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Reproductive System > Zero to finals gynae > Flashcards

Zero to finals gynae Flashcards

1
Q

What is the hypothalamic-pituitary gonadal axis?

A

Hypothalamus releases gonadotrophin releasing hormones. These stimulate anterior pituitary to produce lutenising hormone and follicle stimulating homrone. Stimulate the development of follices in the ovaries. The theca granulosa cells aroudn the ovary secrete oestrogen. Oestrogen has a negative feedback on hypothalamus and anterior pituitary

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2
Q

What is oestrogen

A

A steroid sex homrone produce by ovaries in response to LH and FSH

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3
Q

Where does oestrogen act?

A

Acts on tissues witb oestrogen receptors

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4
Q

What does oestrogen stimulatre?

A

Breast tissue development
Growth and development of female sex organs
Blood vessel development in the uterus
Development of the endometrium

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5
Q

What is progestrone?

A

Steroid sex hormone

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6
Q

What is progestrone produced by? When?

A

Corpus luteum
After ovulation

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7
Q

What happens to progestrone if pregnancy occurs?

A

Mainly produced by placenta from 10 weekjs gestation onwards

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8
Q

Where does progestrone act?

A

On tissues that have been previously stimulated by oestrogen

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9
Q

What does progestrone act to do?

A

Thicken and maintain the endometrium
Thicken cervical mucus
Increase the body temperature

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10
Q

When does puberty start in girls?

A

8-14

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11
Q

When does puberty start in boys?

A

9-15

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12
Q

What is aromatase?

A

Enzyme found in adipose tissue
Important in creation of oestrogen
Therefore more adipose the higher the quantity of enszy,e responsible for oestrogen creation

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13
Q

What is the first episode of menstration called?

A

Menarche

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14
Q

What can the satge of pubertal deveopment be determined by?

A

Tanner sc ale

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15
Q

What are the hormonal changes during puberty?

A

Growth hormone increases initally causing a hrowth during the initial phase of puberty

Hypothalamus starts to secrete GnRH initially during sleep then throughout the day in later stages of puberty. GnRH stimulates the release of FSH and LH from the pituitary gland. FSH and LH make ovaries produce oestrogen and progesterone. FSH levels plateau about a year before menarche. LH levels continue to rise and spike just before they induce menarche

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16
Q

What does oestrogen do?

A

Suppress growth hormone causing rowth to slow down as oestrogen levels increase/ This suppression is the reason growth spurt finishes sooner in girls leaving them short in adult hood

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17
Q

What is the follicular phase?

A

From the start of menstruation to the moment of ovulation

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18
Q

What is the luteal phase?

A

From the moment of ovulation to the start of menstration

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19
Q

What surrounds oocytes and what does this create?

A

Granulosa cells surroudn the oocytes forming structures called follicles

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20
Q

What are the 4 key stages of development of the ovaries?

A

Primordial follicles
Primary follicles
Secondary follicles
Antral (graffian) follicles

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21
Q

What happens once the follciles reach the secondary follicle stage?

A

They have receptors for follicle stimualting hormones
Further deelopemtn requires stimulation of FSH

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22
Q

What happens when FSH stimulates the secondary follicle?

A

The follicle grows and the granulosa cells that surround them secrete increasing amounts of oestrogen. This has a negative feedback on pituitary so LH and FSH decreased. Also cervical mucus becomes more permeable allowing sperm to penetrate cervix around time of ovulation.

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23
Q

What is the dominant follicle

A

One follicle will dveelop further than the others and become the dominant follicle. LH spikes just before ovulation and dominant follicle is released to the ovum

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24
Q

What happens to the follicle after ovulation

A

The follicle that released the ovum collapses and becomes the corpus luteum. This secretes high levels of progesterone which maintains the endometrial lining. This progesterone also causes the cervical mucus to become thick and no longer permeable.. Corpus luteum also secretes a small amount of oestrogen

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25
Q

What happens to the corpus luteum if ovulation occurs

A

The syncytiotrophoblast of the embryo secretes HCG. This maintains corpus luteum. Withput HCG corpus luteum degenerates

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26
Q

What happens to corpus luteum if no fertilisation

A

Degenerates and stops producing oestrogen and progestrone. This fall causes the endometrium to break down and menstration to occur

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27
Q

What do prostagalndins cells do and what releases them?

