregnant: Oral fluconazole (1 dose)
- 2nd line: PV clotrimazole (pessary)
- Pregnant: Only local treatments (cream/pessary).
145
What is the treatment for recurrent Vulvovaginal Candidiasis?
Induction-maintenance regime:
Induction: 1 daily dose of oral fluconazole for 3 days.
Maintenance: 1 weekly dose for 6 weeks.
146
What is Bacterial Vaginosis (BV)?
A sexually associated condition (not an STI) caused by an overgrowth of vaginal bacteria, commonly affecting sexually active individuals.
147
What causes Bacterial Vaginosis?
Overgrowth of Gardnerella vaginalis, which leads to decreased lactic acid production and an increased vaginal pH.
148
What are the clinical features of Bacterial Vaginosis?
- PC: Offensive (fishy) white thin discharge.
- O/E: pH > 4.5
149
How is Bacterial Vaginosis diagnosed?
- Ix: Microscopy revealing epithelial clue cells.
150
What is the treatment for Bacterial Vaginosis?
- Asymptomatic: Do not treat.
- Symptomatic: Oral metronidazole (1st line).
- 2nd line: Topical clindamycin.
151
What is Trichomoniasis?
An STI caused by the Trichomonas vaginalis parasite, a flagellated protozoan parasite.
152
What are the clinical features of Trichomoniasis?
- PC: Vulvovaginitis (inflammation of vulva causing redness, itching, and pain).
- O/E: Offensive green-yellow frothy discharge, strawberry cervix, pH > 4.5.
153
How is Trichomoniasis diagnosed?
- Ix: Microscopy revealing motile trophozoites.
154
What is the treatment for Trichomoniasis?
- Oral metronidazole.
155
How is Syphilis treated?
Painless ulcer → IM benzathine benzylpenicillin.
156
How is Herpes treated?
Painful ulcer → Antivirals (aciclovir).
157
What is the difference between vulvovaginal and high vaginal swabs?
- Vulvovaginal swab (low vaginal) is used for Chlamydia and Gonorrhoea.
- High vaginal swab is used for BV, Trichomonas, Candida, GBS.
158
What is the most common STI in the UK?
Chlamydia - 50-70% are asymptomatic. If symptomatic: discharge, dysuria, PV bleeding.
159
How is Chlamydia diagnosed?
Nucleic Acid Amplification Test (NAAT):
Male - urine sample
Female - vulvovaginal swab
160
What is the treatment for Chlamydia?
Doxycycline.
If pregnant: azithromycin/erythromycin or amoxicillin.
161
How is Gonorrhoea treated?
IM Ceftriaxone (single dose).
If not available: oral cefixime + oral azithromycin (both single doses).
162
What is a complication of untreated Gonorrhoea?
Disseminated Gonococcal Infection (DGI) can lead to:
-Dermatitis (rash/lesion)
-Migratory polyarthritis (painful joints)
-Tenosynovitis (tendon swelling)
163
What is menopause?
The cessation of menstruation due to a drop in oestrogen and progesterone, typically occurring at an average age of 51 years.
164
What are the features of menopause?
- Vasomotor symptoms: hot flushes, night sweats, insomnia
-Oligomenorrhea and amenorrhea
-Urogenital: dryness, urinary symptpoms
-Psychiatric - anxiety, depression, memory
Long term ↑ cardiovascular risk, ↑ osteoporosis risk
165
What are the lifestyle management options for menopause?
- Sleep improvements
-Exercise
-Weight loss
-diet
166
What non-HRT therapies can be used for menopause symptoms?
- Dryness: lubricants
- Vasomotor symptoms: fluoxetine, citalopram, venlafaxine
-Psychiatric: CBT
167
When is Hormone Replacement Therapy (HRT) indicated?
- Vasomotor symptoms
-Premature menopause - HRT until the age of 50
168
What are the types of HRT?
- Combined: oestrogen + progesterone (e.g., dydrogesterone, norethisterone, levonorgestrel)
- Oestrogen only (e.g., estradiol) for women without a womb
169
What are the types of combined HRT?
- Sequential (cyclical): oestrogen every day, progesterone for the last 14 days (for women with LMP < 1 year)
- Continuous: both hormones every day (for women with LMP > 1 year)
170
What are the formulations of HRT?
- Oral
- Transdermal (first-line if VTE risk is elevated): patch, gel
171
What are the side effects of HRT?
