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FCM > Female Health FCM > Flashcards

Female Health FCM Flashcards

1
Q

What is amenorrhoea?

What are the 2 types?

A

the absence or cessation of menstruation

  1. PRIMARY = failure to establish menstruation by the time of expected menarche
  2. SECONDARY = cessation of menstruation in women with previous menses
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2
Q

What is the causes Primary amenorrhoea?

A
  1. constitutional delay
  2. pregnancy
  3. genito-urinary malformations
  4. endocrine disorders
  5. androgen insensitivity syndrome
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3
Q

What are the causes of secondary amenorrhoea?

A
  1. primary ovarian insufficiency - PCOS
  2. hypothalamic dysfunction
  3. ambiguous genitalia
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4
Q

What are the risk factors associated with amenorrhoea?

A 
excessive exercise 
obesity/overweight 
Family history of amenorrhoea
Genetics 
eating disorders
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5
Q

List the signs and symptoms of primary amenorrhoea

A

not established menstruation by age of 13 alongside having no secondary sexual characteristics

not established menstruation by age of 15 but has developed secondary sexual characteristics.

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6
Q

List the signs and symptoms of secondary amenorrhoea

A

cessation of menstruation for 3-6months for a women who previously had normal and regular menses

cessation of menstruation for 6-12months for a women who previously has oligomenorrhoea (irregular)

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7
Q

what investigations/exams are done in primary amenorrhoea?

A

physical pelvic exam

pelvic ultrasound

bloods - serum prolactin, TSH, FSH, LH and total testosterone

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8
Q

what investigations/exams are done in secondary amenorrhoea?

A

bloods
- FSH, LS, prolactin level, total testosterone, TSH

Ultrasound scan done is PCOS suspected

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9
Q

How is primary amenorrhoea managed?

A

referral to secondary care specialist - either gynae or endocrinologist

manage certain obvious causes by

  • encouraging weight gain or refer to dietician if required
  • advise reducing exercise, increasing caloric intake and weight gain
  • stress-related amenorrhoea would require measures of manage and improving coping strategies for stress.

if amenorrheoa persists for 12months, consider whether osteoporosis prophylaxis is required - this may involve HRT or COC pill.

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10
Q

How is secondary amenorrhoea managed?

A

manage the following causes of secondary amenorrhoea in primary care

  • PCOS
  • Hypothyroidism
  • Menopause
  • pregnancy

similar to primary amenorrhoea

  • weight gain and reduce exercise
  • stress relief/improving coping mechanisms
  • manage chronic illnesses
  • hypothalamic/pituitary causes e.g. tumour
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11
Q

what warrant a referral to gynae in amenorrhoea?

A
  • persistent raised LH and FSH
  • recent urterine/cervical surgery
  • infertility
  • suspected PCOS
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12
Q

what warrants a referral to endocrinologist?

A
  • hyperprolactinaemia
  • low FSH and LH
  • increased testosterone not explained by PCOS
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13
Q

What is Dysmenorrhoea?

A

painful cramping, usually in the lower abdomen which occurs shortly during or before menstruation or both.

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14
Q

What are the 2 types of Dysmenorrhoea?

A

Primary Dysmenorrhoea - no underlying pathology but is caused by uterine production of prostaglandins during menstruation

Secondary Dysmenorrhoea- after several years of painless periods caused by an underlying pelvic pathology or IUD

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15
Q

what are the risk factors associated with Dysmenorrhoea?

A

Primary Dysmenorrhoea

  • early age of menarche
  • heavy menstrual flow
  • nulliparity
  • Family history
  • stress
  • smoking
  • poor diet & obesity

Secondary Dysmenorrhoea
- dependent on the underlying cause

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16
Q

What are the signs and symptoms of Dysmenorrhoea?

A
  • cramping/pain in the lower abdomen
  • lower back pain
  • nausea and vomiting
  • lethargy and fatigue
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17
Q

What investigations/exams are done for Dysmenorrhoea?

A

physical abdo exam - fibroids/other masses
physical pelvic exam

consider ultrasound - to rule out fibroids, adenexal pathology and endometriosis or asses an IUD

consider high vaginal and endo-cervical swabs - if pt at risk of STI (any associated vaginal discharge/abnormal bleeding)

pregnancy test - exclude ectopic

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18
Q

How is primary Dysmenorrhoea managed?

