Differential Diagnosis in Gynae

Question 1

Primary Amenorrhoea

Answer 1

hypothalamus or pituitary gland pathology (hypogonadotropic hypogonadism)

Abnormal functioning of the gonads (hypergonadotropic hypogonadism)

Imperforate hymen or other structural pathology

Question 2

Secondary Amenorrhoea (9)

Answer 2

Pregnancy (the most common cause)

Menopause

Physiological stress due to excessive exercise, low body weight, chronic disease or psychosocial factors

Polycystic ovarian syndrome

Medications, such as hormonal contraceptives

Premature ovarian insufficiency (menopause before 40 years)

Thyroid hormone abnormalities (hyper or hypothyroid)

Excessive prolactin, from a prolactinoma

Cushing’s syndrome

Question 3

Irregular Menstruation (8)

Answer 3

Hormonal contraception

Cervical ectropion, polyps or cancer

Sexually transmitted infection

Endometrial polyps or cancer

Vaginal pathology, including cancers

Pregnancy

Ovulation can cause spotting in some women

Medications, such as SSRIs and anticoagulants

Question 4

Dysmenorrhoea (6)

Answer 4

Primary dysmenorrhoea (no underlying pathology)

Endometriosis or adenomyosis

Fibroids

Pelvic inflammatory disease

Copper coil

Cervical or ovarian cancer

Question 5

Menorrhagia (12)

Answer 5

Dysfunctional uterine bleeding (no identifiable cause)

Extremes of reproductive age

Fibroids

Endometriosis and adenomyosis

Pelvic inflammatory disease (infection)

Contraceptives, particularly the copper coil

Anticoagulant medications

Bleeding disorders (e.g. Von Willebrand disease)
Endocrine disorders (diabetes and hypothyroidism)

Connective tissue disorders

Endometrial hyperplasia or cancer

Polycystic ovarian syndrome

Question 6

Postcoital Bleeding (6)

Answer 6

Cervical cancer, ectropion or infection

Trauma

Atrophic vaginitis

Polyps

Endometrial cancer

Vaginal cancer

Question 7

Pelvic Pain (12)

Answer 7

Urinary tract infection

Dysmenorrhoea (painful periods)

Irritable bowel syndrome (IBS)

Ovarian cysts

Endometriosis

Pelvic inflammatory disease (infection)

Ectopic pregnancy

Appendicitis

Mittelschmerz (cyclical pain during ovulation)

Pelvic adhesions

Ovarian torsion

Inflammatory bowel disease (IBD)

Question 8

Vaginal Discharge (12)

Answer 8

Bacterial vaginosis

Candidiasis (thrush)

Chlamydia

Gonorrhoea

Trichomonas vaginalis

Foreign body

Cervical ectropion

Polyps

Malignancy

Pregnancy

Ovulation (cyclical)

Hormonal contraception

Question 9

Pruritus Vulvae (8)

Answer 9

Irritants such as soaps, detergents and barrier contraception

Atrophic vaginitis

Infections such as candidiasis (thrush) and pubic lice

Skin conditions such as eczema

Vulval malignancy
Pregnancy-related vaginal discharge

Urinary or faecal incontinence
Stress