Differential Diagnosis in Gynaecology Flashcards
What is amenorrhoea?
Amenorrhoea refers to a lack of menstrual periods.
Briefly differentiate between primary and secondary amenorrhoea
Primary amenorrhoea is when the patient has never developed periods.
Secondary amenorrhoea is when the patient previously had periods that subsequently stopped.
Give differentials for primary amenorrhoea
Primary amenorrhoea is when the patient has never developed periods. This can be due to:
- Abnormal functioning of the hypothalamus or pituitary gland (hypogonadotropic hypogonadism)
- Abnormal functioning of the gonads (hypergonadotropic hypogonadism)
- Imperforate hymen or other structural pathology
Give differentials for secondary amenorrhoea
Secondary amenorrhoea is when the patient previously had periods that subsequently stopped. This can be due to:
- 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
What is abnormal uterine bleeding?
Abnormal uterine bleeding refers to irregularities in the menstrual cycle, affecting frequency, duration, regularity of the cycle length and the volume of menses. Irregular menstrual periods indicate anovulation (a lack of ovulation) or irregular ovulation. This occurs due to disruption of the normal hormonal levels in the menstrual cycle, or ovarian pathology.
Give differentials for abnormal uterine bleeding
It can be due to:
- Extremes of reproductive age (early periods or perimenopause)
- Polycystic ovarian syndrome
- Physiological stress (excessive exercise, low body weight, chronic disease and psychosocial factors)
- Medications, particularly progesterone only contraception, antidepressants and antipsychotics
- Hormonal imbalances, such as thyroid abnormalities, Cushing’s syndrome and high prolactin
What is intermenstrual bleeding (IMB)?
Intermenstrual bleeding (IMB) refers to any bleeding that occurs between menstrual periods. This is a red flag that should make you consider cervical and other cancers, although other causes are more common.
Give differentials for intermenstrual bleeding (IMB)
The key causes of intermenstrual bleeding are:
- 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
What is dysmenorrhoea?
Dysmenorrhoea describes painful periods.
Give differentials for dysmenorrhoea
The causes are:
- Primary dysmenorrhoea (no underlying pathology)
- Endometriosis or adenomyosis
- Fibroids
- Pelvic inflammatory disease
- Copper coil
- Cervical or ovarian cancer
What is menorrhagia?
Menorrhagia refers to heavy menstrual bleeding.
Give differentials for menorrhagia
This can be caused by:
- 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 cance
- Polycystic ovarian syndrome
What is postcoital bleeding?
Postcoital bleeding (PCB) refers to bleeding after sexual intercourse. This is a red flag that should make you consider cervical and other cancers, although other causes are more common. Often no cause is found.
Give differentials for postcoital bleeding
The key causes are:
- Cervical cancer, ectropion or infection
- Trauma
- Atrophic vaginitis
- Polyps
- Endometrial cancer
- Vaginal cancer
Give differentials for pelvic pain
Pelvic pain can be acute or chronic. The presentation of pelvic pain varies significantly. A detailed history and examination are usually able to identify the cause. There are a large number of possible causes, including:
- 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)