- Nausea
- Weight gain
-Breast tenderness
172
What are the benefits of HRT?
- Prevents osteoporosis
-Imroves cardiovascular health
-Reduces muscle loss
-Alleviates symptoms
173
What are the drawbacks of HRT?
- Increased VTE risk (especially in oral formulation)
- Increased breast cancer risk (progesterone increases risk further, but risk declines after HRT stops)
-Increased stroke risk
- Endometrial cancer risk (if oestrogen-only in a woman with a womb)
174
What is polycystic ovary syndrome (PCOS)?
A complex ovarian dysfunction characterized by multiple ovarian cysts in women of reproductive age.
175
What is the pathophysiology of PCOS?
The exact cause is poorly understood but involves ↑ insulin and ↑ LH.
176
What are the clinical features of PCOS?
- Oligomenorrhoea or amenorrhoea
- Hirsutism (abnormal hair growth) & acne
- Sub/infertility
- ↑ weight
177
What are the signs on examination for PCOS?
- Rash: acanthosis nigricans
178
What are the key investigations for PCOS?
- Pelvic USS: multiple ovarian cysts
- LH, FSH: ↑, with LH much higher than FSH
- Prolactin: normal/↑
- Testosterone: normal/↑ (if very high, consider another cause)
-bG
179
What are the diagnostic criteria for PCOS?
Rotterdam criteria: must meet 2+ of the following:
-Infrequent or no ovulation
- Signs of hyperandrogenism (hirsutism, acne, ↑ testosterone)
- Polycystic ovaries on USS
179
What is the conservative management for PCOS?
- Weight loss
180
What is the treatment for hirsutism and acne in PCOS?
COCP (Combined oral contraceptive pill)
- If risk factors, consider MIRENA
181
What is the treatment for infertility in PCOS?
- Metformin and/or Clomifene
- Metformin is preferred if weight is ↑↑
182
What is premature menopause?
Onset of menopausal symptoms before the age of 40, also known as Premature Ovarian Failure.
183
What are the causes of premature menopause?
- Idiopathic (most common)
- Bilateral oophorectomy
- Radio/chemotherapy
- Autoimmune disorders
184
What are the clinical features of premature menopause?
- Menopausal symptoms: hot flushes, night sweats, vaginal dryness
- Secondary amenorrhoea (period stops)
- Infertility
185
What are the key investigations for premature menopause?
- ↑ FSH and LH
- FSH > 30 to confirm
- Repeat FSH 4-6 weeks after initial test to confirm diagnosis
186
What is the management for premature menopause?
- HRT or COCP until the average menopausal age (51 years)
187
What is the prevalence of infertility?
It affects 1 in 7 couples.
188
What is the likelihood of conception over time?
- 84% conceive in 1 year
- 92% conceive in 2 years
189
What are the most common causes of infertility?
- Sperm problems (30%)
- Ovulation problems (25%)
- A mix of male and female factors in the majority of cases.
190
What are the key investigations for infertility?
- Semen analysis
- Serum progesterone (7 days prior to expected period start, day 21)
- USS scans for uterine/tubal abnormalities
- LH/FSH tests
191
How is serum progesterone used in infertility diagnosis?
- <16: repeat; if consistently low, refer
- 16-30: repeat
- >30: indicates normal ovulation
192
What does LH/FSH indicate in infertility testing?
- ↑ FSH: poor ovarian reserve
- ↑ LH: possible PCOS
193
What is the management for infertility?
- Folic acid supplementation
- Reduce BMI if high
- Regular sexual intercourse every 2 to 3 days
- Smoking/drinking advice
194
What is the definition of amenorrhea?
Amenorrhea is the absence of menstruation, and oligomenorrhea refers to irregular bleeding.
195
What is primary amenorrhea?
Primary amenorrhea is the failure to establish initial menarche by age 15 (if secondary sexual features are present) or age 13 (if secondary sexual features are absent).
196
What are common causes of primary amenorrhea?
- Turner’s syndrome: ↑ FSH/LH, webbed neck, short stature, wide nipples
- Androgen insensitivity syndrome: X-linked, raised testosterone
- Imperforate hymen
- Congenital adrenal hyperplasia
197
What is Androgen Insensitivity Syndrome?
