Woman's health Flashcards
what hormonal change causes the shedding of the endometrium during menstruation? why does this change occur?
DECREASED PROGESTERONE: the thickened lining is supported by an increased blood supply owing to the progesterone being produced by the corpus luteum. if the follicle isnt fertilised the corpus luteum will fail and progesterone levels will fall
which hormone stimulates the release of LH and FHS from the pituitary? and where is this hormone released from?
GnRH from the hypothalamus
on which day in the menstrual cycle does each hormone peak?
oestrogen - day 12
LH and FSH - day 14
progesterone - day 21
LH and FSH induce follicular growth. these follicles produce which hormones and what is the effect of this?
oestradiol - increases LH in a +ve feedback loop and thickens endometrium
inhibin - inhibits FSH in a -ve feedback loop (so that only 1 follicle matures)
define pelvic inflammatory disease
inflammation of any pelvic organs: tubes, ovaries, uterus and peritoneum
what are the 3 most common causative organisms in PID?
chlamydia Trachomatis
Neisseria gonorhoea
mycoplasma
the following presentation is classical of which gynae problem: constant lower abdo. pain purluent vaginal discharge deep dyspareunia pyrexia
PID
what clinical findings might be found on exam of a patient with PID?
purluent discharge
cervical excitation
blood
what Ix should be performed in ?PID including imaging?
BhCG
urine dip
high vaginal and endocervial swabs
chlamydia and gonorrhoea screening
Bloods: CRP, cultures (if febrile), U&E, FBC
pelvic USS
what are the complications of PID?
infertility (in as many as 20%)
increased risk of ectopic
chronic pelvic pain
what is that causes inflammation in endometriosis?
proliferation of endometrial tissue outside the uterus during the proliferative phase which cant drain so forms clots
what is adenomyosis and how does it present?
endometrial like tissue in the myometrium
presents v similar to endometriosis
the following presentation is classical of which gynae problem:
painful periods which starts before menstruation
deep dyspareunia
chronic pelvic pain
endometriosis
what finding might be found on examination in endometriosis
on bimanual: tenderness palpable nodules thickening of the adnexus immobile and retroverted uterus (only in advanced cases and not always)
endometriosis is most common in which age category?
25-35
what is the first line imaging in endometriosis and what might be seen? what is the gold standard for diagnosis?
pelvic USS: endometriomas (large nodules) aka chocolate cysts
laparoscopy
‘since symptoms seem to regress in pregnancy and the menopause, treatment aims to mimic these states’
what condition does this statement refer to and how are pregnancy and the menopause mimicked for tx?
endometriosis
COCP - preg
progesterone - preg
GnRH analogues (e.g. Danazol) - menopause
IUS (Mirena) - preg
a woman reports a white discharge and vaginal itching. what is the most likely cause from this v short history? and what else might be noticed on exam of the vagina?
candidiasis
vulvitis - not always
a woman reports a really smelly grey/ white discharge. what is the most likely cause from this v short history? what might the smell remind one of? and what else might be noticed on cytology of the discharge?
bacterial vaginosis
fishy smell
CLUE CELLS - irregular bordered squamous epithelial cells
how does trichomonas vaginalis present? what might be seen on exam?
offensive yellow/green and frothy discharge
vulvovaginitis
strawberry cervix
define the menopause
no periods for 12 months
what change in hormone profile takes place during the menopause and why
increased LH and FHS (gonadatrophin hormones)
decreased oestrogen and progesterone (follicular hormones)
there are a finite number of follicles and these are now depleted
what are the two different types of HRT available to women and what are the indications for choosing them?
women might want/ need HRT if they have a premature menopause or if they suffer badly from the symptoms
a women with a uterus should have combined therapy (oestrogen and progesterone)
a women without a uterus should have oestrogen only
the are the risks associated with HRT?
VTE breast cancer endometrial cancer gall bladder disease vascular disease
the definition of heavy menstrual bleeding has changed this year from what to what?
old: >80ml of blood lost per menses
new: any amount of bleeding that significantly interferes with a patients life
what are the causes of heavy menstrual bleeding?
uterine fibroids coagulopathy pelvic malignancies thyroid disorders (particularly hypo) PID
if a woman with heavy menstrual bleeding wants to try for children, what should the medical mx be?
what if she also wants contraception?
tranexamic acid (anti-fibrinolytic) during periods (1st line) mefenamic acid (NSAID) during periods
COCP
Mirena
what are the two categories for amenorrhoea and define them?
primary - absence of onset of menses by age 14 in the absence of secondary sexual characteristics OR by 16 with secondary sexual characteristics
secondary - absence of periods for >6months in a woman who previously had them
a 17 year old girl has not started their periods. what is your differential?
Turners
congenital adrenal hyperplasia
congenital malformation of the genital tract
what is an ovarian cyst? and what are the two types?
benign epithelial neoplasia on the ovaries
- serous cystadenoma (most common)
- mucinous cystadenoma
what are the possible presentations of ovarian cysts?
can be asymptomatic any pressure effects swollen adbo. +/- palpable mass lower abdo pain dysparenuria
RUPTURE: peritonitis and shock
TORSION: sudden onset deep colicky pain
Meigs syndrome
1) benign ovarian tumour
2) ascites
3) Pleural effusion
what is the common name for leiomyomas?
fibroids
what is a uterine fibroid?
leiomyoma: benign smooth muscle tumour arising form myometrium of the uterus
what kind of bleeding might you expect with uterine fibroids?
HMB most common
what is the medical management of fibroids?
COCP
tranexemic acid
GnRH analogues for short term reduction
‘red degeneration’ is a rare complication of what gynae problem ? describe it and when it happens
haemorrhage of fibroid
more common in pregnancy as some fibroids grow too quickly for their blood supply to support them
n/b most fibroids dont actually grow during pregnancy and those that do tend to return to normal size after delivery
a woman comes in with lower abdo pain
on exam she has adnexal tenderness
the USS shows free fluid in the pelvis
this is a classical presentation of which condition?
torsion of an ovarian cysts
a young woman presents with post coital bleeding and some discharge
imaging shows redness around the os
what is the most likely diagnosis? what is less likely but needs ruling out? how is that done?
cervical ectropion
cervical cancer - smear +/- colposcopy
