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Block 42 - Women's Health > Period problems > Flashcards

Period problems Flashcards

1
Q

Symptoms of PMS

A 
Psych:
Irritable
Tense
Dysphoria (unhappy)
A severe form of this is premenstrual dysphoric disorder where there's episodes of depression each month that responds to AD treatment

Physical:
Breast tenderness
Bloating
Headache

Behavioural:
Reduced visuospatial and cognitive ability
More frequent accidents.

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2
Q

6x gynaecological causes of menorrrhagia

A 
Fibroids
Endometriosis
Adenomyosis
PID
Endometrial polyps
Cancer of the womb
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3
Q

Menorrhagia management

A 
IUS is first line 
One of the acid is first line non hormonal	
Mefenamic is their is pain
Tranexamic if no pain
All women should get FBC
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4
Q

Whihc hormones cause increased fibroid growth?

A

Oestrogen and progesterone

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5
Q

4 types of fibroids (classification)

A

intramural
subserosal
submucosal
cervical

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6
Q

intramural fibroids definition

A

within myometrium

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7
Q

subserosal fibroids…

A

below peritoneal surface of uterus

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8
Q

submucosal fibroids …

A

beneath endometrial cavity - can distort uterine anatomy -> infertility

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9
Q

Which types of fibroids lead to infertility and recurrent miscarriage

A

submucosal and intramural

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10
Q

Sx fibroids

A

cramping, menorrhagia, bladder and bowel disregulation,

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11
Q

pregnancy fibroids Sx

A

foetal malpresentation, preterm labour, pph

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12
Q

Inidications for treatment in uterine fibroids (4)

A

excessive menstrual blood loss, pressure Sx, uterine cavity distortion, rapid growth (can be sarcomatous change)

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13
Q

Heavy bleeding in uterine fibroids management

A

1st - levonorgestrel releasing ius (not if cavity distorted)

Combined pill, tranexamic acid

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14
Q

Surgical management of uterine fibroids

A

myomectomy (if want kids)

hysterectomy (if not)

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15
Q

Endometriosis

A

when endometrial cells grow outside uterus

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16
Q

RF endometriosis

A

FH, oestrogen excess (low parity, early menarchem late menopause)

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17
Q

Sx endometriosis

A

fluctuate and worsen during menstrual phase.
subfertility, dysmenorrhea, chronic pelvic pain, menorrhagia, deep dyspareunia, pain on defecation (if in pouch of douglas), urinary Sx, abdo pain

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18
Q

endometriosis pelvic examination findings

A

reduced uterine motility, often fixed retroverted uterus tender nodularity, visible vaginal lesions, tender adnexal mass

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19
Q

Dx endometriosis

A

laparascopy, confirmed w biopsy

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20
Q

Mx endometriosis pain

A

NSAIDS, if helps then add hormonal (COCP, progesterone analogues)
if odesn’t help GnRH analogue to surpress growth of existing mass - consider HRT as causes pseudomenopause

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21
Q

adenomyosis - def, sx, mx

A

endometrial tissue within myometrium
causes painful heavy period and enlarged boggy uterus
managed GnRH agnoists/hysterectomy

22
Q

PID

A

ascending infection of upper female genital tract - common complication of lower infections ie chlamydia

23
Q

RF PID

A

under 25y, multiple sex partners, unprotected sex, copper IUD insertion recently

24
Q

PID Sx

A

severe lower abdo pain - can radiate to back or upper thigh
dyspareunia
menorraghia, IM spotting, irregular periods, pc bleeding
mucopurulent/blood stained discharge
fever

25
Q

us findings pid

A

dilated uterine tube or tubo ovarian abscess

26
Q

Mx PID

A

broad spec ab for anaerobic and aerobic - oral ofloxacin + metronidazole or IM ceftiaxone +doxycycline +metronidazole
consider removing IUD
surgical removal of abscess if continues to grow despite ab

27
Q

PID complications

A

10-20% chance infertility
chronic pelvic pain
pelvic adhesions
increased risk ectopic

