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medicine > Repro- TBL > Flashcards

Repro- TBL Flashcards

1
Q

Post menopausal bleeding?

A

aginal bleeding occurring after twelve months of amenorrhoea, in a woman of the age where the menopause can be expected

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2
Q

‘unscheduled bleeding’

A

non-cyclical bleeding still continuing six months after commencing HRT or after six months of amenorrhoea.

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3
Q

Postmenopausal bleeding could indicate what?

A

endometrial cancer

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4
Q

risk factors for endometrial cancer

A
  1. oestrogen only HRT
  2. early menarche or late menopause
  3. PCOS
  4. low parity or infertility
  5. Hypertension
  6. obesity combined with diabetes
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5
Q

protective factors for endometrial cancer

A
  1. smoking
  2. grand multiparity
  3. COCP
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6
Q

Aetiology of PMP vaginal bleeding

A 
vaginal atrophy
HRT 
endometrial hyperplasia
endometrial cancer
endometrial or cervical polyps 
cervical cancer 
ovarian cancer 
vaginal cancer (rare)
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7
Q

1st line investigation in PMP bleeding

A

transvaginal ultrasound scan

look at thickness

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8
Q

thickness in postmenopausal women that = ?endometrial cancer

A

> 5mm = 7.3% chance of endometrial cancer

if the thickness is less than 5mm but high clinical suspicion –> biopsy and hysteroscopy

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9
Q

what is Tamoxifen?

A

drug used to treat breast cancer that with long term use increases your risk of endometrial cancer.
people on this who have PMB –> normally have hysteroscopy and biopsy in addition to ultrasonography.

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10
Q

polycystic ovarian syndrome

A

very commonly seen in reproductive women, with 33% have polycystic ovaries on USS
majority of women with PCOS do not have symptoms and do not require intervention
PCOS AFFECTS 5-15% of people of reproductive age

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11
Q

pathophysiology of PCOS

A 
multifactorial.
essential changes are:
Excess androgens produced by the theca cells of the ovaries
insulin resistance 
raised LH
raised oestrogen
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12
Q

when do people present with PCOS?

A

from peripubertal period - 20 years old

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13
Q

symptoms of PCOS?

A 
Oligomenorrhoea (defined as <9 periods per year).
Infertility or subfertility.
Acne.
Hirsutism.
Alopecia.
Obesity or difficulty losing weight.
Psychological symptoms - mood swings, depression, anxiety, poor self-esteem.
Sleep apnoea.
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14
Q

Clinical signs of PCOS?

A

The presence of hirsutism, (often on the upper lip, chin, around the nipples and in a line beneath the umbilicus). This occurs in 60% of women with PCOS.
Male-pattern balding, alopecia.
Obesity - this is common (usually central distribution).
Acanthosis nigricans - may be present and is thought to be a sign of insulin resistance.
Occasionally, clitoromegaly, increased muscle mass, deep voice (more usually, these are signs of more severe hyperandrogenism syndromes).

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15
Q

diagnostic criteria for PCOS

A

Polycystic ovaries (either 12 or more peripheral follicles or increased ovarian volume (greater than 10 cm3).
Oligo-ovulation or anovulation.
Clinical and/or biochemical signs of hyperandrogenism.

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16
Q

investigations

A 
testosterone: normal or raised 
sex hormone binding globulin: normal or low 
LH: raised 
FSH: normal 
USS
OGTT
fasting lipids
17
Q

risks?

A

CV risks (due to lipideamia, and insulin resistance)

18
Q

how to help?

A

increase exercise and weight loss
low GI diet
COCP- to stop endometrial hyperplasia (–>cancer)

19
Q

pharmacological treatment of PCOS

A

it is targeted at symptoms as no drugs can reverse hormone distribution

20
Q

treatment for women not planning pregnancy

A 
Co-cyprindrol: for hirsutism and acne
COCP: to regulate period 
metformin: insulin
orlistat: obese people
Eflornithine: hirsutism
21
Q

treatment for those wishing to conceive

A

metformin and clomifene (to induce ovulation)

complications in pregnancy can occur: gestational diabetes, pre-term birth and pre-eclampsia

22
Q

Dysmenorrhea

A

term used to describe low anterior pelvic pain which occurs in association with periods.

23
Q

pathogenesis of dysmenorrhea

A

excess or imbalance of prostaglandins and leukotrienes which causes vasoconstriction of uterine vessels.
prostaglandins can also cause diahorrea, nausea, headache

24
Q

dysmenorrhea:
primary:
secondar:

A

primary:
Young females with no pelvic pathology.
occurs 6 months to 1 year after menarche
pain begins with onset of period and can last 24-72hrs

secondary:
some form of pelvic pathology
occurs years after menarche
can start well before period and last through out period
dyspareunia
causes of secondary: endometriosis, PID, fibroids, IUD

25
Q

risk factors for dysmenorrhea

A

early menarche, smoking, alcohol and obesity

child birth reduces pain and pain decreases with age

26
Q

management of dysmenorrhea

A

stop smoking
TENS
camomile tea
massages

27
Q

pharmacological treatment

A 
NSAIDs (Ibuprofen)
COCP
POP
depo
IUS
HYSTERECTOMY IF SEVERE AND NOT HAVING KIDS
28
Q

hot flushes and night sweats last how long?

A

7 or more years

29
Q

what % of women experience symptoms of menopause?

A

80%

30
Q

how many women have severe symptoms?

A

1/4

31
Q

long term risks associated with menopause

A

osteoporosis, CV disease, stroke

32
Q

when to take HRT

A

over 60 is not recommended

Women with premature (age <40 years) or early (<45 years) menopause, HRT until the age of 51 years for the treatment of vasomotor symptoms and for bone and cardiovascular protection (even if no symptoms)

For those women under 60 years who are at risk of an osteoporotic fracture in whom non-oestrogen treatments are unsuitable.

33
Q

benefits of HRT

A

Reduction in vasomotor symptoms (helps within 4 weeks and maximises at 3 months)
improves QOL- improves sleep, muscle pain and aches
improves changes in mood
Improvement of urogenital symptoms- vaginal dryness and atrophy
reduces osteoporosis risk
reduces CV disease
lower risk of colorectal cancer
IUS can protect endometrium

34
Q

risks of taking HRT

A 
VTE
stroke 
breast cancer (absolute risk is low) (combined)
endometrial cancer (if oestrogen only)
ovarian cancer
35
Q

transdermal HRT vs oral HRT

A

transdermal preferred in those with diabetes, hx of VTE, thyroid problems, and migraines or gall bladder probs

36
Q

which preparation to prescribe (cyclic or continuous)

A

sequential combined HRT if: last period was less than 1 year ago
continuous combined HRT if: have had sequential HRT for at least 1 year
OR
it has been at least 1 year since their last period
OR
2 years since last period if PREMATURE MENOPAUSE

37
Q

common SE (bleeding, progesterone)

A

erratic bleeding for first 3-6 months

weight gain, mood changes, fluid retention

medicine (8 decks)

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