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Year 4 > Women's health 1 > Flashcards

Women's health 1 Flashcards

1
Q

What are the features of premenstural syndrome?

A
  • Occurs during luteal phase (high serum progesterone)
  • 90% of women get it
  • Psychological: irritable, tense, low mood
  • Physical: breast tenderness, bloating, headaches
  • Decrease in cognitive ability
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2
Q

Management of pre-menstrual syndrome?

A
  • Keep a diary and journal
  • Conservative: exercise
  • Medical: COCP, SSRI for depression
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3
Q

What is menorrhagia?

A
  • Heavy menstrual bleeding
  • Defined as more than normal for that individual
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4
Q

What are the causes of menorrhagia?

A

PALM & COEIN

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5
Q

What are PALM & COEIN

A
  • Polyps
  • Adenomyosis
  • Leiomyoma (fibroid)
  • Malignancy & hyperplasia
    &
  • Coagulation disorder
  • Ovulatory (e.g. PCOS)
  • Endometriosis
  • Iatrogenic (COIL, POP, anticoagulation)
  • No cause found (50%)
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6
Q

What are uterine fibroids?

A
  • Uterine leiomyoma (benign smooth muscle tumour in myometrial layer)
  • Monoclonal growth that is reactive to female sex hormones
  • Common to have many, can vary in size, grey in colour
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7
Q

What is the epidemiology of uterine fibroids?

A
  • 50% of women have them
  • Increased risk in black women
  • Worse perimenopause
  • Pregnancy can worsen them or cause them to bleed (red degeneration)
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8
Q

What is the classification of uterine fibroids?

A
  • Intramural (most common; inside myometrium)
  • Subserosal (below peritoneum)
  • Sub mucosal (beneath endometrium; these distort the cavity)
  • Cervical
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9
Q

What are the features of uterine fibroids?

A
  • Menorrhagia and cramps
  • If very large can cause pressure effect (e.g. on bladder) and abdo pain/discomfort/bloating
  • Endometrial distortion can cause infertility and miscarriage
  • Rapid growth in pregnancy
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10
Q

Rapid fibroid growth not in pregnancy suggests what?

A

Sarcomatous change

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11
Q

Management of fibroids if wanting kids?

A
  • TXA for heavy bleeding
  • Surgery: myomectomy
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12
Q

Management of fibroids if not wanting kids?

A
  • IUS (Mirena)
  • Hysterectomy
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13
Q

What medications can be used pre-suregyt to shrink fibroids?

A

GnRH agonists (e.g. Leuprolide or gosereline)

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14
Q

What is the epidemiology of endometriosis?

A
  • 40% of infertility due to endometriosis
  • 80% of chronic pelvic pain due to endometriosis
  • Ovary most common site (chocolate cyst; can rupture and cause lots of pain; increased risk of cancer)
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15
Q

RisK factors for endometriosis?

A
  • Family history
  • Oestrogen excess
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16
Q

Features of endometriosis?

A
  • Menorrhagia, dysmenorrhoea, dyspareunia
  • Subfertility
  • Depression and fatigue
  • Symptoms of tissue in the systems (e.g. dyschezia, urinary symptoms)
17
Q

What is the investigation for endometriosis?

A
  • Laparoscopic imaging and histology is diagnostic
  • On exam: reduced motility with fixed retroverted uterus and pain on BM
  • May have visible lesion on speculum (e.g. endometrial tissue in vagina)
18
Q

What is the medical management of endometriosis?

A

1) NSAIDs and paracetamol for pain
2) GNrH antagonists (creates early menopause)

19
Q

What is the surgical management of endometriosis?

A
  • Want kids: scraping off
  • Don’t: hysterectomy
20
Q

What is the prognosis for endometriosis?

A
  • Gets better post-menopause
  • Chronic for 2/3
  • Spontaneous remission for 1/3
21
Q

Adenomyosis?

A
  • Endometrial tissue in the myometrium
  • Common for multiparous women towards end of reproductive years
  • Enlarged boggy uterus
  • Dysmenorrhoea and menorrhagia
  • GnRH agonist + hysterectomy
22
Q

Epidemiology of PID?

A
  • Common below 25
  • Chlamydia most common cause
  • Presents similarly to endometriosis but in younger women
23
Q

Risk factors for PID?

A

Same as STI + copper coil insertion (give prophylactic ABx)

24
Q

Features of PID?

A
  • Severe lower abdo pain and dyspareunia
  • Irregular bleeding (heavy, postcoital, dysmenorrhoea)
  • Offensive discharge
  • Fever (infective)
  • Cervical excitation
25
Q

What are the investigations for PID?

A
  • Rule out pregnancy
  • Look for evidence of infection (WCC, CRP, STI)
  • Transvaginal USS may show dilated tubes
26
Q

What its the management of PID?

A

1st) 1g IM ceftriaxone stat + doxy 100mg 2ds + metronidazole 400mg 2ds for 14/7
2nd) Oral ofloxacin + oral metronidazole both 400mg BD for 14/7

27
Q

What is are the complications for PID?

A
  • 20% infertility
  • Chronic pelvic pain
  • Adhesions
  • Ectopic
  • Fitz-Hugh-Curtis syndrome (perihepatic irritation; RUQ pain)

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