Treatments

Question 1

what is the first line treatment for prolapse?

Answer 1

pelvic floor exercises

Question 2

what are the treatment options for stress incontinence?

Answer 2

1st line: pelvic floor exercises
2nd line: duloxetine or pdeudoephedrine
2nd or 3rd line: surgery

Question 3

give examples of surgical options available for treating stress incontinence?

Answer 3

tension free vagina tape
burchi colposuspension
autologous rectus fascial sling
bladder neck bulking

Question 4

what are the treatment options for prolapse?

Answer 4

1st line: pelvic floor exercises
2nd line: pessaries
3rd line: surgery

if severe prolapse then you can skip 1st and 2nd line and go straight to surgery

Question 5

what are the treatment options for idiopathic menorrhagia?

Answer 5

1st line: LNG IUD
other options: OCP, POP, tranexamic acid
2nd line: decapeptyl injections (GnRh analogue)
3rd line: hysterectomy

Question 6

what is the first line treatment for endometriosis?

Answer 6

NSAIDS + OCP or progestogen (LNG IUD, POP)

Question 7

describe the treatment options for an ectopic pregnancy.

Answer 7

patient is stable, bhcg < 500, no foetal heart beat and foetal mass < 35mm: Expectant management

patient is stable, bhcg < 1500, no foetal heat beat, foetal mass < 35mm: Methotrexate (once off dose)

patient unstable or bhcg > 5000, foetal heart beat, foetal mass > 35mm: Surgery (salpingectomy, salpingostomy or hysterectomy)

if patient unstable/rupture - IV fluids with isotonic solution + bloods before surgery.

Question 8

what are the treatment options for atrophic vaginitis?

Answer 8

1st line:

• vaginal cream e.g. KY liquibeads
• water-based lubricants e.g. KY Jelly

2nd line: topical oestrogen

• creams e.g. estrace
• tablets e.g. vagifem
• rings e.g. estring
• pessaries e.g. invexxy

3rd line: systemic oestrogen
- transdermal patch or pill

Other options: vaginal dilators (if oestrogen is contraindicated)

Question 9

what are the treatment options for cervical cancer?

Answer 9

stage 1A1: LLETZ

stage 1A2 and IB1:
< 2cm - Radical trachelectomy
> 2cm (fertility not desired) - Radical hysterectomy
> 2 cm (fertility desired) - Chemoradiotherapy

stage 1B2 - stage 2A: radical hysterectomy

stage 2B - 4A: chemoradiotherapy

stage 4B: combination chemotherapy

Question 10

what are the treatment options for endometrial cancer?

Answer 10

stage 1 - 2: hysterectomy
stage 3- 4: staging surgery + chemotherapy

if stage 1 and fertility is desired - Progestin therapy

Question 11

what are the treatment options for ovarian cancer?

Answer 11

stage 1A and 1B, grade I and II: Oophorectomy surgery
stage 1c, or grade III: surgery + chemotherapy
stage 2-4: chemotherapy and debunking of tumour

Question 12

what is the first line treatment for fibroids?

Answer 12

if < 3cm and asymptomatic: no treatment

if symptomatic
- 1st line: LNG IUD

if pressure symptoms and/or > 3cm
- surgery

Question 13

what are surgical treatments for fibroids?

Answer 13

fertility sparing;

• uterine artery embolisation
• myomectomy
• lazer ablation

fertility not sparing;
- hysterectomy

Question 14

what is the first line treatment for ovarian cysts?

Answer 14

conservative treatment + gynaecologist referral if suspicion of malignancy 
if rupture: surgery 
if pregnant:
- < 8cm conservative 
- > 8cm surgery

Question 15

what are the treatment options for urge incontinence/over active bladder?

Answer 15

lifestyle modifications

1st line: anticholinergic i.e. Oxybutynin 
2nd line:
- neuromodulation 
- botulism toxin 
3rd line: surgery

Question 16

what is the management for infertility in females?

Answer 16

1st line: clomifene + dexamethasone
2nd line: GnRh analogues (3-6 cycles of FSH injection)
3rd line: IVF

Question 17

what is the treatment options for an uncomplicated UTI (cystitis) in females?

Answer 17

1st line:
200mg trimethoprim 2x per day for 3/4 days
or
100mg nitrofurantoin 2x per day or 50mg 4x per day for 3/4 days

2nd line:
Nitrofurantoin if not used for 1st line
pevmicillinam

Question 18

what is the treatment for UTI in pregnancy?

Answer 18

1st line: 500mg cephalexin orally 2/3x per day

2nd line: 750-1500mg Cefuroxime IV every 6-8 hours

Question 19

what is the treatment for urosepsis?

Answer 19

IV 12g co-amoxiclav every 8 hours

Question 20

what is the treatment for pyelonephritis?

Answer 20

500mg orally cefalexin 2/3x per day for 7 days

Question 21

what is the treatment for pelvic inflammatory disease?

Answer 21

mild/moderate disease;
single dose i/m ceftriaxone 500mg then 100mg oral doxycycline + 400mg oral metronidazole both 2x daily for 14 days
or
ofloxacin + metronidazole for 14 days

severe disease;
IV ceftriazone 2g + IV doxycycline 100mg both 2x per day followed by 500mg oral metronidazole and 100mg doxycycline for 14 days

Question 22

what is the treatment for eclampsia?

Answer 22

IV bolus 4g magnesium sulphate over 5-10 minutes

followed by infusion of 1g per hour