Paediatric and Adult Gynaecology Flashcards
What is meant by Gillick competence?
- children under 16 can consent if they have sufficient understanding and intelligence to fully understand what is involved in a proposed treatment, including its purpose, nature, likely effects and risks, chances of success and the availability of other options
- if a child does not pass the Gillick test, parental or court consent is required
- in certain circumstances, a parent’s wish can over rule
What is the Fraser Guidline?
A doctor could proceed to give contraceptive advice and treatment to a girl under 16, provided they are satisfied on the following matters;
- the girl will understand the advice
- they cannot persuade her to inform her parents or allow them to inform her parents she is seeking contraceptive advice
- she is very likely to continue having sexual intercourse with or without contraception
- unless she receives contraceptive advice or treatment, her physical or mental health or both are likely to suffer
- her best interest require them to give her contraceptive advice, treatment or both without the parental consent
What endocrine changes occur during puberty?
- there is an inc. in pulsatile secretion of LH, from pituitary gland- in response to an inc. of pulsatile GnRH from hypothalamus at night
- this stimulates a rise in estradiol levels
- the physical changes are progressive and are described as the Tanner stages
What is precocious puberty + delayed puberty?
- appearance of secondary sexual characteristics, before age 8 in girls and age 9 in boys
- boys have no sign of testicular development by age 14 + girls have not started to develop breasts by age 13 OR have developed breasts but their periods have not started by age 15
What is menorrhagia?
- too frequent/irregular/heavy periods
- is common following menarche, due to anovulation
- is common is first 2 years of period, as HPO axis establishes regular cycles
- aquired and congenital bleeding disorder account for 10-15% of cases
What are the investigations + treatments for menorrhagia?
- von Willebrand disease + immune thrombocytopenic purpura should be excluded
- US but rarely shows any pathology
- OCP (most common)
- tranexamic acid
- mefenamic acid
- POP, Depo-Provera, Mirena IUD (considered)
What is dysmenorrhoea?
- pain during menstuation
- pain attributed to high levels of prosaglandins
- treat with anti-prostaglandin drugs (mefenamic acid) OR supress ovulation (OCP)
What is amenorrhoea?
- primary- failure of menstruation by age 16 in the presence of normal secondary sexual characteristics OR age 14 in the absence of other evidence of puberty
- secondary- absent periods for at least 6 months in a women who has previously had regular periods, OR 12 month if she previously had oligomenorrhoea (bleeds less frequently than six-weekly)
What are investigations for primary amenorrhoea?
- FSH, LH, PRL, TSH, testosterone, oestrogen
- pelvic US
- progesterone withdrawal bleed
- pregnancy
- not enough oestrogen
What is the treatment of puberty induction?
- gradual build up of oestrogen
- add progesterone
- once max. height potential is reached
- at least 20mg of oestrogen dose
What are some causes of secondary amenorrhoea?
- weight
- PCOS
- pregnancy/breast feeding
- fluctuating LH/oestrogen
- contraception
- early menopause
- endocrine disease
What is the treatment for secondary amenorrhoea?
- treat specific cause
- assume fertile and use contraception, unless 2 years after confirmed menopause
- premature ovarian insufficiency (POI)- HRT till 50 years
What are the investigations for PCOS?
- FSH:LH
- transabdominal US
diagnose with 2/3 of following;
- oligo/anovulation
- clincal/biochemical signs of hyperandrogenism
- polycystic ovaries on US/direct inspection
* other causes of hyperandrogenism should be excluded
What is the management for PCOS?
- weight loss/exercise for symptoms
- antiandrogen
- combined hormonal contraception (CHC)
- spironolactone
- eflornithine cream
- endometrial protection
- CHC
- progestogens
- Mirena IUS
- fertility
- clomiphene/metformin
What is the management of endometriosis in adolescent girls?
- if pelvic pain is refractory- NSAIDs + OCP
- diagnostic laparoscopy
* 38% of adolescents presenting with chronic pelvic pain have endometriosis