A

The stromal cells of the endometrium release prostaglandins.These encourage the endometrium to break down and the uterus to contract.

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28
Q

What does menstration involve?

A

Involves the superficial and middle layers of the endometrium separating from the basal layer. The tissue is broken down inside the uterus and released via the cervix and vagina. The release of fluid containing blood from vagina lasts 1-8 days

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29
Q

What does the primordial follicle contain?

A

A primary oocyte
Oocyte are the germ cells that eventually undergo meiosis to become the mature ovum ready for fertilisation
Contain full 46 chromosomes
These spend the majority of their lives waiting in the ovary

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30
Q

Where is the primary oocyte contained?

A

Within the pregranulosa cells surrounded by the outer basal lamina layer

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31
Q

What do the primordial follicles grow and become

A

Grow and become primary follciles. 3 layers- Primary ooyte in centre, zona pellucida and the cuboidal shaped granulosa cells

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32
Q

What do the granulosa cells secerete

A

Material that becomes the zona pellucida. They also secrete oestrogen

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33
Q

What happens as follicles grow larger?

A

Develop a further layer called the theca follucli
Inner layer of this is the theca internal

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34
Q

What does the theca interna secrete?

A

Androgen hormones

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35
Q

What is the outer layer of the theca external made up of?

A

Connective tissue cells containing smooth muscle and collagen

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36
Q

What happens as primary follicles become secondary follicles

A

They become larger and develop small fluid filled gaps between the granulosa cells
Once the follicles reach the secondary follicle stage, they have receptors for follicle stimulating hormone
Further development after the secondary follicle stage requires stimulation from FSH
At the start of the menstrual cycle, FSH stimulates further development of the secondary follicles

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37
Q

What happens with further development of the secondary follicles

A

Develops a single large fluid filled area with graulosa cells called the antrum

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38
Q

What is the antrium

A

Refers to naturral chamber within a structure

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39
Q

What happens to the antrum of the follicle?

A

This antrum fills with increasing amount of fluids, making the follicle expanded rapidly

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40
Q

What is the corona radiata

A

Made up of granulosa cells and surrounds the zona pellucida and oocyte
At this point one of the follicles become the dominant follicle
The other follicles start to degenerate, while the dominant follicle grows to become a mature follicle
This follicle bulges through the walls of the ovary

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41
Q

What happens when there is a surge of lutenising hormone from the pituitary?

A

Causes the smooth mucles of the theca external to squeeze and the follicle to burst

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42
Q

Where is the oocyte released into?

A

Released into the area surrounding the ovary
At this point it is floating in the perioteal cavity but is quickly swept up by the fimbriae of the fallopian tube

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43
Q

Where does the corpus luteum come fropm?

A

The leftover part of the follicle colapses and turn yellow. The collapsed follicle becomes the corpus luteum

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44
Q

The cells of the granulosa and theca internal become what?

A

Luteal cells

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45
Q

What do luteal cells secrete?

A

Steroid hormones most notably progestrone

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46
Q

When does the corpus luteum persist?

A

In response to human chornic gonadotrophin from a fertilised blastocyst when pregnancy occurs

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47
Q

How long does corpus luteum take to degenerate?

A

Degenerates after 10-14 days

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48
Q

Where does the sperm enter the ovum

A

Attempt to penetrate the corona radiata and zona pellucidum

Only one sperm will get through usually

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49
Q

What happens to the chromosomes once the sperm enters the egg

A

23 chromones of the egg multiply into 2 sets

One set combine with 23 of sperm

The second makes a second polar body

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50
Q

23 chromomsones from the egg and 23 from sperm make what?

