Womens health Flashcards
important causes of menorrhagia PERIODS’
P: Polyps & Pelvic inflammatory disease
E: Endometriosis & Endometrial carcinoma
R: Really bad hypothyroidism
I: Intrauterine contraceptive device
O: polycystic Ovary syndrome
D: Dysfunctional uterine bleeding
S: Submucosal fibroids
Polyp
may cause intermenstrual bleeding
asymptomatic
Typically occur in multiparous patients >40 years
Criteria for PCOS
Rotterdam: 2/3
1. Oligoovulation or anovulation (irregular or absent menstrual periods)
2. Hyperandrogenism ( hirsutism and acne)
3. Polycystic ovaries on ultrasound (or ovarian volume of more than 10cm3)
Key features of PCOS
Oligomenorrhoea or amenorrhoea
Infertility/subfertility
Obesity
Hirsutism
Acne
Hair loss in a male pattern
Congenital adrenal hyperplasia
inherited disorder that results in low levels of cortisol and high levels of male hormones, causing development of male characteristics in females, and early puberty
measure 17- hydroxyprogesterone levels
Hormonal blood tests for PCOS typically show
Raised LH
Raised LH to FSH ratio (high LH compared with FSH, >2)
Raised testosterone, can be normal
Raised insulin
Normal or raised oestrogen levels
Co-cyprindiol (Dianette)
- PCOS
- combined oral contraceptive pill
- anti-androgenic effect
- Increased VTE risk
- stopped after three months of use.
Endometriosis symptoms
Cyclical abdominal/pelvic pain , constant if adhesions
Deep dyspareunia
Dysmenorrhoea
Infertility
Cyclical bleeding from other sites
Urinary symptoms eg dysuria (
Bowel symptoms eg dyschezia
Endometriosis O/E
Endometrial tissue visible in the vagina on speculum examination
fixed retroverted cervix on bimanual examination
Uterosacral ligament nodules
Tenderness in the vagina, cervix and adnexa,
Mx endometriosis
Hormonal management options can be tried before establishing a definitive diagnosis with laparoscopy. Suppressing ovulation for 6-12 months can cause atrophy of the endometriosis lesions and therefore a reduction in symptoms eg OCP
Another treatment option for endometriosis is to induce a menopause-like state using GnRH agonists eg goserelin (Zoladex)
Laparoscopic surgery to excise or ablate the endometrial tissue and remove adhesions (adhesiolysis)
Hysterectomy
Cause of Cervical ectropion
occurs when the columnar epithelium of the endocervix (the canal of the cervix) has extended out to the ectocervix
Lichen Planus
autoimmune condition that causes localised chronic inflammation with shiny, purplish, flat-topped raised areas with white lines across the surface called Wickham’s striae. hep c associated.
Mx lichen Planus
Treatment may involve corticosteroids, retinoids, calcineurin inhibitors, immunosuppressants, and phototherapy.
For genital disease corticosteroid or calcineurin inhibitor used
Lichen sclerosis
chronic inflammatory skin condition that presents with patches of shiny, “porcelain-white” skin
5% risk of developing squamous cell carcinoma of the vulva
associated with other autoimmune diseases
Mx lichen Sclerosus
Lichen sclerosis cannot be cured, but the symptoms can be effectively controlled
Lichen sclerosus is usually managed and followed up every 3 – 6 months
Potent topical steroids are the mainstay,clobetasol propionate 0.05% (dermovate)
Emollients should be used regularly
Bartholin’s cyst
swelling is typically unilateral
typically occupies the posterior part of the labia majora
can become infected and form abcess
Mx Bartholin’s cyst
usually resolve with simple treatment such as good hygiene, analgesia and warm compresses.
Incision is generally avoided, as the cyst will often reoccur
surgical options include Word catheter (Bartholin’s gland balloon) and Marsupialisation
biopsy may be required if vulval malignancy needs to be excluded
abscess will require antibiotics
High vaginal swab
used to look for bacterial vaginosis, candidiasis and trichomoniasis
NAAT swabs / ECS (endocervical swabs)
used to look for gonorrhoea and chlamydia.
PID tx
A single dose of intramuscular ceftriaxone 1g (to cover gonorrhoea)
Doxycycline 100mg twice daily for 14 days (to cover chlamydia and Mycoplasma genitalium)
Metronidazole 400mg twice daily for 14 days (to cover anaerobes such as Gardnerella vaginalis)
Complications of PID
Long-term complications: infertility, ectopic pregnancy, chronic pelvic pain
Short-term complications: sepsis, Tubo-ovarian abscess, Fitz-Hugh-Curtis syndrome
Fitz-hugh curtis syndrome
rare complication of PID
RUQ pain due to peri-hepatitis
can be referred to the right shoulder tip
caused by inflammation and infection of the liver capsule (Glisson’s capsule), leading to adhesions between the liver and peritoneum.
Bacterial vaginosis symptoms
thin, profuse and fishy-smelling discharge without itch or soreness
Candidiasis symptoms
Thick, typically curd like, white, non-offensive discharge which is associated with vulval itch and soreness.
Treatment vaginal candidiasis
clotrimazole
T. vaginalis symptoms
yellow vaginal discharge, which is often profuse and frothy, associated with vulval itch and soreness, dysuria, abdominal pain and superficial dyspareunia.t may have a fishy smell.
Examination of the cervix can reveal a characteristic “strawberry cervix”
BV treatment
Metronidazole and clindamycin administered either orally or vaginally
Trichomoniasis treatment
oral metronidazole.
Gonorrhoea symptoms
Odourless purulent discharge, possibly green or yellow
Dysuria
Lower Pelvic pain (25%)
abnormal bleeding (rare)
Gonorrhoea treatment
ceftriaxone
vaginal ph testing difference between BV and trichomonas vs candidiasis
bacterial vaginosis and trichomonas (pH > 4.5) and candidiasis (pH < 4.5)
Amsel criteria
BV, 3/4 criteria need to be met
Vaginal pH > 4.5
Typical discharge
Positive whiff-amine test: development of fishy odour with addition of 10% potassium hydroxide to vaginal discharge
Clue cells (on microscopy): vaginal epithelial cells studded with adherent coccobacilli
Syphilis causative organism
Treponema pallidum
menorrhagia management: contraception wanted
- intrauterine contraceptive system Mirena coil 2.Combined oral contraceptive pill
- Cyclical oral progestogens, such as norethisterone
4.Progesterone only contraception
menorrhagia management: trying to conceive/no contraception wanted
1.tranexamic acid ( if there is no associated pain)
2.NSAID- mefanamic acid ( if there is associated pain)
Stress incontinence management
- Lifestyle changes – weight loss and smoking cessation.
- Treatments of risk factors – such as conditions that raise the intra abdominal pressure (e.g chronic cough).
- trial of at least 3 months’ supervised pelvic floor muscle training.
- surgery should be considered.
- duloxetine (combined noradrenaline and serotonin reuptake inhibitor)
