Gynae presentations (for history taking) Flashcards
(23 cards)
Presentation of uterine fibroids?
- Heavy menstrual bleeding
- Intermenstrual bleeding
- Painful menstrual bleeding
- Urinary symptoms (if pressing on bladder)
- Impaired fertility
- Palpable mass
Presentation of uterine polyps?
- Heavy menstrual bleeding
- Intermenstrual bleeding
Presentation of adenomyosis?
- Heavy menstrual bleeding
- Painful menstrual bleeding
Name 8 causes of heavy menstrual bleeding.
- Uterine fibroids
- Uterine polyps
- Adenomyosis
- Iatrogenic - anticoagulants
- Dysfunctional uterine bleeding - main cause (no underlying pathology)
- Hypothyroidism
- Pelvic inflammatory disease
- Endometriosis
Presentation of ectopic pregnancy?
- Dark abnormal vaginal bleeding
- Colicky abdominal pain (acute)
- Amenorrhoea for 4-10 weeks
- Dizziness/fainting/syncope
- Intraperitoneal blood loss may cause shoulder tip pain
- Cervical excitation on examination
Risk factors for ectopic pregnancy?
- Pelvic inflammatory disease
- Assisted reproduction
- Smoking
- Previous ectopic
- Increased maternal age
Presentation of pelvic inflammatory disease?
- Pelvic pain - can be acute or chronic
- History of infection
- Pain ‘deep’ during sex
- Abnormal vaginal bleeding or discharge
- Cervical excitation
- Painful periods
- Subfertility (less fertile)
- Right upper quadrant pain (caused by perihepatic inflammation)
Presentation of endometriosis?
- Chronic pelvic pain
- Infertility
- Painful periods before onset of menstruation
- Pain ‘deep’ during sex
- Heavy periods
- Intermenstrual bleeding
- Retroverted fixed uterus on examination if severe and painful examination
- Dyschezia (painful bowel movements)
Presentation of polycystic ovary syndrome
- Amenorrhoea or irregular menstrual bleeding
- Acne
- Excess body/facial hair
- Miscarriage
- Weight gain
If someone has secondary amenorrhoea following surgery, miscarriage, cervical trauma or cervical dyskaryosis what should you suspect?
Outflow tract obstruction
If someone has secondary amenorrhoea following post-partum haemorrhage what should you suspect?
Sheehan’s syndrome- following post partum haemorrhage you can get hypotension. This leads to under perfusion of anterior pituitary, which causes necrosis of the pituitary gland, leading to low FSH and LH and subsequently amenorrhoea
Presentation of prolactinoma?
- Amenorrhoea
- Milky nipple discarge
- Infertility
What is lactational amenorrhoea?
Amenorrhoea due to breastfeeding
Presentation of premature ovarian failure?
<40, not on hormonal contraceptive with menopausal symptoms including no/infrequent periods
Causes of premature ovarian failure?
- Chemo/radiotherapy
- Idiopathic (family history relevant)
- Autoimmune
- Infection e.g. mumps
Name 10 causes of secondary amenorrhoea.
- Pregnancy
- Breastfeeding
- Contraceptives
- Hypothalamic (anorexia, athleticism)
- Polycystic ovary syndrome
- Outflow tract obstruction
- Premature ovarian failure
- Prolactinoma
- Cushing’s disease
- Thyroid disease
What is the most common cause of cervical cancer?
Human papilomavirus infection
What are the risk factors for cervical cancer?
- Increased risk of catching human papillomavirus
- Not getting cervical screening (smears)
- Smoking
- Combined contraceptive pill use for more than 5 years
- Increased number of full-term prenancies
- Family history
- Exposure to diethystilbestrol
Presentation of cervical cancer?
- Can be asymptomatic
- Abnormal vaginal bleeding
- Vaginal discharge
- Pelvic pain
- Pain/discomfort during sex
What are the risk factors for endometrial cancer?
- Obesity
- Diabetes
- Increased exposure to unopposed oestrogen (oestrogen without progesterone):
- ——–> increased age
- ——–> earlier onset of menstruation
- ——–> late menopause
- ——–> oestrogen only hormone replacement therapy
- ——–> no/few pregnancies
- ——–> PCOS
- ——–> tamoxifen (breast cancer treatment)
Presentation of endometrial cancer?
- POSTMENOPAUSAL BLEEDING
- Intermenstrual bleeding
- Unusually heavy menstrual bleeding
- Abnormal vaginal discharge
- Haematuria
- Anaemia
- Raised platelet count
What are the risk factors for ovarian cancer?
- Age (peak age=60)
- BRCA1 and BRCA2 genes (consider family history
- Increased number of ovulations (caused by early-onset of periods, late menopause and no pregnancies)
- Obesity
- Smoking
- Recurrent use of clomifene (drug used to treat infertility by stimulating ovulations)
Presentation of ovarian cancer?
- Abdominal bloating
- Early satiety
- Loss of appetite
- Pelvic pain
- Urinary symptoms (frequency/urgency)
- Weight loss
- Abdominal/pelvic mass
- Ascites
- Hip/groin pain
