Gynae 3 Flashcards
(26 cards)
What are fibroids, how do they present, what would you find on examination, and what are the investigations?
1) monoclonal tumours of smooth muscle cells of the uterine myometrium
2) 30-50y. excessive bleeding/prolonged heavy periods/ intermenstrual bleeding/lower abdo discomfort, fullness
3) examination: palpable abdominal mass, enlarged irregular uterus
4) investigations: pelvic USS/MRI/hysteroscopy
what is the management for uterine fibroids?
pharmacological: NSAIDs/tranexamic acid/IUS/GnRH analogues pre-hysterectomy
surgical: myomectomy/ablation/hysterectomy
what are the causes of intermenstrual bleeding?
physiological vaginal: vaginitis, tumours cervical: cervical ectropion, chlamydia, gonorrhoea uterine: fibroids, cancer any oestrogen dependent tumours
what are the causes of postcoital bleeding?
cervical ectropion
cervical polyps
cervical cancer
vaginal cancer
what are the investigations of abnormal vaginal bleeding?
pregnancy test infection screen TVS (preferably postmenstrually) speculum examination FBC, FSH, LH, clotting endometrial biopsy
what is the management of dysmenorrhoea?
primary: offer NSAID (ibuprofen, naproxen, mefanemic acid), if insufficient, add hormonal contraception, heat application, TENS
secondary (later in life onset): abdominal exam and pelvic exam
what are the differentials of dysmenorrhoea?
endometriosis
fibroids
PID
What is primary and secondary amenorrhoea?
What are the causes of primary amenorrhoea?
Primary amenorrhoea: failure of menstruation before 16y
Secondary: failure of menstruation for >6+ in an individual who has had previously had periods for >12m or more
Causes:
Secondary sexual characteristics?
Yes: hyperprolactinaemia, testicular feminisation, GU abnormalities (imperforate hymen, absent uterus), constitutional
No: ovarian insuffiency, hypothalamic insuffiency, hypothalamic-pituitary insuffiency (Kallmann’s, Prader-Wili)
What are the most common causes of secondary amenorrhoea?
Pregnancy
PCOS
Hypothalamic amenorrhoea
Hyperprolactinaemia
What are all of the possible causes of secondary amenorrhoea?
Signs of androgen excess?
No = pregnancy/lactation/menopause, hyperprolactinaemia, Asherman’s syndrome, premature ovarian failure, contraception, anorexia
Yes = PCOS/Cushing’s/adrenal carcinoma
What are the investigations for amenorrhoea?
pregnancy test
FSH/LH (raised in ovarian failure, decreased in hypothalamic/pituitary failure)
TFTs
total testosterone and sex hormone binding globulin
USS
What are the causes of male infertility?
obesity/smoking/tight fitting underwear/alcohol/illicit drugs
disorders of testis and spermatogenesis: klinefelter's kallmann's testicular tumours cushing's pituitary tumours disorders of the genital tract: hypospadias (semen deposited in vagina instead of cervix) erectile dysfunction
What occurs in kallmann’s syndrome?
hypogonadotrophic hypogonadism
hyposmia/anosmia
decreased GnRH = prevents puberty from happening in the first place
lack of primary and secondary sexual characteristics in males and females
diagnosis: decreased GnRH, decreased LH/FSH, other pituitary tests are fine
What occurs in klinefelter’s sydnrome?
47XXY
increased FSH/LH will be seen as leydig and sertoli cells do not produce as much testosterone and inhibin
hypogonadism, sterility, tall long legs, gynaecomastia
can be diagnosed using amniocentesis (for karyotyping) and a blood test
In a history of male infertility, what would you ask?
Smoking/alcohol/drugs Prior children genetic disorders sense of smell nocturnal emissions puberty normal? painful ejaculating urinary symptoms
what investigations would you do for male fertility?
semen analysis (produced by masturbation after 3 days abstinence. repeat test in 3m)
FSH/LH
USS
testicular biopsy
what is the management for abnormal sperm counts?
loose fitting underwear/no laptops on lap etc
surgical correction of epidydmal blockage
men w/ hypogonadotropic hypogonadism (offered gonadotropins)
what are group I, II and III ovulation disorders?
I: hypothalamic pituitary failure (e.g. hypothalamic amenorrhoea, hypogonadotropic hypogonadism)
II: dysfunctions of the hypothalamic pituitary axis (e.g. PCOS)
III: ovarian failure
what is the treatment of group I, II and III ovulation disorders?
group I: increase body weight, offer pulsatile GnRH
group II: clomifene citrate (SERM) stimulates GnRH production and is the initial treatment
metformin
ovarian drilling
disorders due to hyperprolactinaemia = offered treatment with dopamine agonists e.g. bromocriptine (as dopamine inhibits prolactin)
ovarian hyperstimulation = anastrozole, clomifene citrate
What occurs in IUI?
intrauterine insemination
introduction of prepared sperm into the vaginal canal
good for same sex couples, couples who struggle to have sex, after sperm washing where the man is HIV positive
what hormones are used in IVF during egg retrieval?
ovarian stimulation initially with ultrasound monitoring
progesterone is used after for luteal phase support
what is the access criteria for IVF?
women <40 should be offered three cycles
women who reach 40 during treatment should not be offered further cycles
women >40 should be offered one cycle as long as: never had IVF before, no evidence of low ovarian reserves
single embryo transfers are used
what happens in ICSI?
intracytoplasmic sperm injection (ICSI)
single sperm is injected directly into oocyte
used for couples whom IVF did not work, or those with reduced semen quality
what are the causes of female infertility?
sheehan’s disease
hyperprolactinaemia
turner’s/klinefelter’s
PID STI's Asherman's syndrome Bicornuate uterus endometriosis
