Differential Diagnosis in Gynaecology Flashcards
(20 cards)
What is primary amenorrhoea?
When patient has never developed periods
What is secondary amenorrhoea?
When patient previously had periods that have subsequently stopped
List 3 causes of primary amenorrhoea.
- Abnormal functioning of the hypothalamus or pituitary gland
- Abnormal functioning of gonads
- Imperforate hymen or other structural pathology
What is hypogonadotropic hypogonadism?
Abnormal functioning of the hypothalamus or pituitary gland
What is hypergonadotropic hypogonadism?
Abnormal functioning of gonads
List 9 causes of secondary amenorrhoea.
- Pregnancy
- Menopause
- Physiological stress due to excessive exercise, low body weight, chronic disease or psychosocial factors
- Polycystic ovarian syndrome
- Medications (e.g. hormonal contraceptives)
- Premature ovarian insufficiency (menopause before 40)
- Thyroid hormone abnormalities (hyper or hypothyroid)
- Excessive prolactin from a prolactinoma
- Cushing’s syndrome
What is the most common cause of secondary amenorrhoea?
Pregnancy
What is anovulation?
A lack of ovulation
What is irregular menstruation/ abnormal uterine bleeding?
Irregularities in the menstrual cycle, affecting frequency, duration, regularity of the cycle length and the volume of menses.
List 5 causes of irregular menstruation.
- Extremes of reproductive age (early periods or perimenopause)
- Polycystic ovarian syndrome
- Physiological stress (excessive exercise, low body weight, chronic disease and psychosocial factors)
- Medications, especially progesterone only contraception, antidepressants, antipsychotics
- Hormonal imbalances such as thyroid abnormalities, Cushing’s syndrome, high prolactin
What is intermenstrual bleeding (IMB)?
Any bleeding that occurs between menstrual periods.
What is more worrying: irregular menstruation or intermenstrual bleeding?
Intermenstrual bleeding - is a red flag for cervical and other cancers.
What can cause intermenstrual bleeding?
- Hormonal contraception
- Cervical ectropion, polyps or cancer
- STIs
- Endometrial polyps or cancer
- Vaginal pathology (incl. cancers)
- Pregnancy
- Ovulation can cause spotting
- Medications e.g. SSRIs and anticoagulants
List 7 causes of dysmenorrhoea.
- Primary dysmenorrhoea (no underlying pathology)
- Endometriosis
- Adenomyosis
- Fibroids
- Pelvic inflammatory disease
- Copper coil
- Cervical or ovarian cancer
List 12 causes of menorrhagia.
- Dysfunctional uterine bleeding (no identifiable cause)
- Extremes of reproductive age
- Fibroids
- Endometriosis and adenomyosis
- Pelvic inflammatory disease
- Contraceptives (esp. 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
What are the key causes of postcoital bleeding?
- Cervical cancer, ectropion or infection
- Trauma
- Atrophic vaginitis
- Polyps
- Endometrial cancer
- Vaginal cancer
What are potential causes of pelvic pain?
- UTI
- Dysmenorrhoea
- IBS
- Ovarian cysts
- Endometriosis
- PID
- Ectopic pregnancy
- Appendicitis
- Mittelschmerz (cyclical pain during ovulation)
- Pelvic adhesions
- Ovarian torsion
- IBD
What are 12 potential causes of vaginal discharge?
- Bacterial vaginosis
- Candidiasis (thrush)
- Chlamydia
- Gonorrhoea
- Trichomonas vaginalis
- Foreign body
- Cervical ectropion
- Polyps
- Malignancy
- Pregnancy
- Ovulation (cyclical)
- Hormonal contraception
What term refers to ‘itching of the vulva and vagina’?
Pruritis vulvae
What can cause pruritis vulvae (8)?
- Irritants (soaps, detergents, barrier contraception)
- Atrophic vaginitis
- Infections (candidiasis + pubic lice)
- Skin conditions e.g. eczema
- Vulval malignancy
- Pregnancy-related vaginal discharge
- Urinary or faecal incontinence
- Stress
