Womens Health

Question 1

For women using non-hormonal contraception, when can you stop contraception at menopause?

Answer 1

For women >50: stop after 12 months of amenorrhoea

For women <50: wait 24 months after amenorrhoea

Question 2

When can you cease contraception for women >50 on hormonal contraception?

Answer 2

LNG-IUD/POP/ENG implant: check 2x FSH levels at least 6 weeks apart and if both are >30Iu/L then contraception can be ceased in 12 months

Depot medroxyprogesterone: not recommended >50

• switch to non-hormonal until amenorrhoea for 24 months OR
• change to another progesterone form

COCP: not recommended >50

• switch to non-hormonal until amenorrhoea for >12 months OR
• switch to another progesterone only form

Question 3

When should you consider antibiotic prophylaxis for recurrent UTI?

Answer 3

Non pregnant
Frequent symptomatic infections
- >2 in 6 months or >3 in 12 months

Question 4

Describe a strategy for UTI prophylaxis

Answer 4

Continuous prophylaxis for 6 months then cease:
150mg trimethoprim note

Intermittent post-coital prophylaxis:
150mg trimethoprim within 2 hours after sex

Question 5

Contraindications to systemic oestrogen therapy (9)

Answer 5

Age >60
Previous VTE
CVD - previous stroke, TIA, or MI 
Uncontrolled hypertension 
Oestrogen dependent cancer (breast, ovarian)
Undiagnosed vaginal bleeding 
High breast cancer risk 
Significant liver disease
Porphyria or SLE

Question 6

Contraindications to oral oestrogen therapy (transdermal considered ok)

Answer 6

Risk factors for VTE - obesity, smoking, thrombophilia
Risk factors for CVD - previous CVD, insulin resistance, diabetes, obesity, hypertension (even if controlled), smoking
Elevated triglycerides
Liver or gallbladder disease

Question 7

Vaginal therapy for menopause

Answer 7

If symptoms include urogenital:
intravaginal oestrogen

If vaginal dryness is only symptom:
Silicone based vaginal moisturiser/lubricant (eg replens)

Question 8

Risk factors for increased risk endometrial cancer

Answer 8

Oligomenorrhoea
PCOS
Use of unopposed oestrogen or tamoxifen
Obesity
Age >45
Endometrial thickness >12mm if premenopausal 
Endometrial thickness >5mm if perimenopausal
 - measure in first half of cycle

Question 9

Who is at moderately increased risk of breast cancer?

Answer 9

First degree relative dx. <50
2 x first degree relatives on same side
2x second degree relatives on same side, at least one of them <50yo

Question 10

Breast cancer screening for moderately increased risk group

Answer 10

2 yearly from age 50-74

Annually from 40yo if 1st degree relative was dx. <50

Question 11

What are the 3 emergency contraception options

Answer 11

Copper IUD - up to 120 hours after sex
Ulipristal acetate 30mg (oral) - up to 120 hours after sex
- might not be effective if BMI >30
Levonorgestrel 1.5mg emergency contraception
- up to 72 hours after sex
- might not be effective if BMI >30
- not as effective as above options

Question 12

Empirical treatment of acute cystitis in pregnancy

Answer 12

nitrofurantoin 100mg qid for 5 days

OR trimethoprim 300mg daily for 3 days in 2nd and 3rd trimester only

Question 13

7 causes of abnormal nipple discharge

Answer 13

Duct ectasia 
Breast cancer - uncommon cause 
Pagets disease of nipple - type of breast ca
Duct papilloma 
Nipple eczema 
Hormonal (pituitary/thyroid)
Drugs