A

A fertilised zygote

Divides rapidly to make the morula

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51
Q

What does the blastocyst contain?

A

The main group of cells in the middle called the embryoblast and a fluid filled cavity celled the bastocele

The outer layer is the trophoblast

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52
Q

What happens when the blastocyst enters the uters?

A

Contains 100-150 cells

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53
Q

What is the outer layer of the trophoblast cells?

A

Syncytioreophoblast

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54
Q

What happens to cells of the stroma?

A

Convert into a tissue called decicdua that is specialised in providing nutrients to the trophoblast

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55
Q

Why is HCG importnat for the corpus luteum?

A

Allowing the ovary to continue producing progestrone and oestorgen

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56
Q

Where does the fetus get oxugen?

A

Placenta

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57
Q

What has a higher affinity for oxygen fetal or adult haemoglobin?

A

Fetal

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58
Q

What does the syncytiotraphoblast produce?

A

HCG

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59
Q

What symptoms does HCG cause

A

Nausea and vomiting in early pregnancy

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60
Q

Whatdoes the placenta producing oestrogen do?

A

Soften tissues and make them more flexible

Allows the muscles and ligaments of the uterus and pelvis to exam and the cervix to become soft and ready for birth

Enlarges and prepares the breasts and nipples for breastfeeding

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61
Q

What is the role of progestrone?

A

Maintain the pregnancy

Relaxation of the uterine muscles and maintains the endometrium

Relaxes LOS, the bowel and blood vessels

Raises body temperature between 0.5 and 1 degree celcius

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62
Q

How do embryos develop immunity

A

The mother’s antibodies can transfer across the placenta to the fetus during pregnancy

Antibodies allow the fetus to benefit from the long term immunity of the mother during pregnancy and shortly after birth

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63
Q

What are changes in the anterior pituitary during pregnancy?

A

Produce more ACTH, Prolactin and melanocyte stimulating hormone in pregnancy

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64
Q

What thyroid levels rise in pregnancy?

A

T3 and T4 rise

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65
Q

What changes occur to the uterus during pregnancy?

A

Size of the uterus increases from 100g to 1.2 kg

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66
Q

What does oestrogen in pregnancy do to uterus?

A

Cervical ectropion and increased cervical discharge

Oestrogen also causes hypertrophy of the vaginal muscles and increases vaginal discharge

These changes in the vagina prepare it for delivery, however they make bacterial nd candidial infection more common

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67
Q

What do prostaglandins do to the uterus during pregnancy?

A

Prostaglandins break down collagen in the cervix allowing it to dilate and efface during childbirth

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68
Q

What are some cardiovascular changes during pregnancy?

A

Increased blood volume

increased plasma volume

Increased CO with increased SV and HR

Decreased peripheral vascualr resistance

Decreased blood pressure in early and middle pregnancy, returning to normal by term

Varicous veins can occur due to peripheral vasodialtion and obstruction of the IVC by the uterus

Peripheral vasodilation also causes flushing and hot sweats

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69
Q

What are the respiratory changes in pregnancy?

A

Tidal volume and respiratory rate icnreases in later pregnancy to meet the increase oxygen demands

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70
Q

What are the renal changes in pregnancy?

A

Increased blood flow to the kindyes

Increased GFR

Increased aldosterone leads to increased salt and water reabsorptuon and retention

Increased protein excretion from the kidneys

Dilation of the ureters and collecting system, leading to a physiological hydronephrosis

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71
Q

WHat happens to RBC producgtion im pregnancy?

A

Leads to higher iron, folate and B12

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72
Q

What happens to plasma volume during pregnancy?

A

Increases more than RBC volume leading to a lower concentration of RBC

High plasma volume means the haemoglobin concentration and red cell concentration falls in pregnancy resulting in anaemia

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73
Q

What happens to clotting factors during pregnnsayc?

