Womans Health Flashcards
Menorrhagia
Heavy cyclical bleeding
Polymenorrhoea
Normal duration and flow but shortened cycle with intervals less than 25 days
Metorrhagia
Uterine bleeding independent of menstrual pattern
Menometorrhagia
Increased flow during menstruation and between periods
Chronic AUB
More than 6 months
Acute AUB
Severe enough to require immediate intervention
HMB
Heavy menstrual bleeding that affects quality of life
Objective Menorrhagia (HMB)
- blood loss > 80ml per cycle
- 60% have iron deficiency anaemia
Subjective Menorrhagia
50% have bold loss in normal limits
Still considered abnormal
Normal blood loss
10-55 ml
Causes of AUB
- polyps
- adenomyosis
- leiomyomas
- malignancy
- coagulopathy
- ovulation dysfunction
- endometrial disorders
- iatrogenic
- not classified
Types of leiomyomas
- sub mucosal
- other (intramural and sub serosal)
- hybrid
Feature of coagulopathy
One of: - postpartum haemorrhage - surgical related bleeding - dental bleeding Two or more of: - bruising - epistaxis - frequent gum bleeding - fam history of bleeding symptoms
What are LOOP events?
- luteal out of phase events
Premature development of estradiol-producing follicles in the luteal phase
Things causing endometrial disorders
- deficiencies in the local production of vasoconstrictors (endothelin1)
- increased prod of vasodilatory prostaglandins (prostacyclin)
- accelerated lysis of endometrial clot (plasminogen activator)
Things causing iatrogenic AUB
- break through bleed
- mirena
What is used for endometrial sampling?
Pipelle
Who do you take an endometrial sample from?
- over 40’with irreg bleeding
- risk factors for endometrial Ca
Prolonged chronic anovulatin
Obese
Fam Hx of Ca
Who do you refer for hysteroscopy?
- chronic irreg bleeding
- peri-menopause with abnormal bleeding
- US suggests fibroid or polyp
- post- menopause ET >5mm or ongoing bleeding with ET <5 mm
How to hormonally manage an acute bleeding episode
- high dose oestrogen for atrophic endometrium
- high dose OCP if bleeding not too severe
- progesterone for anovulatory bleeding
- cyclokapron (antifibrinolytic)
Medical management of AUB
- antifibrinolytic drugs (tranexamic acid)
- NSAIDS (mefenamic acid)
- low dose Monophasic oral contraceptives
- progesterone
- mirena
Mechanism of tranexamic acid
Prevents action so plasminogen
Mechanism of mefenamic acid
Altered ratio of prostaglandin E2 to F2
- increased ratio of prostacyclin to thromboxane
Mirena method of action
- reduction in endometrial prostaglandin synthesis
- reduction in endometrial fibrinolytic activity
- production of an inactive endometrium
When is endometrial ablation done
- HMB with uterus <3 cm and no desired fertility
Types of endometrial ablation
First gen - electrocautery Second gen - microwave endometrial ablation - hydrothermablation
What does UAE stand for?
Uterine artery embolisation
When is UAE, myomectomy or hysterectomy done?
HMB with fibroids >3 cm
When is hysterectomy done?
- completed family
- over 45
- fAiled medical treatment
- failed endometrial ablation
- failed myomectomy
What is a haematinic?
Stimulates the production of red blood cells
AUB-O
Abnormal menstrual bleeding with a disorder of ovulation (endometrial sampling NB- assoc with endometrial hyperplasia)
When is normal vag discharge least acidic?
Days prior to and during menstruation
Physiological causes of changes in discharge
- menstrual cycle
- emotional stressors
- nutritional status
- pregnancy
- medications
- sexual arousal
Trichomoniasis discharge
Yellow/green, offensive, frothy
What constitutes the adnexa?
Fallopian tubes, ovaries, round ligaments
Most common pelviabdominal mass in reproductive age
- functional or physiological cysts
Things to describe about a mass
- size (weeks)
- surface
- consistency
- tender
- mobile or fixed
- ascites
- cannot get below the mass
Starting point in mass differential
- gynae (pregnant or non-pregnant)
- non gynae (urinary tract or bowel)
Types of physiological cysts
- follicular
- corpus lutuem
- theca-lutein
Why do follicular cysts occur?
- failure of the mature follicle to ovulate or
- failure of the immature follicle to reabsorb or undergo atresia
(Asymptomatic)
Why corpus lutuem cysts occur
- haemorrhage into the corpus lutuem 2 days after ovulation
- can rupture and mimic tubal pregnancies
- occur late in cycle
- assoc with acute pain
Why do theca lutein cysts occur?