28
Q

8 pathological causes of irregular bleeding and IM spotting

A

STI, recent miscarriage, hormone dysfunction (PCOS, menopause), vaginal dryness, cervical ectoprion/erosison, cancer (cervical, uterine, vaginal. vulval), polyps, fibroids

29
Q

charecteristics of PCOS (hormones)

A

increased LH, suppressed FSH -> suppressed normal menstrual cycle

30
Q

PCOS: implications of high LH

A

increased androgen production, converted by aldipose tissue to oestrogen - more commen in obese women with more aldipose tissue

31
Q

PCOS: implications of high oestrogen

A

no LH surge or FSH for follicular development -> anovulation and a/oligomenorrhea. Follicle becomes cystic/degenerates

32
Q

clinical features PCOS

A

menstual cycle disturbance, hyperandrogenism (hirsutism, acne, alopecia - bitemporal/male pattern baldness), obesity in 50% cases, acanthosis nigricans (increased insulin levels). mood swings/depression

33
Q

Rotterdam criteria

A

2 of following present for PCOS diagnosis:
infequent/absent periods
clinical features of hyperandrogenism or raised serum testosterone
USS evidence of >12 ovarian cysts

34
Q

PCOS Ix

A

bloods - LH:FSH ratio > 3:1 within first 5 days of menstual cycle. raised serum oestrogen, testosterone, androstenedione.
Imaging - pelvic USS

35
Q

Mx PCOS

A

weight loss, for fertility - clomiphene citrate induces ovulation (risk of multiple pregnancies) if not then gonadotrophs, metformin, COCP for hirsutism. surgical - ovarian drilling (less common)

36
Q

cervical ectropion definition

A

distal migration of cervical columnar epithelium outside cervix into normal squamous region, resulting in exposure to vagina acid

37
Q

cervical ectroprion causes

A

elevated oestrogen - COCP, pregnancy, lots of cycles, commonest cause of bleeding in last stages of pregnancy

38
Q

sx cervical ectroprion

A

spotting, vaginal discharge, post coital bleeding and pain

39
Q

how is menopause diagnosed

A

retrospectively when no periods for 12 mnths

40
Q

define perimenopause

A

from onset of Sx to 1 year after menopause, can happen up to 5 years before cessation of periods

41
Q

what causes perimenopause

A

GnRH, LH, and FSH levels increasing due to loss of negative feedback from reduced levels of oestrogen and progesterone

42
Q

Menopause physiology (hormone changes and reasons)

A

decrease in development of ovarian follicles -> reduced oestrogen production -> no negative feedback -> increased levels of FSH and LH

failing follicle development -> anovulation -> irregular menstrual cycles

No oestrogen -> endometrium doesnt develop -> amenorrhoea

43
Q

Which hormone causes perimoenopausal symtoms

A

low oestrogen

44
Q

Perimenopausal Sx

A

hot flushes, emotional lability/low mood, premenstrual syndrome, irregular periods, arthralgia/muscle pain, skin thinning and decreased elasticity, heavy/light periods, vaginal dryness/atrophy, reduced libido

45
Q

risks of menopause and low oestrogen

A

osteoporosis, CV risk (low oestrogen -> body fat alterations, increased BP, reduced glucose tolerance, endothelial dysfunction and vascular inflammation), pelvic organ prolapse, urinary incontinence

46
Q

When is FSH blood test recommended to diagnose menopause/perimenopause

A

women under 40 with suspected premature menopause, women aged 40-45 with menopausal Sx or change in menstrual cycle

47
Q

HRT contraindications

A

current/pmh breast cancer, any oestrogen sensitive cancer, undiagnosed vaginal bleeding, untreated endometrial hyperplasia

48
Q

Risks of HRT

A

VTE, stroke, IHD, breast/ovarian Ca

49
Q

Risk reduction in HRT

A

only give unopposed oestrogen if previous hysterectomy, transdermal is pmh VTE or at risk

50
Q

How long should

A

Block 42 - Women's Health (4 decks)

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