Gynae 2

Question 1

PCOS?

Answer 1

• Dysfunction in hPG axis
• Leading cause of infertility worldwide (10%)
• Linked with metabolic syndrome and high insulin

Question 2

Features of PCOS (Rotterdam criteria)?

Answer 2

• Rotterdam criteria (2/3 is diagnostic)
  
  • Amenorrhoea or oligomenorrhoea
  • Hyperandrogenism (deep voice, male pattern baldness, acne)
  • USS evidence of cyst (12 in 1 ovary)

Question 3

Other features of PCOS?

Answer 3

• Obesity
• Acanthosis nigricans from high insulin
• Mood disturbance

Question 4

Investigations for PCOS?

Answer 4

• Positive Rotterdam
• LH:FSH ratio >3:1 on day 1-5 is diagnostic
• Pelvic USS shows string of pearls

Question 5

Management of PCOS?

Answer 5

• Conservative: weightloss
• Medical
• Surgical: laparoscopic ovarian drilling

Question 6

What is the medical management of PCOS?

Answer 6

• Fertility: clomifene 1st line (SERM), metformin 2nd line/adjunct
• COCP for contraception and hirsutism

Question 7

What are the associations/complications of PCOS?

Answer 7

• Obesity, dyslipidaemia and T2DM all associated
• HTN and vascular problems
• Increased risk of endometrial cancer from lots of oestrogen

Question 8

What is a cervical ectropion?

Answer 8

• When the internal columnar epithelium of the cervix is present on the external os

Question 9

What causes cervical ectropion?

Answer 9

• Increased oestrogen
• COCP, lots of cycles, pregnancy

Question 10

What is the commonest cause of minor bleed in 3rd trimester?

Answer 10

Cervical ectropion

Question 11

What is the presentation of cervical ectropion?

Answer 11

PV bleeding and pain most common

Question 12

How is ectropion managed?

Answer 12

• Benign but can be treated if problematic
• LA diathermy
• Silver nitrate

Question 13

What are the age classifications for menopause?

Answer 13

• <40: premature (need HRT for bone support)
• 40-45: early
• Average age is 51

Question 14

Menopause and perimenopoause definitions?

Answer 14

• Perimenopause: from onset of symptoms (up to 5 years before) to 1 year amenorrhoeaic (80% get symptoms)
• Menopause: retrospective diagnosis made after 1 year since LMP

Question 15

What is the hormonal pattern in menopause?

Answer 15

• High FSH and LH
• Low oestrogen

Question 16

How is menopause diagnosed?

Answer 16

• > 45 is clinical diagnosis
• <45 requires FSH blood test

Question 17

What are the gynae symptoms of menopause?

Answer 17

• Vaginal dryness
• Period changes
• Decreased libido

Question 18

What are the non-gynae changes in menopause?

Answer 18

• Dry skin
• Hot flushes (spontaneous, triggers by stress, caffeine, alcohol, change in temp)
• MSK pain
• Emotional lability

Question 19

What does menopause increase the risk of?

Answer 19

• Osteoporosis
• CV disease from decreased oestrogen
• Pelvic organ prolapse
• Urinary incontinence

Question 20

What is the management for menopause?

Answer 20

• No real treatment and most symptoms gone in 5 years
• HRT
• Tibolone (synthetic steroid hormone) acts as continuous HRT, must be amenorrheic for 1 year
• Clonidine - alpha antagonist
• CBT + SSRI
• Testosterone for libido
• Vaginal oestrogen and lube for dryness

Question 21

What is the main reason for having HRT?

Answer 21

Vasomotor symptoms

Question 22

How can VTE risk be reduced in menopause?

Answer 22

Give transdermally

Question 23

What does progesterone increase the risk of?

Answer 23

• Breast cancer
• Risk returns to normal 5 years after treatment

Question 24

What are some considerations for giving oestrogen only HRT?

Answer 24

• Increases endometrial cancer risk
• Only appropriate if patient had hysterectomy

Question 25

Contraception in perimenopausal women?

Answer 25

• Required 2 years post LMP if before 50
• Required 1 year if after 50
  -Over 40: COCP UKMEC 2
• Over 45: Depot UKMEC 2 - BMD risk