- An X-linked recessive condition
- Primary amenorrhea despite having female external genitalia
- No axillary or pubic hair
- Raised testosterone
- Treatment: raise as female, bilateral orchidectomy, oestrogen therapy
198
What is secondary amenorrhea?
Secondary amenorrhea refers to the cessation of menstruation in a previously menstruating female for 3-6 months.
199
What are common causes of secondary amenorrhea?
- Hypothalamic hypogonadism: stress, excessive exercise, anorexia
- PCOS
- Premature ovarian insufficiency/failure
- Hyperprolactinaemia
- Hyperthyroid
200
What investigations are used for amenorrhea?
- Exclude pregnancy (urinary/serum bHCG)
- FBC, U&E, Coeliac screen, TFTs
- Prolactin, androgen levels
- LH/FSH levels (↑ suggests ovarian cause, ↓ suggests hypothalamic cause)
201
What is the treatment for amenorrhea?
Treat the underlying cause
202
What is the definition of pelvic organ prolapse?
Pelvic organ prolapse is a very common gynecological condition in post-menopausal women, affecting around 40%. It involves the descent of pelvic organs (e.g., bladder, rectum, uterus).
203
What are the risk factors for pelvic organ prolapse?
- Obesity
-Multiparity
-Age
204
- Age
205
What are the clinical features of pelvic organ prolapse?
PC (Patient Complaints):
- Sensation of pressure/heaviness
- Urinary symptoms: incontinence, frequency, urgency
206
Types of prolapse?
- Cystocele (prolapsed bladder)
- Cystourethrocele (prolapsed bladder and urethra)
- Rectocele (rectal prolapse)
- Uterine prolapse
207
What are common treatments for pelvic organ prolapse?
Conservative treatment:
Weight loss
Pelvic floor muscle exercises
Other treatments
Pessary
Surgical
208
What investigations are helpful in diagnosing pelvic organ prolapse?
Physical examination and often imaging (such as pelvic ultrasound) to assess the extent of prolapse, though physical findings are typically sufficient for diagnosis.
209
What is the definition of ovarian torsion?
Ovarian torsion is the complete or partial turning of the ovaries on its ligaments, leading to compromised blood supply.
If the fallopian tubes are involved, it's termed adnexal torsion.
210
What are the risk factors for ovarian torsion?
- Ovarian mass (90%), often a cyst (complex/multi-lobulated cysts may require biopsy)
Pregnancy
Reproductive age
211
What are the clinical features of ovarian torsion?
PC (Patient Complaints):
-Sudden onsewnt of deep colicky abdo pain
N&V
212
What are common physical exam findings in ovarian torsion?
O/E (On Examination):
Adenexal tenderness
213
What investigations are useful in diagnosing ovarian torsion?
Transvaginal ultrasound (USS) to look for the whirlpool sign (indicating twisting of the ovary) and possible free fluid in the pelvis.
214
What is the treatment for ovarian torsion?
Surgical management via laparoscopy to untwist the ovary and assess the blood supply.
215
What is the definition of adenomyosis?
Adenomyosis is the presence of endometrial tissue within the myometrium (the muscular layer of the uterus).
216
What are the risk factors for adenomyosis?
- Multiparity (having multiple pregnancies)
- End of reproductive years (typically ages 30+)
217
What are the clinical features of adenomyosis?
PC (Patient Complaints):
- Dysmenorrhoea (painful periods, typically a few days before menstruation)
- Menorrhagia (heavy bleeding)
218
What are the physical exam findings for adenomyosis?
O/E (On Examination):
Large, boggy uterus
219
What investigations are used for diagnosing adenomyosis?
Transvaginal ultrasound (USS) is 1st line. If not feasible, MRI can be used.
220
What is the definitive treatment for adenomyosis?
Hysterectomy is the definitive treatment for adenomyosis.
221
What are the options for symptomatic management of adenomyosis?
- TXA for managing menorrhagia (heavy bleeding)
- Mirena (IUS, a form of intrauterine contraception)
- GnRH agonists to reduce symptoms
222
What is the definition of endometriosis?
Endometriosis is a common gynecological condition where endometrial tissue grows outside the uterus.
223
What is the pathophysiology of endometriosis?
Endometriosis is responsive to oestrogen, causing the tissue to behave like normal endometrial tissue, shedding and causing inflammation.
224
What are the clinical features of endometriosis?