A

Fibrinogen and factor VII, VIII, and X increase in pregnancy making women more hypercoaguable

This increases the risk of venous thromboembolism

Prengnat women are more likely to develop DVT and PE

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74
Q

What are some skin chages durin gpregancy

A

Increased skin pigmentation due to increased melanocyte stimulating hormone, wth linea nigra and melasma

Striae graviadarum

General itchiness

Spider naevi

Palmer erythma

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75
Q

WHat is the first stage of labour?

A

From the onset of labour until 10cm cervical dialtion

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76
Q

What si the second stage of lbaour?

A

Is from 10cm cervical dilation to delivery of the baby

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77
Q

What si the third stage of labour?

A

Delibery of the baby to delivery of the placenta

78
Q

What do prostaglandins do?

A

Act like hormones, triggering specific effects in local tissue

Tissues throughout the entire body contain and respond to prostaglandins

Play a crucial role in menstration and labour by stimulating contraction of the uterine muscles

Ripen the cervix before delivery

79
Q

What is a key prostaglandin?

A

Pessiary containing prostaglandin E2 (Dinoprostone) can be used to induce labour

80
Q

What are braxton-hicks contractions?

A

Occasional irregular contractions of the uterus

Felt during the second and third trimester

Temporary and irregu;ar tightening or mild cramping in the abdmen

81
Q

What is the show?

A

Mucus plug in the cervix that prevents bacteria from entering the uterus during pregnancy falling out and creating space for the baby to pass through

82
Q

Stages of labour in the first stage?

A

Latent phase: 0-3 cm dilation of the cervix. This progresses at around0 0.5 cm per hour. There are irregular contractions

Active phase: 3-7 cm dilation of the cervox. Progesses at around 1cm per hour and there are regular contractions

Transition phase: From 7cm-10m dilatio of the. cervix. This progresses at around 1cm per hour and there are strong and regular contractions

83
Q

When does the second stage of lbaour last from?

A

10cm dilation of the cervix to delivery of the baby

84
Q

What does the success of the second stage depend on?

A

Power- Strngth of uterine contractions

Passanger- Size, lie, attitude, presentation

Passage- Size and shape of passegway mainly the pelvis

85
Q

What are the cardinal movements of labour?

A

Engamgement

Descent

Flexion

Internal rotation

Extension

Restitution and external rotation

Expulsion

86
Q

Descent is measured in centimeters from?

A

Ischial spines

  • 5: when the baby is high up at around the pelvic inlet
    0: when the head is at the ischial; spines

+5 when the fetal head has descended further out

87
Q

What is phsyiological manageent of the placenta?

A

Where the placenta is delivered by maternal effort without medications or cord traction

88
Q

What is the active manage,ent of the third stage?

A

Where the midwife or doctor assist in delivery of the placenta. Active management shortens the third stage and reduces risk of bleeding

Haemorrhage or more than 60 minute delay of the placenta should promote active mangement

Active management can be associated with nausea and vomiting

89
Q

What medication is given for actie management of labour?

A

Intramusuclar oxytocin to help the uterus contract and expel the placenta

Careful traction is applied to the umbilical cord to guide the placenta out of the uterus and vagina

90
Q

What is amenorrhea?

A

Lack of menstral period

91
Q

What is primary amenorrhea?

A

When the patient has never to develop periods

92
Q

What can primary amenorrhea be due to?

A

Abnormal functioning of the hypothalamus or pituitary gland

Abnormal functioning of the gonads

Imperforated hymen or other structural pathology

93
Q

What is secondary amenorrhea?

A

Patient previosuly had periods that subsequently stopped

94
Q

What is secondary amenorrhea due to?

A

Prenancy

Menopause

POS

Meds

Premature ovarian insufficiaency

Thyroud hromone

Cushing’s sryndrome

95
Q

What does irregular menstal bleeding indicate?