A
  1. offer NSAID unless contraindicated
    - either ibuprofen, naproxen, mefanamic acid etc
    - paracetamol if NSAID contraindicated
  2. if the pt doesn’t wish to concieve then consider prescribing a 3-6month trial of hormonal contraceptive as a first-line alternative
  3. if the response to individual treatments is insufficient then a combination of simple analgesia and hormonal contraception may be considered.
  4. consider recommending local application of heat or transcutaneous electrical nerve stimulation (TENS) to help reduce pain
  5. is symptoms don’t respond to initial treatment within 3-6months of there is doubt in diagnosis - refer to gyanecologist
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19
Q

How is secondary Dysmenorrhoea managed?

A

dependent on the underlying cause

suspect a serious secondary cause and refer urgently if any ‘red flags’ are present such as
- ascites and/or a pelvic/abdominal mass
- an abnormal cervix on examintion
persistent IMB, PCB with associated features of PID
- an ultrasound suggestive of cancer

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20
Q

What is premenstrual syndrome?

A

PMS is a condition characterised by psychological, physical, behavioural symptoms occurring in the luteal phase of the normal menstrual cycle.

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21
Q

What causes PMS?

A

Exact cause is unknown.
likely to be related to hormonal
- sensitivity to changes in progesterone levels
- oestrogen and progesterone also have an impact on neurotransmitters including GABA and serotonin

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22
Q

What are risk factors for PMS?

A
  • presence of periods
  • family history of PMS
  • mood disorders
  • cigarette smoking
  • alcohol intake
  • sexual abuse +/- trauma
  • weight gain
  • stress
23
Q

What are the signs and symptoms of PMS?

A

psychological
mood swings, irritability, depressed/anxious, poor concentration

physical
breast tenderness, bloating, headaches, backaches, weight gain

behavioural
reduced visio-spatial and cognitive ability and aggressive

24
Q

what are the investigations/exams done for PMS?

A

a physical exam

record of daily symptom in a diary

25
Q

How is PMS managed?

A
  1. offer lifestyle advice such as regular sleep and exercise, minimise stress, smoking cessation and alcohol reduction
  2. NSAIDs for any pains - consider COC
  3. arrange a CBT referral and consider SSRIs
  4. review in 2 months after to assess the effectiveness of treatment
26
Q

What is PCOS?

A

A heterogenous condition/endocrine disorder that appears to emerge at puberty

27
Q

What causes PCOS?

A

exact cause isn’t fully known but it is likely to be both a genetic predisposition alongside environmental factors.

associated with hyperinsulinaemia as it reduces SHBG in the liver which increases androgen production.

Hormonal imbalance os common in women PCOS

28
Q

What are the investigations/exams done for PCOS?

A 
Total testosterone
SHBG 
free androgen index 
LH, FSH, prolactin, TSH  
Abdominal Ultrasound
29
Q

How is PCOS managed?

A
  1. encourage lifestyle modifications
  2. offer screening for impaired glucose tolerance test and T2DM and CVD risk factors.
  3. screen for depression and anxiety & consider psychosexual problems/ body image and eating disorders
  4. if pregnant or considering pregnancy - oral glucose tolerance test & consider changes to metformin and hormonal treatment
  5. manage clincial features of PCOS - consider COC alone if not contraindicated
30
Q

How does vaginitis present?

A

changes in colour/odour of discharge
vaginal itching/irritation
pain/soreness around the vulva causing either dysuria or dyspareunia
some light bleeding/spotting

31
Q

How is vaginitis examined/investigated?

A

pelvic examination

vaginal swabs

32
Q

How is vaginitis managed/treated?

A

dependent on the cause

bacterial infections - metronidazole/clindamycin
fungal/yeast like infections - antifungal cream/suppository
vaginal atrophy/dryness can be treated with oestrogen creams (lidocaine), tablets or rings (pessarys)

33
Q

which type of cancer is common in the vagina?

A

vaginal squamous cell carcinoma

34
Q

What does presentation of a vaginal neoplasms involve?

