O+G Flashcards
(197 cards)
1
Q
What is the cervix like pre-puberty?
A
Lined with squamous epithelium
Becomes columnar during pregnancy and puberty
SCJ migrates down
Normal change - ectopy
When SCJ is in low pH vagina region, becomes squamous - transformation zone
2
Q
Transformation Zone vs SCJ
A
TZ wide area between highest and lowest point that SCJ was in lifetime - pre- and post-puberty
SCJ is the exact position of histological change
3
Q
What is ectopy also known as?
A
An ectropion
4
Q
What is the pathology in an ectropion?
A
Columnar epithelium present on vaginal surface - normal physiological state
5
Q
Presentation of an ectropion
A
Excess mucous secretion
Post-coital bleeding
O/E Red looking area on os
6
Q
RFx for an ectropion?
A
Oestrogen-containing contraceptives
Menstruating age - Raised oestrogen
7
Q
Ix For ectropion?
A
Colposcopy +/- biopsy for sinister causes
8
Q
Mx for Ectropion
A
Not usually needed
Can stop pill
Ablation
9
Q
What are the high risk HPVs
A
16 and 18
16 = 50% Ca’s
10
Q
What is CIN?
A
Cervical intraepithelial neoplasia AKA dyskaryosis
Abnormal growth, potentially pre-malignant
Almost always caused by HPV
11
Q
How Dx and staging CIN made?
A
Picked up on cervical screening, which shows degree of dyskaryosis
Colposcopy and histology
Dx made by cytology
12
Q
How many grades of CIN?
A
3
Stage 1: Mild dyskaryosis - basal 1/3 epithelium of TZ
Stage 2: Moderate - Basal 2/3 epithelium
Stage 3: Severe - >2/3 epithelium AKA carcinoma in situ
13
Q
Prognosis of CIN
A
~15 years until cervical Ca
14
Q
RFx for CIN
A
Sexual promiscuity Birth < 16y Young age commencing sexual activity Aged 25-35 Not vaccinated Smoker
15
Q
How to Ix CIN?
A
Colposcopy - 2 solutions: acetic acid (dysplastic cells), iodine (stains yellow/orange - should go dark in normal)
Biopsy usually done
Silver nitrite for cauterisation
16
Q
Mx CIN
A
One stop clinic - ablation/excision
CIN 1 not treated
LLETZ (Large Loop excision of TZ) procedure - curative
Cold coagulation or laser ablation - efficacy 90-95%
17
Q
What is common cell type of cervical Ca?
A
SCC
18
Q
Epidemiology of cervical Ca?
A
Disease of young
Less common due to screening
Highly linked to smoking
19
Q
Smear test screening
A
Negative - no further Mx
Inadequate - repeat - 3 inadequate - Colposcopy
Borderline - Endocervical - Colposcopy; Squamous cells - screen in 6m
Mild/Moderate/Severe - Colposcopy
3 years 25 - 49y; 5yearly after
20
Q
Presentation of cervical Ca?
A
Often asymptomatic
Many present on smear testing
Non menstrual bleeding typical presentation
Advanced:
Post-coital
PMB
Very advanced:
Backache, leg pain, hydronephrosis
21
Q
RFx cervical Ca?
A
High parity STI Hx Sexual promiscuity Birth < 16y Young age commencing sexual activity Aged 25-35 Not vaccinated Smoker
22
Q
Mx of Cervical Ca?
A
Curative vs Palliative
Ia: Hysterectomy/Biopsy
Ib: Total Hysterectomy + RTx +/- CTx
II-IV: Chemo/RTx
23
Q
Prognosis of Cervical Ca?
A
Average 5y survival 61%
24
Q
What is the HPV vaccine?
A
Vaccination against 16 and 18
Given at 12-13y
3 doses over 6 months
25
What is Vulval Cancer?
Mostly SCC
| Post menopausal females
26
Presentation of Vulval Cancer?
```
Elderly
PM
Itching
Burning
Patches discolouration - red, black or white
Lumps or growths
Vulval bleeding
Dyspareunia
Dysuria
```
27
RFx for Vulval Cancer?
HPV
Smoking
CIN/VIN
28
DDx of Vulval Cancer?
Vulval dermatoses - lichen sclerosis - steroid cream
VIN - Vulval intraepithelial neoplasia
Vaginal cancer - upper 1/3 post wall most common
Senile vaginitis - atrophic vaginitis
29
Mx for Vaginal Cancer?
RTx - preserve genitalia
30
What is the staging system for Vulval Cancer?
FIGO staging
31
Mx of Vulval Cancer?
Surgery and reconstruction AKA excision
RTx - shrink pre-op
Chemo
Palliative - symptom control
32
What is the most common genital tract Ca?
Endometrial Ca
33
What is the pathology of Endometrial Ca?
Adenocarcinoma
34
What is the presentation of Endometrial Ca?
