Women’s and Men’s Health Flashcards
List 3 key aspects of Breakthrough Bleeding
Irregular bleeding on hormonal contraception
- Common when new contraceptive is started, often settles without treatment
- More common with Progestogen-only methods.
- Greater risk in smokers
List causes of PCB (No specific cause in 50%)
- Infection
- Cervical Ectropion (especially if taking COCP)
- Cervical/ Endometrial Polyps
- Vaginal/ Cervical Cancer
- Trauma/ Sexual abuse
- Vaginal atrophic change
List investigations for Menorrhagia
- FBC (Anaemia), TFTs, Clotting screen
- Hysteroscopy/ USS if suspected Fibroids, Polyps, Endometrial pathology
- Vaginal/ Cervical Swab
Outline 1st and 2nd line Menorrhagia treatment
1: IUS/ Hormonal (COCP)/ Hormonal (NSAIDs, Tranexamic Acid- can take 4mths to work)
2: Uterine artery embolisation, Surgery:
- Hysterectomy
- Endometrial ablation (Full lining, Increased ectopic risk, Lining grows back)
When would you consider treating Menorrhagia without examination?
(Unless treatment is IUS, always needs examination)
Menorrhagia history without other symptoms
When would you consider treating Menorrhagia without investigating cause?
Low risk of Fibroids, Adenomyosis, Uterine Cavity/Histological abnormality
When do you refer someone with Menorrhagia
- Symptoms of cancer
- Iron deficiency anaemia
- Complications (such as compressive symptoms from Fibroids)
List Investigations for Dysmenorrhea
USS, Pregnancy test, Vaginal/ Cervical swabs
Outline Primary treatment of Dysmenorrhea
Secondary: Treat underlying cause or Refer
- NSAID or Paracetamol/ 3-6mth trial of Hormonal contraceptive/ Combination of both
- Local application of heat or Transcutaneous Electrical Nerve Stimulation (TENS)
List Investigations for Amenorrhoea
Treatment: treat underlying cause
- TFTs, PRL, FSH+LH, Total testosterone and Sex-hormone binding globulin
- Pregnancy test, Pelvic USS
- Karyotyping, MRI/ CT, Hysteroscopy
List 3 scenarios where you would consider asking bloods to diagnose Menopause
- Women> 45 with Atypical symptoms
- Women 40-45 with Menopausal symptoms
- Women< 45 in whom Premature Menopause is suspected
List causes of incontinence other than Stress, Mixed, Urgency
- Overflow incontinence
- Urogenital fistula
- Urethral Diverticulum
When do you refer a woman with incontinence for bladder cancer?
- ≥ 60 with non-visible haematuria + Dysuria/ Raised WCC
- ≥45 with unexplained visible haematuria without UTI
- ≥45 with persistent/ recurrent visible haematuria after successful UTI treatment
Outline General Management of Incontinence in Women
- Absorbent containment products/ toileting aids
- Manage RFs (Age, Parity, Obesity, Constipation, Smoking, FHx, Drugs, Menopause)
- Less caffeine
Outline Urgency Incontinence management in women
- Bladder training for 6/+wks. Add Antimuscarinic if symptoms continue.
- Review after 4wks
Name 3 Antimuscarinics used in Urgency Incontinence (may take 4wks to work)
- Oxybutinin
- Tolterodine
- Darifenacin
Name 3 Antimuscarinics that can’t be used in Urgency Incontinence
Flavoxate, Propantheline, Imipramine
Outline the follow-up when treating Urgency incontinence in women with Antimuscarinics
- Review after 4wks. Consider referral, dose adjustment/ alternate drug then review in another 4wks
- If treatment effective, review every 12mths (6mths if >75)
When treating Urgency Incontinence in women, when do you consider Desmopressin and Intravaginal Oestrogen
Desmopressin: If Nocturia (unless 65y/o with CVD/ HyperT)
Intravaginal Oestrogen: If Post-menopausal + Vaginal Atrophy
How is Stress and Mixed Incontinence managed in Women?
