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Women’s Health Flashcards

1
Q

Mastitis (lactating women): Mx

5

A
  1. Simple analgesia
  2. Continue breastfeeding if possible, express if needed
  3. May require Abx - 1st line flucloxacillin
  4. May send milk culture
  5. Admit if unwell, sepsis, etc
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2
Q

Mastitis (non-lactating): Mx

3

A
  1. More likely to be infective cause cf lactating women, therefore ALL given Abx - first line co-amoxiclav 10-14 days
  2. Simple analgesia
  3. Admit if unwell, sepsis, etc
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3
Q

Nipple discharge - when to act

A

Blood discharge - all need to be referred

Consider further Ix if:

  • Unilateral
  • Only one duct involved
  • Thin consistency
  • Happens spontaneously (ie. Without pressure)
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4
Q

Familial breast cancer - when to refer for full risk assessment (genetic clinic, breast clinic)

(6)

A
  1. 1º F breast cancer <40
  2. 1º M breast cancer any age
  3. 1º relative with bilateral breast cancer (first one <50)
  4. Two 1º (or one 1º & one 2º) with breast cancer
  5. One relative w breast cancer and one w ovarian cancer
  6. Three relatives with breast cancer
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5
Q

Copper coil

A

—> toxic to sperm/ovum

Can be inserted and removed any time

Can be used as emergency contraception

Change very 5-10 years

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6
Q

IUS - levonorgestrel

Names 4; MOA; Insertion; Removal

A

4 licensed for use in UK:

  • Mirena (5 years)
  • Kyleena (5 years)
  • Levosert (5 years)
  • Jaydess (3 years)

MAO: Prevents implantation of fertilised ovum

Insertion:

  • On day 1-7 of cycle - no extra protection
  • Any other day (= off-label) - extra protection for 7 days

Can be removed at any point, no delay in return to fertility

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7
Q

LARC injections

A

3 licensed in UK:

  • Depo-provera —> 12 weekly, long-term (medroxyprogesterone acetate 150mg)
  • Saya-press —> 13 weekly, long term (medroxyprogesterone acetate 104mg)
  • Noristerat —> 8 weekly, only licensed for 2 doses (norethisterone enantate)

OK up to 14 weeks since last dose (Noristerat up to 10 weeks)

No known interactions with liver-enzyme inducing drugs

Review every 2 years

Can take up to a year to return to normal fertility (periods can take several months to return to normal)

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8
Q

Antenatal advice - food

A

Avoid…

  • Listeria (soft mould ripened cheese, e.g. Brie, unpasteurised milk, pate)
  • Salmonella (raw shellfish, uncooked/undercooked cured meat)
  • Liver and liver products (high vitamin A)
  • High levels of methylmercury (e.g. swordfish, shark, marlin)
  • Toxoplasmosis (so throughly cook meat, thoroughly wash fruit and veg)
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9
Q

Antenatal advice - general lifestyle

A

Vitamin D:
10mcg every day throughout pregnancy

Smoking:
Increases risk of miscarriage, prematurity, ectopic, low birth weight.
Consider NRT (different to usual forms)

Alcohol:
Avoid as no safe limit identified.
—> fetal alcohol spectrum disorder (structural birth defects, learning and behavioural problems)

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10
Q

Nausea & vomiting in pregnancy

A

Usually resolves buy around 16/40

Ketonuria suggests hyperemesis

Mx:
Mild…ginger, P6 wrist acupressure
1st line… oral promethazine/cyclizine —> reassess at 24 hours
If continues… oral prochlorperazine/metoclopramide/ondansetron —> reassess at 24 hours
If continues then specialist advice

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11
Q

Dyspepsia/heartburn in pregnancy

A

Lifestyle modification

1st line: antacids / alginates

2nd line: acid-suppressants - omeprazole…. (ranitidine alternative but not licensed in pregnancy)

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12
Q

Constipation

A

Increase fluid/fibre

Laxatives only if dietary measures fail —> bulk-forming laxatives 1st line, (then lactulose/macrogol)