- overstimulation of ovaries by hCG
Features suggestive of ovarian malignancy
- bilateral
- cysts >8cm
- multiloculated
- thick walled
- papillary projections
- ascites
Types of ovarian neoplasia
- celomic epithelium
- germ cell
- specialized gonadal stroma
- non-specific mesenchyme
- metastatic to ovary
Possible tubal masses
- ectopic pregnancy
- pyosalpinx
- hydrosalpinx
- tubo-ovarian abscess
- para tubal cyst
Where do leiomyomas originate?
Müllerian duct
Appearance of a fibroid
- round, firm, white
- pseudo capsule
- whorled.
- grow gradually
- relatively avascular
- undergo degeneration (hyaline, red, sarcomatous)
What is a didelphic uterus?
- double uterus with 2 cervices and 2 vaginas
Factors associated with cervical cancer
- early sexual debut
- multiple partners
- other STIs
- smoking
- OCP
Symptoms of cervical cancer
- abnormal vag bleeding (postcoital)
- malodorous discharge (infection)
- pelvic pain, weight loss, renal failure, fistula
Patterns of spread of cervical cancer
- direct
- haematogenous
- lymphatic (obturator nodes)
Treatment of micro-invasive cervical Ca
- cone biopsy
- simple hysterectomy
What is removed in a radical hysterectomy?
Uterus, parametria, cuff of vagina, pelvic lymph nodes
Vaccines for cervical Ca
- bivalent (cervarix)
- quadrivalent (gardasil)
What does VIA stand for
Visual inspection with acetic acid
Features of ideal contraception
- forgettable
- reversible
- usable
- buy able
- acceptable
- invisible
- infallible
What does UPSI stand for?
Unprotected sexual intercourse
Types of emergency contraception
- progesterone only (Norlevo up to 72 hrs)
- combined regimen (2 tablets 12 hrly)
- CuT (up to 120 hrs)
At what concentration can a pregnancy test work?
20mU (7-10 days after conception)
Riffs of acute pregnancy related pain
- rupture of ectopic
- miscarriage
- pre term labour
- fibroid degeneration
Adnexal disorders that cause pelvic pain
- haemorrhagic functional ovarian cysts
- torsion of adnexa
- twisted para-ovarian cyst
- rupture of functional cyst
Causes of recurrent pelvic pain
- mittelshmerz (ovulation pain)
- primary or secondary dysmenorrhea
Where can pain refer in ectopic?
Right shoulder
How to diagnose ectopic pregnancy
- bhcg more than 2000
- empty uterus on US
- adnexae mass
Medical management of ectopic
Methotrexate (anti-folate)
Difference between gonococcal and chlamydial PID
Gonococcal is acute, chlamydial is insidious
Dyschezia
Painful defeacation
Causes of chronic pelvic pain
- endometriosis
- adenomyosis (endometrium in myometrium)
- adhesions
- pelvic congestion
- salpingo-oopheritis
- ovarian remnant syndrome
- fibroids
- IBS
Type of pain with adhesions
- non-cyclical
- increases with coitus
Features of pelvic congestion
Pain starts with ovulation to end if menses
- bulky uterus with enlarged tender ovaries
What does TAH BSO stand for?
Total abdominal hysterectomy bilateral salpingo-oophorectomy
Where is pain felt with ovarian remnant syndrome
Lateral pelvic pain
Definition of rape
Any person who unlawfully and intentionally commits an act of sexual penetration with another person without such persons consent
Clip used to do tubal ligation
Filshee clip
What is fitz- Hugh- Curtis syndrome?
A thinning of cervical mucus to allow bacteria from the vagina into the uterus and oviducts, causing infection and inflammation
Another name for vaginal reconstruction
Colporhapphy
What is colpocleisis?
Closure of the vagina
Methods of TOP
- vacuum curettage
- medical
- dilatation and evacuation
- induction of labour
- hysterotomy
- hysterectomy
Definition of TOP
The separation and expulsion by surigcal or medical means of the contents of the uterus of a pregnant woman
When can medical TOP be performed
Up to 9 weeks
Drugs used in medical TOP
Mifepristone
- progesterone antagonist
Misoprostol
- prostaglandin analogue (stim myometrium contraction)
ERPOC
Evacuation of retained products of conception
Amsel’s diagnostic criteria for bacterial vaginosis
3out of 4
- homogenous vaginal discharge
- fishy odour when mixed with pat assign hydroxide
- clue cells present
- raised vaginal PH
Definition of menopause
Permanent cessation of menstraution due to loss of ovarian follicular activity
- 12 consecutive months of amenorrhea without other cause
Definition of premature ovarian failure
Menopause before 40
