Session 3 - IMPORTANT

Question 1

Give age landmarks of female puberty

Answer 1

Thelarche – breast enlargement 8-11 years
Adrenarche – pubic hair 11-12 years
Growth Spurt - 10-14 years
Menarche - 11-15 years

Question 2

How are fibroids diagnosed? (4)

Answer 2

• abnormal bleeding, typically menorrhagia and the women is
  usually in her 40s.
• palpable on bimanual examination (irregularly shaped uterus)
• examination by anaesthesia and curettage or by laparoscopy.
• ultrasound may show the presence of a mass but may not distinguish other ovarian tumours.

Question 3

How would you assess whether menstrual blood loss is sufficiently great to have
adverse effects?

Answer 3

Menorrhagia is usually defined as menstrual loss greater than 80ml which will produce
anaemia.
Assess by pad and tampon counts and measuring haemoglobin/haematocrit levels.

Question 4

What options are there for treating this condition (i) in a woman under 35

Answer 4

Treatment options< 35-depends on size/symptoms/desire for fertility
Wait and see with serial exams and monitoring of blood loss
Non-surgical options with GnRH agonist
Surgery with endoscopic resection or abdominal myomectomy or hysterectomy

Question 5

What might be the advantages and disadvantages
of removing the ovaries as well as the uterus? What evidence bases would you quote in
helping a woman to decide whether to have her ovaries removed?

Answer 5

Potential benefits include, avoidance of ovarian pathology in the future(although some ovarian
type tumours can arise from the peritoneum de novo)
Potential disadvantage, sudden onset of menopause as the albeit aging ovary is removed and
loss of ovarian androgen.