Women's health

Question 1

What are the indications for progestogen only pill?

Answer 1

over 35 and a smoker
hereditary risk of thrombosis

Question 2

How does the oral combined pill work?

Answer 2

Inhibits ovulation by inducing negative feedback, thickens cervical mucus, and thins endometrium

Question 3

What does monophasic oral contraceptive pill mean?

Answer 3

same dose everyday as opposed to phasic

Question 4

What are the two phases of the menstrual cycle?

Answer 4

follicular and luteal phases

Question 5

Around which days does menstruation occur?

Answer 5

Days 1-5

Question 6

Around which days does ovulation occur?

Answer 6

Days 12-16 (day 14 typically)

Question 7

A 20 year old female is about to start taking the OCP. It has been two days since her last period. What advice should you offer her?

Answer 7

Wear condoms for the next 7 days. If she had started the pill whilst on her period then she would not need barrier protection.

Question 8

List two other uses for the COCP other than contraception

Answer 8

reduces benign ovarian cysts and tumours
reduced heavy menstrual bleeding and dysemenorrhoea
reduced symptoms of endometriosis
treatment of PMS (premenstrual syndrome) and PCOS
improves menopausal symptoms

Question 9

Name two cancers whose risks are reduced by OCP

Answer 9

endometrial
ovarian
colorectal

Question 10

List two conditions which the OCP is a risk factor for

Answer 10

stroke
CVS disease
breast cancer
cervical cancer
venous thromboembolism

Question 11

List two contraindications for the COCP

Answer 11

smoking >35 years old
hypertension
history of stroke
high BMI >35
migraines
liver disease
thombogenic risk
breast feeding

Question 12

Is it more important to take the COCP at the same time every day or the progestogen only pill?

Answer 12

POP!! Must treat late pill as missed pill

Question 13

What is the mechanism of contraception in POP?

Answer 13

thickens cervical mucus
thinning of endometrium
inhibits ovulation

Question 14

Which oral contraceptive pill is safe to use in breast feeding women?

Answer 14

prostogen only

Question 15

List one emergency contraception option

Answer 15

copper IUD- within 5 days
ulipristal- taken within 120 hours after sex
levonorgestrel- taken within 72 hourso

Question 16

Which is the most effective emergency contraception method?

Answer 16

copper IUD

Question 17

List two structural causes of abnormal bleeding

Answer 17

PALM
polyps
adenomyosis
leiomyoma= fibroids
malignancy/hyperplasia- endometrial cancer

Question 18

List two non-structural causes of abnormal uterine bleeding

Answer 18

COEIN
coagulopathy
ovulatory disorder
iatrogenic- contraceptives
endometrial- pelvic inflammatory disease
not otherwise classified

Question 19

40 year old lady has persistent intermenstrual bleeding. What should you do?

Answer 19

refer directly to outpatient hysteroscopy

ALL women with persistent intermenstrual or persistent irregular bleeding, and ALL women with infrequent heavy bleeding and risk factors for endometrial pathology (including obesity), DIRECTLY for outpatient hysteroscopy.

Question 20

What is the first line treatment for abnormal uterine bleeding?

Answer 20

levonorgestrel IUS

Question 21

List three causes of post menopausal bleeding

Answer 21

cervical ectropian
cervical polyp
cervicitis
vulvovaginal atrophy
CIN
cervical cancer

Question 22

What is endometriosis?

Answer 22

growth of endometrial like tissue outside the uterus which induces chronic inflammatory reaction and leads to adhesions, fibrosis, and anatomical distortion

Question 23

What is the management of endometriosis?

Answer 23

paracetamol +- NSAID
hormonal treatment- COCP, levonorgestrel IUS, POP
surgery

Question 24

WHat is the precursor compound for androgens?

Answer 24

cholesterol

Question 25

What is the precursor compound for oestradiol?

Answer 25

androgens

Question 26

List three features of PCOS

Answer 26

oligo/amenorrhoea
heavy/irregular periods
acne
alopecia
hirsutism
obesity
infertility

Question 27

Name the criteria to diagnose PCOS

Answer 27

Rotterdam criteria

Question 28

List one feature of the rotterdam criteria

Answer 28

amenorrhoea or oligomenorrhoea
polycystic ovaires on ultrasound scan
clinical biochemical hyperandrogenism

Question 29

Which biochemical test is used in PCOS?

Answer 29

free androgen index= FAI
measures biologically active testosterone

Question 30

Which level of FAI (free androgen index) indicates PCOS

Answer 30

FAI >5

Question 31

What is the management of PCOS?

Answer 31

lifestyle and weight loss
menstrual regulation- COCP
endometrial protection- active monitoring
hirsutism- cosmetics, laser hair removal
Acne- COCP, topicals
Fertility

Question 32

List three symptoms of the menopause

Answer 32

hot flushes, night sweats (differential for malignancy!!)
vaginal dryness
loss of libido
mood changes
cognitive disturbance
urinary problems
sleep disturbance

Question 33

HRT is beneficial for which symptoms?

Answer 33

low mood, vasomotor symptoms
sexual function
urogenital atrophy
MSK symptoms
bone mineral density

Question 34

List two contraindications for HRT

Answer 34

breast cancer history
arterial thromboembolic disease
recurrent VTE
thrombophilic disorder
liver disease

Question 35

Aside from HRT, list three other options for management

Answer 35

lifestyle- regular exercise, stop smoking, healthy diet and BMI…
CBT
SSRIs (mum)

Question 36

Which HRT for women with total hysterectomy or mirena coil in place? (IUS)

Answer 36

oestrogen only HRT (unopposed oestrogens cause endometrial proliferation in women with uterus)

Question 37

Which HRT for postmenopausal women?

Answer 37

continuous combined HRT

Question 38

HRT for perimenopausal women?

Answer 38

sequential combined HRT

Question 39

When do you advise cyclical HRT?

Answer 39

If woman still has periods. Do this for first year and then switch to continuous

Question 40

Antibiotics for upper UTI?

Answer 40

cefalexin