A 
unusual vaginal bleeding - PMB, IMB, PCB 
watery vaginal discharge 
lump/mass in the vagina 
dysuria/urinary frequency 
pelvic pain 
constipation
35
Q

How is vaginal neoplasm examined/investigated?

A

pelvic exam
colposcopy & biopsy
vaginal swab/smear

36
Q

What does management of vaginal neoplasms entail?

A

dependent on stage and type of cancer
typically involves surgical removal - using vaginectom
radiation therapy is often given alongside this

37
Q

what is a cystocele?

A

anterior vaginal prolapse - bladder droops into the vagina due to weakened muscles

38
Q

How does a cystocele present?

A

bulging sensation/ feeling of fullness/heaviness
difficulty passing urine - more frequent
dyspareunia
problems inserting tampons/applicators
frequent UTIs

39
Q

investigations for suspected cystocele?

A

start off with a pelvic exam

urine tests - rule out any UTIs etc
cytoscopy

40
Q

how is cystocele managed?

A

mild/asymptomatic may not require treatment

Tx options include

  • weight loss
  • kegel exercises/pelvic floor strengthening
  • pessary to hold vagina
  • HRT - replace oestrogen - more for symptoms
  • surgical intervention
41
Q

What is a rectocele and how does it present?

A

herniation/buldge of rectum onto the posterior wall of the vagina

presents

  • difficulty with bowel movement
  • rectal pressure/fullness
  • feeling of incomplete emptying of bowels
  • sexual concerns - discomfort
42
Q

What investigations/exams are done when this is suspected?

A

mainly based on pelvic exam

sometimes using Ultrasound

43
Q

What does management of rectocele involve?

A

Asymptomatic = no Tx required

symptomatic - initially a pessary may be given to help hold/support the vaginal walls

surgical repair of prolapse - removal of weakened tissue /insertion of mesh patch to provide support.

44
Q

How does bartholin’s cyst present?

A

often asymptomatic when small - small painless lump
larger growths/cysts - may make movement slightly more difficult - look for change in gait
swelling of labia
obvious collection of pus/abscess present
fevers may also occur when cysts enlarges with erythema and heat.

45
Q

What is a breast abscess and what causes it?

A

a painful build-up of pus in the breast caused by an infection.
if located in the upper outer quadrant of the breast = lactational
if located in the central of lower quadrants = non-lactation

usually as a complication of mastitis/cellulitis which wasn’t adequately controlled by antibiotics

46
Q

how does a breast abscess present?

A

localised, painful inflammation of the breast
associated fever
malaise

mass - fluctuant, tender, palpable - erythematous/warm to touch

generally diagnosed on physical breast exam can used and using US

47
Q

How is a breast abscess managed?

A

confirmed abscess via US is then drained using US-guided needle aspiration or surgical drainage

culture from fluid produced by abscess - give abx accordinging to culture

advise lactating women to continue breastfeeding if they could/ express until they can resume breastfeeding

48
Q

How does breast fibroadenoma present?

A

firm rubbery painless lump
easily movable
can enlarge/shrink on their own

49
Q

How are breast adenomas investigated?

A

Ultrasound

core biopsy needed definitive diagnosis

50
Q

How are breast fibroadenomas managed?

A

usually no treatment/follow up required

sometimes surgery is considered - excisional biopsy/lumpectomy or cyroablation

51
Q

What is fibrocystic disease? How does it present?

A

Breast composed of lumpy tissue - nodular/glandular tissue

presents:

  • severe localised pain in sudden onset
  • some may experience pain in armpits
52
Q

What is done to manage fibroblastic disease?

A

most don’t require any invasive treatment
OTC pain relievers can usually relieve pain/discomfort
wear supportive bra and use warm/cold compresses

53
Q

How does mastitis present?

A

painful breast
fever or general malaise
tender, red, swollen and hard are of the breast - wedge shaped

investigated milk culture

54
Q

How is the mastitis managed?

A

relieve pain and discomfort with simple analgesia - advise cold/warm compress
prescribe oral antibiotic if infectious/ systemic signs are present - co-amoxiclav TDS 10-14 days

FCM (8 decks)

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