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MSRA > OBGYN > Flashcards

OBGYN Flashcards

1
Q

What is involved in female hormone testing for infertility? What do they indicate?

A
  • Serum LH and FSH on day 2 to 5 of the cycle
  • Serum progesterone on day 21 of the cycle (or 7 days before the end of the cycle if not a 28-day cycle).
  • Anti-Mullerian hormone
  • Thyroid function tests when symptoms are suggestive
  • Prolactin (hyperprolactinaemia is a cause of anovulation) when symptoms of galactorrhea or amenorrhoea

High FSH = poor ovarian reserve

High LH = ?PCOS

Anti-Mullerian hormone indicates ovarian reserve

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2
Q

What imaging investigations can be done in female infertility?

A
  • Ultrasound pelvis to look for polycystic ovaries or any structural abnormalities in the uterus
  • Hysterosalpingogram to look at the patency of the fallopian tubes
  • Laparoscopy and dye test to look at the patency of the fallopian tubes, adhesions and endometriosis
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3
Q

What is the management of anovulation?

A
  • weight loss in PCOS
  • clomifene (stimulates ovulation)
  • letrozole 2nd
  • gonadotrophins if resistant to clomifene
  • ovarian drilling in PCOS
  • metformin if insulin sensitivity and obesity
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4
Q

How does clomifene work?

A

anti-oestrogen (selective oestrogen receptor modulator)
given on days 2-6 of cycle
stops negative feedback of oestrogen on hypothalamus => inc in GnRH => inc in FSH and LH

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4
Q

What is the management of tubal factors?

A
  • Tubal cannulation during a hysterosalpingogram
  • Laparoscopy to remove adhesions or endometriosis
  • In vitro fertilisation (IVF)
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5
Q

What is a suitable contraception in someone with breast cancer?

A

Avoid hormonal contraception, use copper coil or barrier method

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6
Q

What is a suitable contraception in someone with cervical or endometrial cancer?

A

Avoid intrauterine system e.g. Mirena coil

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7
Q

What is a suitable contraception in someone with Wilson’s disease?

A

Avoid copper coil

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8
Q

What are some contraindications for COCP?

A
  • Uncontrolled hypertension (particularly ≥160 / ≥100)
  • Migraine with aura
  • History of VTE
  • Aged over 35 smoking more than 15 cigarettes per day
  • Major surgery with prolonged immobility
  • Vascular disease or stroke
  • Ischaemic heart disease, cardiomyopathy or atrial fibrillation
  • Liver cirrhosis and liver tumours
  • Systemic lupus erythematosus and antiphospholipid syndrome
  • Breastfeeding before 6 weeks postpartum
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9
Q

How long after menopause is contraception still required?

A

2 years in women under 50 and 1 year in women over 50

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10
Q

What contraception should not be used in women over 50 and why?

A

progesterone injection (Depo-Provera) due to risk of osteoporosis

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11
Q

How long should amenorrhoeic women keep taking POP?

A
  • until FSH > 30 IU/L on 2 tests 6 wks apart then cont contraception for 1 more year OR
  • 55 years of age
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12
Q

How long before fertility returns after childbirth?

A

21 days

lactational amenorrhoea is 98% effective for up to 6 months (if fully breastfeeding)

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13
Q

What contraception can be used after childbirth?

A

POP and implant are safe at any time

Copper coil or Mirena coil can be inserted either within 48hrs of birth or 4 weeks after but not in between

COCP should be avoided in breastfeeding before 6 weeks post partum

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14
Q

How does COCP prevent pregnancy?

A
  • Preventing ovulation (this is the primary mechanism of action)
  • Progesterone thickens the cervical mucus
  • Progesterone inhibits proliferation of the endometrium, reducing the chance of successful implantation
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15
Q

How do oestrogen and progesterone affect the hypothalamus and anterior pituitary?

A

They suppress the release of GnRH, LH, and FSH through negative feedback.

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16
Q

Why are pills containing drospirenone (e.g., Yasmin) used for premenstrual syndrome?

A

Drospirenone has anti-mineralocorticoid and anti-androgen effects that help with bloating, water retention, and mood changes.

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17
Q

What COCP is used for treating acne and hirsutism, and why is its use limited?

A

Dianette (containing cyproterone acetate); it has a higher risk of venous thromboembolism (VTE) and is usually stopped after acne control.

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18
Q

What are the three common regimes for taking the COCP?

