Gynaecology 1 Flashcards
(53 cards)
Amenorrhoea definition
Primary
Primary: failure to establish menses by 15yo with secondary sexual characteristics or 13yo if no secondary sexual characteristics
Amenorrhoea definition
Secondary
Cessation of menses for 3-6 months in women with previously normal and regular menses
Or 6-12 months in women with previous oligomenorrhoea
Postpartum hypopituitarism caused by necrosis of the pituitary gland.
Sheehan’s
An acquired condition where scar tissue (adhesions) form inside your uterus
Asherman’s syndrome
Investigations for amenorrhoea
FBC, U+E, Coeliacs, TFTs, prolactin, androgen levels, oestradiol, gonadotrophins
Amenorrhoea screen
Raised gonadotrophins versus low
Raised = ovarian cause
Low = hypothalamic cause
Bleeding in the first trimester
Who should be referred to an early pregnancy assessment service?
> =6 weeks
How is bleeding for <6K managed?
If no pain or RF for ectopic then to return if bleeding develops
Repeat pregnancy test in 7-10days and return if positive
If negative then = miscarriage
Most common type of cervical ca?
SCC 80%
Adeno 20%
HPV serotypes that can increase risk of cervical ca (3)
16,18, 33
Cervical ca RF (8)
HPV
Smoking
HIV
Early first intercourse
Many sexual partners
High parity
Lower socioeconomic status
COCP
Cervical screening ages:
25-49 - every 3 years (Scotland every 5 years)
50-64 - every 5 years
Cervical screening in pregnancy
Delay for 3 months post partum unless missed screening or previous abnormal smears
Screening explained/ results explained
HPV negative =
HPV negative - return to normal recall
Screening explained/ results explained
HPV +ve =
Cytology if normal then repeat test at 12 months
Cytology if abnormal then for colposcopy
If inadequate then repeat sample within 3 months, if x2 inadequate then colposcopy
Mx of patients who have been treated for CIN 1/2/3
Test of cure repeat cervical sample at 6 months
Mx cervical ectropion
Ablative treatment such as cold coagulation
Primary dysmenorrhoea =
Mx (3)
No underlying pelvic pathology
Pain during and a few hours prior to the period starting
Mx mefanamic acid and ibuprofen
2nd line COCP
Secondary dysmenorrhoea (how does it differ from primary)
CKS Mx
Usually starts a few days prior to the period
Refer all patients with secondary dysmenorrhoea to gynae
Ectopic pregnancy bHCG
> 1500
Endometrial cancer is classically seen in which group of women?
Post menopausal
RF endometrial cancer (9)
Nulliparity
Early menarche
Late menopause
Obesity
Unopposed oestrogen
DM
Tamoxifen
PCOS
Hereditary colorectal ca
Cervical versus endometrial ca RF
Early first intercourse
High parity
Endo - nulliparity, late menopause
Smoking and COCP RF for cervical but protective for endo ca
Symptoms of endometrial ca (2)
PMB, IMB in premenopausal women
