Benigne Gynae. Flashcards
(42 cards)
What is the ROME III chriteria
are the most recent diagnostic criteria for IBS‐based on symptoms, and can be summarised as
follows: recurrent abdominal pain or discomfort at least 3 days a month in the last 3 months associated with two or more
of the following:
improvement with defecation
onset associated with a change in frequency of stool
onset associated with a change in form (appearance) of stool.
SOSURE
Survey/sigmoid mobilization
Ovarian mobilization
Suspension of uterus and ovaries
Ureterolysis
Rectovaginal and pararectal space
Excision of all endo
What is mCCune-Albright syndrome
Precocious puberty
Cafe at lair spots
Polyosottic fibrous dysplasia
Syndrome caused by activating mutations in the GNAS gene and often presents with autonomous hormone secretion
endometrial hyperplasia stats
Less than 5% of over 20 years risk of endometrial hyperplasia without atypia will progress to cancer - majority will regress spontaneously during FU
Ospemifene for what?
For genitourianay symptoms associated with menopause - dryness, pain at sex and vulvovaginal discocomfrt or irritation when urinating
ASE OSPEMIFENE IF LOCALLY APPLIED TREATMENTS ARE IMPRACTICAL OR DUE TO DISABILITY
Does HRT increase risk of breast CA
🎖️HRT for women in early menopause does not increase breast cancer risk
HRT in women that have estrogen receptor positive boob CA can you give HRT?
NO
A range of other therapies can be used if a woman is unable to take HRT. These include behavioural
therapy and non-hormonal medicines
When can RRSO be offered to women- what risk factors
If moderate risk gene mutations including
RAD51C
RAD51D
BRIP1
PALB2
5-13% risk of lifetime ovarian cancer
intermediate risk
As well as to women with a significant fam history of ovarian cancer - eg. one or two first degree relatives with ovarian cancer
5-10% lifetime risk
High risk
10% or more lifetime risk of ovarian cancer
Post op RRSO when is HRT started
Immediately post op until natural age of menopause 51
What age can you offer RRSO
35-40 for BRACA 1 carries
40-45 for BRCA2
40-50 for RAD51C/D carriers and nearer or after menopause , 40-45 for PALB2 carriers
BR1P1 carrier and mutation meg- intermediate risk with strong fam hx can be delayed to 45-50yrs
When is routine hysterectomy justified with RRSO
If had LYNCH syndrome
40-60% risk of endometrial CA
Transdermal estrogen facts/risks…
have a lower risk of venous thromboembolism (VTE), stroke and myocardial
infarction than oral preparations, vaginal estrogen is not associated with an increased risk of
endometrial hyperplasia.
If triple negative breast CA
HRT can be considered for short-term use on an
individual basis, particularly in those with good prognosis. It can also be considered in long term
survivors who have undergone bilateral mastectomy, as may happen in some BRCA carriers who
develop breast cancer.
Can you use vaginal estrogen creams for urogenital symptoms and breast CA if non hormonal lubricants which are 1st line therapy are not working
short-term topical
estrogen at the lowest effective vaginal dose may be considered following specialist advice (including for
estrogen receptor-positive breast cancer with a good prognosis)
When is HRT contraindicated
If undiagnosed abnormal vag bleeding or suspected/acitve endometrial cancer
When is hysterectomy indicated when diagnosed with hyperplasia with no atypia
-pregression to atypical hyperplasia at FU
- there is no jistological repression of hyperplasia despite 12 months of treatment
-
Relapse of endometrial hyperslasia after competing progesterone treatment
-persistence of bleeding symptoms
- woman declines to undergo endometrial surveillance or comply with medical treatment
What is premature thelarche
Isolated breast development in young girls without other signs of puberty or growth acceleration
Is usually benign and self limiting no treatment required
What is functional hypothalamic amenorrhea
Occurs due to hypothalamic suppression caused by low energy availability , stress, excessive exercise
Presents with low gonadotrophins and secondary sexual characteristic delay
Idiopathic precocious puberty
A diagnosis of exclusion after ruling out CNS abnormalities or other underlying causes
Treatment often involves GNRH analogues to preserve potential
Menopause treatment for vasomotor symptoms post ER positive breast CA still on tamoxifen
1st) CBT
2nd) gabapentine or clonidine
If current breast CA and or tamoxifen therapy and depression
Use CBT +/- antidepressants other than SSRI or SNRI so no fluoxetine , paroxetine ,
Consider switching tamoxifen to aromatase inhibitor if must be on a SSRI or SNRI
If prev breast ca and finished tamoxifen and only risk is for ex brca positive, can they have HRT?
Not combined
Vaginal yes
Tibilone no
Taking HRT earlier may have a higher risk of breast cancer than those who start it later
Treatment for genitourinary syndrome of menopause
1) nonhormonal lube
2) vaginal estrogens - gold standard
3) vaginal dehydroepiandrosterone or oral SORM- OSPEMIFENE
3) vaginal prasterone - if vag oestrogen or lube don’t work or not tolerated
How many % of people will have improvement of symptoms after ablation
80-90%