PC (Patient Complaints):
Chronic pelvic pain
Dysmenorrhea (pain pre period)
Dyspareunia (painful sex)
Subferility
- Non-gynecological symptoms (painful defecation, urinary symptoms like frequency/urgency)
225
What investigations are used to diagnose endometriosis?
- Laparoscopy (gold standard)
- MRI (alternative, may detect advanced disease)
226
What is the first-line management for endometriosis?
- Symptom treatment with NSAIDs or paracetamol
- 2nd line: COCP (combined oral contraceptive pill)
227
What should be done if analgesia or COCP is ineffective?
Referral to specialist for:
- GnRH analogues (reduce oestrogen levels and impact endometrial tissue)
- Surgical management: Laparoscopic excision or ablation of endometriosis
228
What is the definition of uterine fibroids?
Uterine fibroids are benign smooth muscle tumors of the uterus. They may be asymptomatic and normally regress after menopause.
229
What are the risk factors for uterine fibroids?
- Afro-Caribbean descent
-Post pubery
230
What are the clinical features of uterine fibroids?
PC (Patient Complaints):
- Menorrhagia (heavy bleeding) with possible IDA
- Bulk-related symptoms: bloating, urinary frequency, low crampy abdominal pain
-Subferility
231
What are the findings on examination for uterine fibroids?
Mass on pelvic examination
232
What investigations are used to diagnose uterine fibroids?
Transvaginal USS (Ultrasound)
233
What is the management for asymptomatic uterine fibroids?
Conservative management with monitoring
234
What is the management for menorrhagia in uterine fibroids?
- Levonorgestrel IUD (e.g., MIRENA)
- NSAIDs (e.g., mefenamic acid)
-COCP
235
What is the management for fibroids?
Medical: GnRH agonists (e.g., leuprorelin) to shrink fibroids (short-term due to menopause-like side effects)
Surgical
Myomectomy (fibroid removal)
-if FH consider hysterectomy
236
What is the definition of dysmenorrhoea?
Dysmenorrhoea is excessive pain during menstruation, thought to be due to excessive prostaglandin production, leading to uterine contractions (cramping).
237
What are the classifications of dysmenorrhoea?
Primary: No underlying pelvic pathology.
Secondary: Due to underlying pathology such as endometriosis, adenomyosis, fibroids, copper IUD, PID.
238
What is the timing of primary dysmenorrhoea?
Occurs within 1-2 years of menarche and cramping pain begins just before or with the start of the period.
239
What is the management for primary dysmenorrhoea?
1st line: NSAIDs (e.g., mefenamic acid, ibuprofen)
2nd line: COCP (Combined Oral Contraceptive Pill)
240
What is the timing of secondary dysmenorrhoea?
Occurs many years after menarche and pain starts 3-4 days before the period.
241
What is the management for secondary dysmenorrhoea?
Refer to gynae for further investigation. Mirena may help.
242
What are the common causes of secondary dysmenorrhoea?
- Endometriosis
-Adenomyosis
-Fibroids
-Copper IUD
-PID
243
How do NSAIDs work in treating dysmenorrhoea?
NSAIDs inhibit prostaglandin production, which increases uterine contractions (cramping), thereby alleviating the pain.
244
What is the definition of menorrhagia?
Menorrhagia is excessive menstrual bleeding, often with a significant increase in flow and duration. Oligomenorrhoea is irregular bleeding, and amenorrhoea is the absence of menstruation.
245
What are the common causes of menorrhagia?
- Dysfunctional uterine bleeding (50%)
-fibroids
-HyPOthyoroidism
-PID
- Bleeding disorders (e.g., Von Willebrand disease)
246
What investigations are done for menorrhagia?
- FBC to assess for anaemia.
- Transvaginal USS if there are abnormal symptoms like pelvic pain, PCB (post-coital bleeding), IMB (intermenstrual bleeding), or abnormal abdominal exam.
247
What is the management for menorrhagia if contraception is not required?
- Tranexamic acid (TXA) to help blood clot and reduce bleeding.
- NSAIDs (e.g., mefenamic acid) to reduce prostaglandin production and bleeding.
248
What is the management for menorrhagia if contraception is required?
- 1st line: IUD (Mirena) - intrauterine device that releases progesterone.
- 2nd line: COCP (Combined Oral Contraceptive Pill).
- 3rd line: Long-acting progesterone (e.g., Depot Provera).