A

Anovulation or irregular ovulation

96
Q

What is irregular menstration due to?

A

Extremes of reproductive age

POCS

hormonal imbalances

97
Q

What is intermenstral bleeding?

A

Refes to any bleeding that occurs between menstral periods

98
Q

What are the key causes of intermenstral bleeding?

A

Hormonal contractiption

STI

Endometrial polyps

99
Q

What is dysmeorrhea?

A

Painful periods

100
Q

What are the causes of dysenorrea?

A

Endometrisis

Fibroids

Copper coil

101
Q

What is menorrhagia?

A

Heavy menstral bleeding

102
Q

What is heavy menstral periods?

A

Fibroids

PCOS

Connective tissue disorder

103
Q

What is postcoital bleeding?

A

Refers to bleeding after sexual intercourse

Red flag

104
Q

Causes of postcoital bleeding?

A

Cervical cancer

Trauma

Atrophic vaginitis

Vaginal cancer

105
Q

What are some causes of pelvic pain?

A

uti

Dysmenorrhea

IBS

Ovarian cancer

Pelvic adhesions

106
Q

What does abnormal vaginal discharge indicate?

A

BV

Candidaisis

Chalymdia

Gonorrhoea

107
Q

What is pruritus vulvae

A

Itching of the vulva and vagina

108
Q

WHat are the causes of pruitus vulvae

A

Irritants

Atrophic vaginitis

Infections

Vuvae malignancy

109
Q

When does primary amenorrhea defined as not starting menstraiton by when?

A

By 13 years when there is no other evidence of pubertal dveelopment

By 15 years where there are other signs of puberty such as breast bud and development

110
Q

What does hypogonadism refer to?

A

Lack of the sex hormones, oestrogen and testosterone

111
Q

What is hypogonadotrophic hypogonadism?

A

Deficiency of LH and FSH

112
Q

What is hypergonadotrophic hypogonadism?

A

A lack of response to LH and FAH by the gonads

113
Q

What is Kallman syndrome?

A

Genetic condition causing hypogonadotrophic hypogonadism with faikure to start puberty

Associated with a reduced or absent sense of smell (ansomia)

114
Q

What is hypergonadotrophgic hypogonadism?

A

Where the gonads fail to respond to stimulation from the gonadotrophins

Withot negative feedback from the sex hormones the anterior pituitary produces increasing amounts of LH and fsh

Consequently you get high gonadotrophins and low sex hormones

115
Q

What is hypergonadotrophic hypogonadism can be due to?

A

Previosuly damage to the gonads

Congenital absence of ovaries

Turner’s syndrome

116
Q

What is congenital adrenal hyperplasia caused by?

A

Congenital deficincey of the 21 hyroxylase enzyme

Genetic condition inherited in an autosomal recessive pattern

117
Q

WHat does congenital adrenal hyperplasa cause?

A

Underproduction of cortsiol and aldosterona dn overproduction of androgens from birth

118
Q

What happens in severe cases of congenital adrenal hyperplasia?

A

Unwell shortly after birth with electrolyte disturbances and hypoglycaemia

119
Q

What happens in mild female cases of congenital adrenal hyperplasia?

A

Tall

Facial hair

Absent period

Deep voice

Ealry puberty

120
Q

What is androgen insensitive syndrome?

A

Condition occur in males where the tissue are unable to respond to androgen hormones meaning typical male sexual characteristics do not develop

It results in a feaml phenotype other than the internal pelvic organs

Normal female external genitalia and breast tissue

Internally there are testes in the abdomen or inguinal canal and an absent uterus, upper vagina, fallopian tubes and ovaries

121
Q

What is secondary amenorrhea?

A

Defiened as no menstration for more than 3 months after previous regular periods

122
Q

What do high prolactin levels do?

A

High prolactin levels act on the hypothalamus to prevent the release of GnRH

Without GnRh there is no release of LH and FSH this hypogonadotrophic hypogonadism

123
Q

What is the most common cause of hyperprolactinaemia?