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13
Q

Antiepileptics in pregnancy

3

A
  • W COCP —> need increased dose of oestrogen (at least 50 mcg) otherwise increased risk of pregnancy due to reduced efficacy OR change contraceptive method, eg. IUD/IUS
  • Increase teratogenicity risk (e.g. sodium valproate so may require alternatives)
  • Higher folic acid dose needed (5mg) to reduce risk of NTD
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14
Q

Obstetric cholestasis

A
  • exact cause unknown
  • Typically from 28/40 onwards
  • Intense itching, worse at night. May focus on palms and soles but can be anywhere
  • If suspected —> same day maternity review for bloods —> high bile acids +/- abnormal LFTs
  • Mx…
    1. Emollients
    2. Antihistamines
    3. Ursodeoxycholic acid
    4. Monitoring bloods
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15
Q

Polymorphic eruption of pregnancy

A
  • Most common in 3rd trimester
  • Presentation varies, e.g. erythematous rash, urticaria plaques or papules leading to intense itching. Often starts on abdomen
  • Lasts 4-6 weeks usually, settles soon after delivery
  • Mx…
    1. Emollients
    2. Topical steroids
    3. Antihistamines
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16
Q

Nabothian cyst

A

Mucus retention cyst on cervix

Harmless and may need cryotherapy if discharge occurring

17
Q

Cervical polyps

A

Benign neoplasms.
Usually asymptomatic but may bleed, e.g. on intercourse.
Can be removed and sent for histology if concerns.

18
Q

Cervicitis

A

Causes include chlamydia, gonorrhoea, herpes.

May mask underlying cancer.

19
Q

Cervical ectropion

A

= erosion/abrasion

Normal columnar epithelium occurs beyond os

Common in teenagers, pregnancy, on COCP

Can lead to discharge, bleeding

Often does not need treatment, but can remove, e.g. diathermy/cryotherapy

20
Q

Cervical incompetence

A

Painless dilation of cervix which can lead to miscarriage/premature labour —> may need prophylactic stitch

21
Q

Cervical screening

A

Look for two things - HPV and cells

If HPV negative —> routine recall

If HPV +ve….

…W normal cells —> repeat HPV in 1 year, and again in another 1 year —> if still HPV +ve then refer for colposcopy

…W abnormal cells —> colposcopy

22
Q

Amenorrhoea

A

= absence or cessation of periods

Primary = periods dont start by expected menarche…
- may require Ix, e.g. Pelvic USS, hormone levels like TFT, prolactin, LH, FSH, testosterone
- refer for complete Ix and Mx if no 2º sexual characteristics and no periods by age 13
OR if normal 2º sexual characteristics but no periods by age 15

Secondary = periods stop at later point in life for at least 3 months (can happen due to many causes —> may need referral depending on suspected cause like gynae or endo

23
Q

Stopping short term menstrual bleeding

A

—> norethisterone 5mg tds for 10 days

24
Q

Tranexamic acid

A

= antifibrinolytic drug

Indications:

  • Menorrhagia
  • Epistaxis, hereditary angioedema, fibrinolysis

CI:
- fibrinolytic conditions following DIC, Hx of convulsions, severe renal impairment, history of thromboembolic disease

Cautions:
- irregular menstrual bleeding, haematuria, using OCP, using warfarin/anticoagulants

SE:

  • GI - N, V, diarrhoea
  • Allergic dermatitis
  • Visual disturbances
  • Thromboembolic events
  • Convulsions

Dose:
(In menorrhagia) = 1g tds for up to 4 days
Can be increased to 4g per day if required

25
Q

Endometriosis Mx

A

1st line - 3 month trial of paracetamol or NSAID

2nd line - hormonal treatment options, e.g. COCP or progestogen options

26
Q

Fibroids:

Ix 2 and Mx 3

A

Ix:

  1. Usually Dx by USS
  2. Check FBC

Mx:

