General

Question 1

What is primary and secondary dysmenorrhoea?

Answer 1

Primary - no cause

Secondary - caused secondarily to an underlying disease

Question 2

What are the different types of fibroid (leiomyoma)?

Answer 2

Question 3

Symptoms of endometriosis?

Answer 3

HMB

Dysmenorrhoea

Dyspareunia

General Abdo pain

Question 4

Signs of endometriosis

Answer 4

Tenderness on PV

nodules posterior fornix

Question 5

Investigtaions for HMB

Answer 5

FBC (?anaemia)

USS (?fibroids,miscariage, endometriosis)

Poss endometrial biospsy (?Ca)

Question 6

Treatment for primary HMB

ie Dysfunctional Uterine Bleeding

…….and what does it do?

Answer 6

?Amaemic - Fe supplements

Tranexamic acid - Antifibrinolytic - reduces blood loss

Mefenamic acid - NSAID for pain relief

OR

OCP - if contraception required/not attempting pregnancy

OR

IUD - Intra-uterine device - releases progesterone. Encourages endometrial shedding to thin the endometrium.

Question 7

What does a submucousal fibroid do wrt endometrial bleeding?

Answer 7

Increases bleeding due to increase in surface area of endometrium

Question 8

Symptoms of fibroids (Leiomyomas)

Answer 8

50% asymptomatic

HMB

amaemia

infertility

Pressure - causing incontinence

Question 9

?Fibroid (leiomyoma) investigations

Answer 9

USS - poss trans vaginal

FBC (?amaemia)

Ovarian Tumour markers (Ca125, CEA)

Endometrial biopsy (?Ca)

Hysteroscopy

Question 10

Fibroid (leiomyoma) risk factors

Answer 10

>30

menopause

black

Question 11

Fibroid (Leiomyoma) treatment

Answer 11

Watchful waiting

treat symptoms (50% asymptomatic)

Ulipristal Acetate - reduces HUB and volume of fibroids

Unless indicated - no need to biopsy - leiomyomas are benign (rarely do they become malignant leiosarcomas)

Question 12

What are the red flags for ovarian Ca?

Answer 12

Gynae hx with

Bloating

Weight loss

Loss of appetite

Question 13

What tumour markers are used for ovarian Ca?

Answer 13

Ca125

CEA

Ca 19-9