A

Pituitary adenoma secreting prolactin

124
Q

What can reduce prolactin productio?

A

Dopamine agonsists such as bromocriptine or cabergoline

125
Q

WHat does the assessment of secondary amenorrhea involve?

A

Detailed history and examination to assess for potential causes

Hormoonal blood tests

US of the pelvis to dianose PCOS

126
Q

What does patients with amenorrhea associated with low oestrogen levels are at increased risk of what?

A

Osteoporosis

127
Q

What is PMS?

A

Physiological, emotional and psychological symptoms that occr during the luteal phase of the menstral cyctle

Resolve once menstration begins

128
Q

Symtoims of PMS

A

Low mood

Anxiety

Mood swings

Irritability

Bloating

129
Q

Premenstral dysphoric disorder

A

Whe PMS has a significant effect on QOL

130
Q

Management of PMS

A

General healthy lifestyle changes

Combined contraceptive pill

SSRI antidepressant

CBT

131
Q

What is heavy menstral bleeding also called?

A

Menorrhagia

132
Q

What volume of blood loss is menorrhagia?

A

80ml lost

133
Q

What are some symtpoms of menorrhagia?

A

Changing pads every 1-2 hours

Bleeding more than 7 days

Large clots

134
Q

What are causes of Heavy menstral bleeding?

A

Dysfunctional uterine bleeding

Extremes of reproductive age

Fibroids

Endometriosis and adenomyosis

Endocrine disorders

135
Q

What are important hisotry questions in heavy menstral bleeeidng?

A

Age at menarch

Cycle length

Contraceptive hisotry

Sexual history

Intermenstral and post coital bleeding

Possibolity of pregnancy

Plans for future pregnancy

Cervical screening history

Migranes with or without aura

PMH and DH

Smoking and alcohol hisotry

FH

136
Q

What are investigations for heavy menstral bleeding?

A

Pelvic exam

FBC

Outpatient hysteroscopy

Pelvic and transvaginal US

Swabs

Coagulation screen

Ferritin

TFTs

Coagulation screen

137
Q

What is transexamic acid?

A

Antifibrinolytic- reduces bleeding

138
Q

What is Mefenamic acid

A

NSAID

Reduces bleeding and pain

139
Q

Management of heavy menstral bleeding if contracpetion is acceptable?

A

Mirena coil

COCP

Cyclical oral progestrone such as norethisterone 5mg 3X a day from day 5-26

140
Q

What can be done when medical management of heavy menstral bleeding fails?

A

Endometrial abalation

Hysterectomy

141
Q

What is endometrial abalation?

A

Involves destroying the endometrium

142
Q

What are fibroids?

A

Benign tumours of the smooth muscles of the uterus

143
Q

What are the types of fibroids?

A

Intramural means within the myometrium

Subserosal means just below the outer layer of uterus

Submucosal means just below the lining of the uterus

Pedunculated mans on a stalk

144
Q

What are the presentations of fibroids?

A

Asymptomatic

Heavy menstral bleeding

Prologned menstration lasting more than 7 days

Abdominal pain worse during menstration

Bloating or feeling full in the badomen

Urinary or bowel symptoms due to pelvic pressure or fullness

Deep dyspaneuria (pain during intercourse)

Reduced fertility

145
Q

What are investigations for fibroids?

A

Hysteroscopy

Pelvic US

MRI

146
Q

What are the fibroids management if less than 3cm

A

Mirena coil

Symtpomatic management with NSAIDs and tranexemic acid

Combined oral contraceptive

Cyclical oral progestrone

147
Q

What are some surgical options for management of fibroids?

A

Endometrial abalation

Resection

Hysterectomy

148
Q

What can be done with fibroids more than 3cm?

A

Refer to gynae

Medical options- NSAIDS for symtpoms

Mirena coil

Combined oral contraceptive

Cyclical oral progestogens

149
Q

WHat are the surgial options for large fibroids?