  1. Pharmacological…
    - Symptomatic —> e.g IUS, tranexamic acid, NSAIDs, COCP, POP
    - Reduce fibroid size —> e.g. GnRH agonists, ulipristal
  2. Procedures…E.g. uterine artery embolisation, endometrial ablation
  3. Surgery… e.g. myomectomy (laparoscopic, abdominal, hysteroscopic), hysterectomy
27
Q

Ovarian tumours

Types 2; RFs 6; Sx; Refer 2

A

Types:

  • Benign (e.g. serous cystadenoma, fibroma, benign cystic teratoma)
  • Malignant (often present late, e.g. epithelial tumours [most common], germ cell tumours)

RFs:

  • > 50 yo
  • Breast Ca FHx
  • Endometriosis
  • HRT
  • Smoking
  • Overweight

Sx:
Presentation varies - vague abdo pain, early satiety, weight loss, bloating, urine frequency, abdomino-pelvic mass, abnormal bleeding

Refer URGENTLY:

  1. W Ascites
  2. W pelvic/abdo mass (not fibroids)
28
Q

Ovarian cancer: when to Ix in community

A

Especially if >50 and frequent Sx:
Bloating, feeling full/loss of appetite, pelvic or abdo pain, increased urinary urgency/frequency

Consider Ix if…

  1. Unexplained weight loss
  2. Fatigue
  3. Change in bowel habit

If age >50 and symptoms of IBS then consider Ca-125

29
Q

Endometrial cancer

A

Refer 2ww if… Age >55 and PMB

Consider 2ww if… age under 55 and PMB

Consider direct access USS if age >55 and…

  • Unexplained vaginal discharge with either of first time presentation / thrombocytosis / haematuria
  • Visible haematuria with either low Hb / thrombocytosis / raised blood glucose
30
Q

Gynae cancers 2ww

Cervix, vulval, vaginal

A

Consider 2ww if…

Cervix: consistent with cancer

Vulva: unexplained vulval lump, ulceration, bleeding

Vagina: palpable mass in or at entrance of vagina

31
Q

PID

=; Lead to; Sx 4; Mx 3

A

= inflammation of female upper genital tract (including ovaries, uterus and Fallopian tubes)
- is a complication of STI, e.g. chlamydia/gonorrhoea

Can —> infertility, ectopic pregnancy, abscess formation, chronic pelvic pain

Sx can include:

  1. Discharge
  2. Deep dyspareunia
  3. Abdominal pain
  4. Fever

Mx:

  • GUM clinic referral including contact tracing
  • Analgesia, e.g. ibuprofen
  • Oral or IV Abx (e.g. cef/met/doxy/oflox) - may need admission
32
Q

Menopause: when to consider FSH test

A

(Provided not on hormonal treatment)…

  • Over 45 with atypical symptoms
  • 40-45 with menopausal symptoms change in cycle
  • under 40 and premature menopause suspected
33
Q

HRT contraindications

7

A
  1. Breast/oestrogen sensitive cancer
  2. VTE
  3. Angina
  4. MI
  5. Undiagnosed vaginal bleeding
  6. Endometrial hyperplasia
  7. Pregnancy
34
Q

Contraceptive/menopause/fertility advice

A

Woman <50 is fertile for 2 years after LMP.
>50 is fertile for 1 year.

In general, can stop contraception at age 55.

35
Q

Incontinence Mx

A

ALL:
Lifestyle - caffeine, fluids, weight loss

STRESS:
- Pelvic floor exercises (ideally for 3 months - 8 contractions 3x per day)
THEN - Refer for surgery (e.g. mid-urethral tape, colposuspension) OR duloxetine if surgery does not work/not wanted/inappropriate

URGE:
- Bladder training (at least 6 weeks)
THEN - Anticholinergic (oxybutynin, tolterodine, darifenacin) 1st line - takes 4 weeks to work
THEN - Refer if no benefit (e.g. for Botox injection, cystoplasty, etc)

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