Obs and Gynae history Flashcards
[gynae] MS COURS stand for
Menstrual Cycle
Sexual History
Contraception
Obstetric Hx
Urinary Sx
Rectal Sx
Smears (if >25)
[gynae] Menstrual cycle features
- LMP
- length and regularity
- abnormal bleeding
- heavy flow
- painful bleeding (dysmenorrhoea)
- pelvic pain
- post-menopausal bleeding
Why is LMP relevant?
Check for possible pregnancy
Why is length and regularity of the cycle important?
check for PCOS and dysfunctional uterine bleeding
Why is abnormal bleeding important?
- dysfunctional uterine bleeding
- STI
- PID
- cancer
- ectropion
what are the red flag types of bleeds and what do they possibly indicate?
1) inter-menstrual bleeding–> cervical cancer
2) post-coital bleeding –> STI, cervical cancer
3) post-menopausal bleeding–> endometrial cancer
why is heavy bleeding important?
- fibroids
- malignancy
- dysfunctional uterine bleeding
- clotting
why is dysmenorrhoea important?
- endometriosis
- adenomyosis
why is pelvic pain important?
- endometriosis
- chronic PID
- non-gynae causes e.g. GI, bladder
why is PMB important?
- atrophic vaginitis
- polyps
- cervical cancer
- endometrial cancer
How do you ask about LMP?
“When was your first day of your last period?”
How do you ask about length and regularity?
“Are your cycles regular?”
“how long are they and how often do you bleed for?”
How to quantify bleeding?
“How often do you have to change your pads in a day?” or “how many pads do you wear in a day?”
how do you ask about dysmenorrhoea?
“is there pain prior to the period starting or is there pain throughout?”
What does time of menarche and menopause tell you?
How long they’ve been exposed to oestrogen for.
Those with early menarche and late menopause are considered to be at increased risk to ovarian cancer (due to prolonged oestrogen exposure).
Late menopause is also a risk factor for endometrial cancer.
PCOS criteria of 3
need 2 of 3 for PCOS diagnosis
1) oligomenorrhoea/ anovulation (irregular periods)
2) hyperandrogenism (elevated levels of sex hormones/testosterone
3) PCO (multiple fluid filled sacs on USS)
why do fibroids present with heavy bleeding?
benign tumours of the myometrium (muscle tissue of the uterus)
why does endometriosis present with urinary and/or rectal sx sometimes?
Endometrial tissue outside of the uterus such as ovaries, bladder, rectum
what are the features of a sexual history?
- active
regular partners - dyspareunia
- pelvic pain
- discharge (smell, colour, consistency)
- STIs and treatments
- bleeding
why is regular partners important?
- STI risks
- Safeguarding (sex workers)
Why is dyspareunia important?
- endometriosis
- PID
- STI
explore whether deep or superficial
why is pelvic pain important in sexual history?
- chronic PID
- endometriosis
- non-gynae e.g. GI, bladder
why is discharge important?
- STI
- PID
how do you explore regular partners?
“in the las 6 months how many partners have you had”
Or
“are you sexually active with a regular partner”
what are causes of superficial dyspareunia?
STI e.g. gonorrhoea with cervicitis
what are causes of deep dyspareunia?
endometriosis
PID
what does yellow, thick, fishy discharge indicate?
trichomonas
what does white cottage cheese discharge indicate?
candida
features of exploring discharge?
Consistency: thick, thin, frothy
Colour: Yellow, white, colourless
Smell: Foul smelling or no smell
how do you explore STIs?
“have you been tested for STIs in the past, if yes what were the results”
(If the results are positive) “how were you treated?”
If they have had an STI test then you also want to make sure if they have had a change in partner since that test.
What are the features of a contraception history?
- current contraception
- safeguarding
- adherence
- symptoms or slide effects from contraception