A

Uterine artery embolisation

Myomectomy

Hysterectomy

150
Q

What do GnRh agonists do in the treatment of fibroids?

A

Reduce the size of fibroids before surgery

Inducing a menopause like state

Reduce amount of oestrogen

151
Q

What is a myomectomy?

A

Involves surgicalluy removing the fibroid via laproscopic surgery or lapraotomy

Only treatment known to potentially improve fertility in patients with fibroids

152
Q

What is a hysterectomy?

A

Involves removing the uterus and fibroids

May be laparoscopy, lapraotomy or vaginal approach

153
Q

What are complications of fibroids?

A

HMB

Reduced fertility

Pregnancy complication

Constipation

Urinary outflow obstruction

Red degeneration of fibroids

Torsion of the fibroid

154
Q

What is red degeneration of fibroids?

A

Refers to ischemia, infarction and necrosis of the fibroid due to disrupted blood supply

May occur as the fibroid rapidly enlarges during pregnancy, outgrowing its blood supply and becoming ischaemic

Severe abdominal pain, low grade fever, tachycardia and vomiting

155
Q

What is endometriosis?

A

Condition where there is ectopic endometrial tissue outside the uterus

156
Q

What is an endometrioma?

A

Lump of endometrial tissue outdside the uterus

157
Q

What are chocolate cycsts?

A

Endometriomas in the ovaries

158
Q

What is adenomyosis?

A

Endometrial tissue within the myometrium of the uterus

159
Q

What is the main symptom of endometriosis?

A

Pelvic pain

160
Q

What is the presentation of endometrisosi?

A

Asymptomatic

Cyclical abdominal or pelvic [ain

Deep dyspaneuria

Dysmenorrhea

Infertility

Cyclical bleeding from other sites, such as haematuria

161
Q

What is the pathophysiology of the endometrisosi?

A

The cells of the endometrial tissue outside the uterus respond to hormones in the same way as endometrial tissue in the uterus

During menstration the shedding happens in the endometrial tissue elsewhere in the body

Causes irritation and inflammation for he tissues

Localised bleeding and inflammation can lead to adhesions

162
Q

What may an exmaintion in endometriosis lead to?

A

Endometrial tissue visible in the vagina on specilum exam partciualrly in the posterior fornix

A fixed cervix on bimanual exmaintion

Tenderness in the vagina, cervix and adnexa

163
Q

Waht is the gold standard way to diagnose abdominal and pelvic endometrisosi

A

Laprascopic surgery

164
Q

What is the inital management of endometriosis?

A

Estabilishing a diagnosis

Providing a clear explanation

Listening to the patient

Analgesia as required for pain

165
Q

What are the surgical manegement options for endometriosis?

A

Laproscopic surgery to excise or ablate the endometrial tissue and remove adhesions

Hysterectomy

166
Q

What can cyclical pain be treated with?

A

Hormonal medications that stop ovulation and reduce endometriual thickening

This can be achieved using the combined oral contracpetive pill, oral progesterone only pill, the progestogen depot injectm the progestrone implant or the mirena coil

167
Q

WHat induces a menopause like state?

A

GnRH agonisits

Exmaples are goserlin (Zoladex) or leuproreline (Prostap)

Shut down the ovaries temporarily and can be useful in treating pain in many women

Risk of osteoporosis

168
Q

Whart does laprascopic surgery do in endometriosis?

A

Used to excise or abalate the ectopic endometrial tissue

169
Q

What is adenomyosis?

A

Endometrial tissue inside the myometrium

170
Q

What does adenomyosis present with?

A

Painful periods- dysmenorrhea

Heavy periods- menorrhagia

Pain during intercouse- dyspanuria

171
Q

What does examination of adenomyosis show?

A

Enlarged and tender uterus

It will feel more soft than a uterus containing fibroids

172
Q

What is the imaging that can be done to diagnose adenomyosis?