A

21 days on, 7 days off; 63 days on, 7 days off (tricycling); continuous use without a pill-free period.

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19
Q

How should the COCP be started to provide immediate contraceptive protection?

A

On the first day of the menstrual cycle.

20
Q

What is the protocol when switching from a traditional progesterone-only pill to the COCP?

A

Extra contraception (e.g., condoms) is required for 7 days.

21
Q

What are common side effects in the first three months of COCP use?

A

Unscheduled bleeding, breast pain, mood changes, headaches, and hypertension.

22
Q

What are the long-term risks associated with COCP use?

A

Small increased risk of venous thromboembolism, breast and cervical cancer, myocardial infarction, and stroke.

23
Q

What are some benefits of the COCP?

A

Effective contraception, rapid return of fertility, and reduced risks of endometrial, ovarian, and colon cancer.

24
Q

What BMI level is a relative contraindication (UKMEC 3) for the COCP?

A

A BMI above 35.

25
Q

What should be done if a woman misses one pill?

A

Take the missed pill as soon as possible, and no extra contraception is required if the other pills are taken correctly.

26
Q

What should be done if more than one pill is missed (72 hours since the last pill)?

A

Take the most recent missed pill and use additional contraception (e.g., condoms) for 7 days.

27
Q

When is emergency contraception required after missing more than one pill?

A

If more than one pill is missed between day 1 – 7 of the packet and unprotected sex has occurred.

28
Q

What is the only UKMEC 4 contraindication for using the POP?

A

Active breast cancer.

29
Q

What are the two types of progestogen-only pills?

A

Traditional POP (e.g., Norgeston, Noriday) and desogestrel-only POP (e.g., Cerazette).

30
Q

What is the time limit for taking the traditional POP and still being protected?

A

It must be taken within 3 hours of the scheduled time.

31
Q

What is the time limit for taking the desogestrel-only POP and still being protected?

A

It can be taken up to 12 hours late and still be effective.

32
Q

How do traditional progestogen-only pills work?

A

By thickening the cervical mucus, altering the endometrium, and reducing ciliary action in the fallopian tubes.

33
Q

What is the primary mechanism of action of the desogestrel-only pill?

A

Inhibiting ovulation

(+thickening the cervical mucus, altering the endometrium, and reducing ciliary action in the fallopian tubes)

34
Q

When does the POP provide immediate protection from pregnancy?

A

When started between day 1 to 5 of the menstrual cycle.

35
Q

How long does it take for the POP to thicken cervical mucus enough to prevent sperm entry?

A

48 hours.

36
Q

When switching from a COCP to a POP, when can the POP be started without extra contraception?

A

If the woman has taken the COCP consistently for more than 7 days or is on days 1-2 of the hormone-free period.

37
Q

What is the most common side effect of the POP?
What other side effects can occur with the POP?

A

Changes in the bleeding schedule (unscheduled bleeding).
Breast tenderness, headaches, and acne.

38
Q

What are the risks associated with the traditional POP?

A

Increased risk of ovarian cysts, small risk of ectopic pregnancy, and minimal increased risk of breast cancer.

39
Q

What should be done if a POP is missed?

A

Take the missed pill as soon as possible, continue with the next pill at the usual time, and use extra contraception for 48 hours.

40
Q

How often is the DMPA/progesterone-only injection given?

A

Every 12 to 13 weeks.

41
Q

How long can it take for fertility to return after stopping the DMPA?

A

Up to 12 months.

42
Q

What are the two versions of DMPA used in the UK?

A

Depo-Provera (intramuscular) and Sayana Press (subcutaneous, self-injectable).

43
Q

What is the UK MEC 4 contraindication for DMPA?

A

Active breast cancer.

44
Q

Name a few UK MEC 3 conditions where DMPA use is cautioned.

A

Ischaemic heart disease, stroke, unexplained vaginal bleeding, severe liver cirrhosis, liver cancer.

45
Q

Why is osteoporosis a concern with DMPA?

A

It decreases bone mineral density due to suppressed estrogen production.

46
Q

At what age is DMPA UK MEC 2, and when should women consider switching to an alternative?

A

MEC 2 for women over 45 years, and switching should occur by age 50.

47
Q

What is the main action of the DMPA injection? What other mechanisms contribute to DMPA’s contraceptive effects?

A

Inhibition of ovulation by suppressing FSH secretion from the pituitary gland.

Thickening cervical mucus and altering the endometrium.

48
Q
A

MSRA (16 decks)

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