1st line: Pelvic floor muscle training
2nd line: Referral or Duloxetine if not surgery
Manage according to most predominant type of incontinence
How do you assess LUTS in Men
- History (Storage/ Voiding/ Post-micturition symptoms)
- Exam (Ab dissension, Suprapubic dullness, Genitalia, DRE)
- IPSS (3/+ day urinary frequency-volume chart)
How are Voiding Symptoms managed in men?
Non-pharmacologically
- Manage cause (Drugs, BPH, Cancer, Diabetes etc)
- Active surveillance (Reassurance, Lifestyle advice)
Conservative treatment;
- Pelvic floor muscle + Bladder training
- Avoid constipation, Excessive limit of fluid intake, Caffeine, Fizzy drinks
- Containment products (Pads, Catheters, Waterproof pants)
How are Voiding Symptoms managed in men?
Pharmacologically, including Reviews
Moderate-Severe/ IPSS of 8;
- Alpha-blocker
- Review at 4-6wks, then every 6-12mths
Enlarged Prostate + High Progression risk;
- 5-Alpha-reductase inhibitor
- Review at 3-6mths, then every 6-12mths
Storage + Voiding symptoms after alone Alpha blocker treatment;
- Add 1st line Antimuscarinic
- Review every 3-6wks until stable, then every 6-12mths
What advice do you give to pt with Overactive Bladder?
Fluid Intake, Constipation, Healthy lifestyle, Caffeine, Fizzy drinks, Containment products
How do you treat a pt with Overactive Bladder?
Pharmacologically, 1st+2nd lines
1: Antimuscarinic;
- Oxybutinin, Tolterodine, Darifenacin
- Review every 4-6wks then every 6-12mths
2: If Antimuscarinic Contra-I/ not tolerated or effective;
- Mirabegron
- Review at 4-6wks
When would you suspect an Organic cause of ED
- Slow onset of symptoms
- Normal libido
- Risk factor presence
When would you suspect a Psychological cause of ED
- Sudden onset
- Less libido
- Good spontaneous/ self-induced erections
- Major life events
- Relationship problems/ changes
Outline Examination of a pt with ED
- General (BP, HR, BMI, Circumference)
- Genitalia (Pre/ malignant lesions, Hypogonadism signs, Deformities)
- Gynecomastia and Reduced body hair, to assess degree of Androgenisation
- DRE if: 50/over, Prostate cancer history, Enlarged prostate signs
What lifestyle advice would you give to manage someone with ED?
- Weight loss, Smoke, Alcohol, Exercise
- Don’t take unlicensed herbal remedies
- If cycling >3hrs a week, try not cycling to see improvement
What is the pharmacological management of a pt with ED?
Which drugs can be used? Which is most effective?
What advice do you give about their effectiveness to patients?
(Admit to hospital if PRIAPISM)
If no Contra-I, PDE-5 Inhibitor REGARDLESS of cause
- Sildenafil (Viagra), Tadalifil (Cialis), Vardenafil (Levitra), Avanafil (Spedra) are equally effective
- Drugs don’t initiate erection
When do you refer a pt with ED to Urology
Endocrinology if Hypogonadism
(Cardiology if CVD makes sex unsafe)
(MH services if Psychogenic cause)
- History of trauma
- Young men who always had difficulty obtaining/ maintaining erection
When on Fe tablets, body replenishes lost Fe before symptoms improve.
How long can this take
5-6mths
When giving Alpha blockers for LUTS in men, what do we warn pts about, regarding the 1st dose?
1st dose Hypotension is common, so advise to take before sleeping
Can you get pregnant on HRT?
Yes, as lower hormone dose than COCP
What is Cyclical HRT?
14 days Oestrogen, 14 days Progesterone
When can you switch from Cyclical to Continuous HRT
After 12mths of Amenorrhea
When is it advised to stop HRT?
After 2yrs
How long does the risk of breast cancer stay after COCP/HRT treatment?
For upto 10yrs after stopping treatment