A

Travaginal US is first line

MRI

Transabdominal US

173
Q

What is adenomyosis associated with?

A

Infertility

Miscarriage

Preterm birth

Small for gestational age

Malpresentaiton

174
Q

What is menopause?

A

Retrospective diagnosis after a women has had no periods for 12 months

Permenant end to menstration

175
Q

What is perimenopause?

A

Refers to the time around the menopasue where the women may experiencing vasomotor symptoms and irregular periods

176
Q

What is premature menopause?

A

Menopaise before the age of 40

Result of premature ovarian insufficiency

177
Q

WHat are the physiological changes in menopause?

A

Caused by a lack of ovarian follicular function, resulting in changes in the sex hormones associated with the mesntral cycyle:

Oestroegne and progesterone are low

LH and FSH are high in response to an absence of negative feedback from oestrogen

178
Q

What do perimenopausal period leads to symptoms of what?

A

Hot flushes

Emotional libaility or low mood

Joint pains

Irregular epriods

Heavier or lighter periods

179
Q

What conditions does menopause put people at higher risk of?

A

CVD

Stroke

Osteoporosis

POP

Urinary incontinence

180
Q

When do women need to use effective contraceptive till?

A

Two years after the last menstral period in women under 50

Women aged 40-45 years with menopausal symptoms or a change in the menstral cycle

181
Q

How long does it take vasomotor symtpoms to resolve in menopause?

A

2-5 years

182
Q

What is the management of perimenopausal symptoms

A

HRT

Tribolone- A synthetic steroid hormone that acts as a continuous combined HRT

Clonidine- Acts as an agonist of alpha-adrengeric and imidazoline receptors

CBT

SSRO

Tesosterone

Vaginal oestroge

Vaginal moisturister

183
Q

What is premature ovarian insufficiency?

A

Defined as menopause before the age of 40

Decline in the normal activity of the ovaries at an early age

Presents with early onset of the typical symptoms of the menopause

184
Q

How is premature ovarian insufficiency characterised by?

A

Hypergonadotropic hypogonadism

Under activity of the gonads means there is a lack of negative feedback on the pituitary gland resulting in an excess of the gonadotrophics

185
Q

What are the causes of premature ovarian insufficiency?

A

Idio[atjoc

Iatrogenic

Autoimmunne- Associated with coielic,. adrenal insufficiency, type 1 diabetes or thyroid disease

Genetic- Positive FH or conditions such as Turner’s syndrome

Infections- Mumps, TB, CMV

186
Q

What is the presenation of premature ovarian insufficiency?

A

Presents woth irregular menstral periods, lack of menstral periods and symptoms of low oestrogen levels, such as hot flushes, night sweats and vaginal dryness

187
Q

What is premature ovarian insufficiency associated with?

A

CVD

Stroke

Osteoporosis

Cognitive impairment

Dementia

Parinsonism

188
Q

What us the management of premature ovarian insufficiency?

A

HRT

2 types: Traditional hormonal replacement therapy and combined oral contraceptive pill

189
Q

What is HRT?

A

Used in perimenopasual and psot menopausal women to alleviate symtpoms associated with menopause

Symptoms are associated with a decline in the level of oestrogen

Exogenous oestrogen is given to alleviate the symtpoms

Progestrone needs to be given to women that have a uterus

190
Q

What are some non hormonal treatments for menopausal syptoms

A

Lifestyle changes

CBT

Clonidine

SSRI andidepressants

Venlafaxine

Gabapentien

191
Q

What is clonidine?

A

Acts as an agonist of alpha-2 adrenergic receptors and imidazoline receptors

Lowers BP and reuces HR

Antihypertensive medication

Helpful for vasomotor symptoms and hot fluses

192
Q

What are side efects of clonidine?

A

Dry mouth

Headache

Dizzines

Fatigue

Reproductive System (88 decks)

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