Womens Flashcards
HMB/menorrhagia definition
blood loss of >80mL, difficult to quantify so diagnosis is based on patient’s perception
HMB/menorrhagia associated symptoms
irregular bleeding (IMB or post-coital bleeding) - endometrial or cervical polyp; excessive bruising at other sites, Hx PPH, excessive postoperative or post dental extraction bleeding, FHx of bleeding problems - coagulation disorders; unusual vaginal discharge - PID; urinary symptoms - pressure from fibroids; weight change, skin change, fatigue - thyroid disease
HMB/menorrhagia key points
aetiology: fibroids, endometrial polyps, coagulation disorders, PID, thyroid disease, drug therapy (e.g warfarin), IUCDs, endometrial/cervical carcinomas
Hx: how many pads, spilling over, time off work, clots?
Exam: anaemia, abdomen, pelvis for masses, cervix to inspect and take swabs for PID and screen if needed
Ix: FBC, coagulation screen, PUU if pelvic mass, high vaginal and endocervical swabs, endometrial biopsy if age >45 years, irregular or IMB or failed drug therapy - performed in outpatient setting. Do an outpatient hysteroscopy if endometrial biopsy fails, TFTs if constitutional symptoms present
Mx: Medical = mefenamic acid/NSAIDs, tranexamic acid, COCP, norethisterone, LNG-IUS/MIrena, GnRH agonists
Surgical = endometrial ablation, hysterectomy
Dysmenorrhoea definition and epi?
painful menstruation. In 45-95% of women of reproductive age. (Some evidence that dysmenorrhoea improves after childbirth and with increasing age)
dysmenorrhoea key points
aetiology: endometriosis, adenomyosis, PID, rarely cervical stenosis and haematometra
Hx: take painkillers for the pain? which ones help? time off work/school because of the pain?
Exam: abdominal and pelvic exam: pelvic mass (endometrioma), fixed uterus (adhesions), endometriotic nodules (palpable in pouch of douglas or on uterosacral ligaments)
Ix: high vaginal and endocervical swabs (exclude chlamydia trachomatis and neisseria gonorrhoea), PUS (endometriosis and adenomyosis), diagnostic laparoscopy - when other Ix are normal, warn patient that it may not show any causes, US and hysteroscopy if Hx and exam suggests cervical stenosis (abnormal bleeding, amenorrhoea, after surgery, doctor can’t insert brush in cervical screening test, pelvic mass from haemo- / pyometra
Mx: NSAIDs, heat, oral contraceptives, Mirena, low-fat vegetarian diet (some evidence), GnRH analogues
dyspareunia definition
pain during sexual intercourse
dyspareunia key points
classified superficial or deep
aetiology: deep - PID, endometriosis
definition of amenorrhoea/oligomenorrhoea
primary: no menarche at 16 years
secondary: no menstruation for 6 months in a normal female of reproductive age that is not due to pregnancy, lactation or menopause
causes of amenorrhoea/oligomenorrhoea
anatomical: tract abnormalities, Asherman’s (uterine adhesions e.g. from curettage), Mullerian agenesis (absent uterus and malformed vagina), transverse vaginal septum, imperforate hymen
ovarian disorders: anovulation e.g. PCOS, POF
pituitary: prolactinoma, pituitary necrosis e.g. Sheehan’s syndrome from prolonged hypotension in major obstetric haemorrhage
hypothalamic: excessive exercise, weight loss, stress. Lesions (cranioparyngioma, glioma) can compress hypothalamus or block dopamine. Head injuries. Kallman’s syndrome: XR - GnRH deficiency - underdeveloped genitalia. Sarcoidosis, tuberculosis infiltration into hypothalamic tissue. Drugs - progestogens, HRT or dopamine antagonists.
Ix for amenorrhoea
pregnancy test, blood test for LH, FSH and testosterone: high LH or testosterone could suggest PCOS; raised FSH could suggest POF. Raised prolactin - prolactinoma. TFTs. USS for PCOS, MRI for pituitary adenoma. karyotyping for Turner’s. Hysteroscopy when Asherman’s or cervical stenosis suspected.
Mx for amenorrhoea
low BMI - dietary advice
hypothalamic lesion - surgery
hyperprolactinaemia/prolactinoma - dopamine agonist
POF - HRT or COCP
PCOS
Asherman’s - adhesiolysis and IUD insertion at time of hysteroscopy
cervical stenosis - hysteroscopy and cervical dilation
Risks from marijuana use in pregnancy
Early onset labour and foetal distress
Poor growth
Behavioral problems
Breathing problems
