Women's Flashcards
Symptoms of ovarian cancer
- Abdominal bloating
- Increased abdominal girth
- Indigestion or early satiety
- Change in bowel habits, specifically constipation
- Urinary frequency, incontinence
- Abdominal or pelvic pain
- Dyspareunia
Potential causes of Ca-125 elevation
- Ovarian cancer
- False positive
- Benign ovarian neoplasm
- Uterine fibroids
- Hepatitis
- SLE / autoimmune disease
- Bowel ca
- Pancreatic ca
- Endometrial ca
Contraindication to oestrogen MHT therapy
- hx hormone dependent cancer
- active hormone dependent cancer
- past hx thromboembolic disease is relative contraindication (transdermal oestrogen preferable)
- cardiovascular / cerebrovascular disease is relative contraindication too
Dx criteria for PCOS
Rotterdam dx criteria (two of three required)
1. Oligo/anovulation
- Hyperandrogenism
- biochemical (raised FAI or free testosterone)
- clinical (hirsutism, acne) - Polycystic ovaries on USS
Risk factors for breast ca
- Family history of breast and ovarian cancer
- Increasing age
- Late childbearing (after the age of 30 years)
- Nulliparity (no children)
- Early menarche (<12 years of age)
- Late menopause
- Use of hormone replacement therapy (particularly combined therapy)
- Ashkenazi Jewish ethnicity
- Obesity (post-menopausal women)
- Lifestyle factors (high alcohol consumption, high-fat diet)
DDx breast lump
- Prominent fibroglandular tissue (normal breast tissue)
- Cyst
- Fibroadenoma
- Abscess
- Lipoma
- Fat necrosis
- Haematoma
- Breast cancer
Hx questions to elicit if female factor underlying cause of infertility
- symptoms of PCOS (hirsutism, acne, irregular menses)
- symptoms to suggest endometriosis
- symptoms of prolactinoma (galactorrhea, headache)
- symptoms of hypothyroidism
- symptoms to suggest PID
- symptoms of uterine polyp
- previous contraception use / depot provera
Causes of bleeding in first trimester
- miscarriage
- ectopic pregnancy
- endometrial implantation
- gestational trophoblastic disease
- cervical lesions
- vaginal lesions
- uterine infection
Options for mx of miscarriage
- Expectant
- Medical
- Surgical
Causes of secondary dysmenorrhea
- endometriosis
- adenomyosis
- fibroids
- pelvic infection
Examination findings in someone with endometriosis
- reduced uterine mobility
- adnexal masses
- uterosacral nodularity
Common causes of itchy vulvitis in postmenopausal woman
- Lichen sclerosus
- Psoriasis
- Dermatitis
(vaginal candidiasis very unlikely in this age group)
Tx for vaginal lichen sclerosis
Super potent corticosteroid
- Diprosone 0.05% in optimised vehicle
Mx troublesome bleeding with Implanon
- COCP, taken continuously or cyclically for 3/12
- 5/7 NSAID Mefenamic acid 500 mg BD to TDS
- 5/7 Tranexamic acid 500mg BD
Post partum nipple pain - what physical examination is required
- examination breasts and nipples - nipple trauma, breast lumps, swelling or erythema
- temp
- baby oromotor assessment - tongue mobility & palate
- baby weight since birth
- observation of a breastfeed with consent
- neonatal examination
Primary amenorrhea causes
failure of menses to start by 16yrs
- Hypothalamic amenorrhea (exercise, low BMI)
- PCOS
- Imperforate hymen
- Congenital absence uterus / vagina
- Chromosomal anomalies
- Pituitary tumours
Secondary amenorrhea
absence of menses for > 6 months in a woman who has established menstruation
- Hypothalamic amenorrhea (exercise, low BMI)
- PCOS
- Pregnancy
- Hyperprolactinaemia
- Premature ovarian insufficiency
- Medication (OCP, antipsychotics)
- Thyroid dysfunction
- Adrenal disorders (Cushing)
- Asherman syndrome
How to prescribe MHT
- previous hysterectomy
Continuous oestrogen
- transdermal or oral preparation
(transdermal oestrogen has lower VTE risk)
How to prescribe MHT
- perimenopausal
LMP < 12 months ago
- cyclical MHT (reduce risk of breakthrough bleeding)
- after 12 months of cyclical MHT, can switch to continuous
eg. Femoston
How to prescribe MHT
- postmenopausal
LMP > 12 months ago
- continuous combined oestrogen / progesterone
eg. Angeliq
Causes of heavy menstrual bleeding
- uterine fibroids
- endometrial / endocervical polyps
- endometrial hyperplasia
- adenomyosis
- presence of an IUD
- hypothyroidism
- bleeding disorder eg. von Willebrand disease
- PCOS
Second and third trimester bleeding
- bloody show with associated labour
- early pregnancy loss (< 20 weeks)
- placenta previa
- placental abruption
- uterine rupture
- vasa previa (rare)
RF for urinary incontinence
- parity
- vaginal deliveries of children
- FMHx urinary incontinence
- smoking hx
- excessive caffeine intake
- faecal incontinence
- vaginal atrophy
- recurrent UTI
- recent weight gain
- hx heavy lifting (occupational or exercise)
3 invx for urinary incontinence
- Urine MCS
- Bladder diary
- Bladder emptying imaging / renal tract USS
5 non-pharm mx options for urinary incontinence
- Limit fluid intake (8 cups / day)
- Minimise bladder irritants such as caffeine, alcohol
- Maintain healthy BMI
- Avoid heavy lifting
- Avoid constipation with high fibre diet
- Pelvic floor training
- Timed voids