Tumour related - abnormal vaginal bleeding (PMB - little and occasional: gets more frequent and heavy; Pre-menstrual - irregular, heavier or change)
Metastases related - Local, lymphogenic or haematogenic
35
RFx for Endometrial Ca?
```
Long-term exposure to oestrogens:
Nulliparous
Early menarche and late menopause
PCOS
Obesity - aromatase
Tamoxifen
DM
```
36
Ix for Endometrial Ca
Transvaginal USS - Ca > 5mm
Biosy via Hysteroscopy (done if >4mm on USS or multiple bleeds)
Pre-menopausal - Hysteroscopy regardless
37
DDx for PMB
```
Endometrial Ca
Cervical Ca
Atrophic vaginitis
Ectropion
Endometrial Polyp
Vaginal Ca
Endometrial Hyperplasia
Tamoxifen
HRT
```
38
Mx of Endometrial Ca?
Surgical: TAH +/- Bilat salpingo-oophorectomy +/- RTx +/- High dose progesterones
39
What is Endometrial Hyperplasia?
Extensive stimulation --> Proliferation of endometrium
AKA HRT without progestin
Pre-cancerous - risk carcinoma in complex hyperplasia with atypia (30%)
40
How to classify Endometrial Hyperplasia?
Based on histology
| Simple or complex
41
Presentation of Endometrial Hyperplasia?
Constant bleeding
Intramenstrual bleeding
Post-menopausal bleeding
42
Ix of Endometrial Hyperplasia?
USS or hysteroscopy
>1cm in pre-menopausal
>5cm in post-menopausal
43
Mx of Endometrial Hyperplasia?
Depends on presence atypia and age
No atypia - progesterone (mirena coil) and surveillance
Atypia - TAH +/- BSO
44
What is Amenorrhoea?
Absence menstruation in women of reproductive age
45
What are the two main reasons for physiological Amenorrhoea?
Pregnancy
| Breast feeding
46
What is primary Amenorrhoea?
When patient never had period
47
When should primary Amenorrhoea be Ix?
14y and no breast development
15y with breast development
48
Most common causes of Amenorrhoea?
```
Late puberty
GU malformation e.g. imperforate hymen
Turner's
Hypothyroid
Congenital absence of organs e.g. uterus/ovaries
```
49
When to consider further Ix in primary Amenorrhoea?
Abnormal genitalia
50
Common causes secondary Amenorrhoea?
```
Emotional distress
Weight loss
Excessive exercise
Drug induced
PCOS
PRegnancy
Contraception
Anorexia
```
51
Ix in secondary Amenorrhoea?
Urinary BHCG
Serum free androgen index - PCOS
FSH in premature menopause
T and LH in PCOS and adrenal hyperplasia
LH and FSH - High = premature ovarian failure; Low = Hypothalamic cause; Normal FSH, High LH = PCOS
Prolactin in prolactinoma/anything blocking DA e.g. antipsychotics
USS for PCOS and sexually inactive girls
52
Mx Amenorrhoea?
Treating cause
| Determined whether want children
53
Dysmorphic features of Turner's
Short stature
Wide neck
Pubertal delay
Low set ears
54
What is PCOS?
Excess androgens
Presence multiple immature follicles ovaries
Assoc. with excessive androgen secretion and insulin resistance
55
Pathology of PCOS?
High LH = High androgens
| Insulin resistance = Low SHBG (sex hormone binding globulin) --> Higher androgens
56
Why is ovulation suppressed despite high levels LH in PCOS?
Androgens suppress surge
57
Presentation PCOS
```
Amenorrhoea
Oligomenorrhoea (irregular)
Acne
Weight gain
Dark patches skin (acanthosis nigricans)
Hirsutism
Infertility
```
58
Diagnostic criteria for PCOS?
Rotterdam Criteria - 2/3 of:
- Oligomenorrhoea +/- anovulation
- Clinical or biochemical signs hyperandrogenism
- Poly cystic ovaries on imaging
59
What would be seen on bloods in PCOS?
Raised T
Low SHBG - high circulating levels of LH
Normal FSH
Low Progesterone
60
What would be seen on USS of PCOS?
String of pearls
| > 5 follicles/ovary
61
Mx of PCOS
Treat DM/HTN/Hyperlipidaemia
Weight management
Oral contraceptive pill (effect oestrogen unopposed - give POP)
Anti-androgen for hirsutism aka spironolactone
Infertility:
Clomifine in conjunction with metformin
Ovarian drilling
COCP
62
Complications of PCOS
T2DM
Weight gain
Increased risk endometrial Ca
63
What is PID?
Inflam condition affecting any part of higher female reproductive system - salpingitis or endometritis
64
Causative organisms in PID?
Chlamydia Trachomitis and Neisseria Gonorrhoea
65
Presentation of PID
```
Lower abdo pain
N&V
Fever >38
Deep dyspareunia
Cervical/Vaginal discharge
Irregular bleeding
Dysuria
Cervicitis
```
O/E: Cervical excitability, tenderness at fornices
66
RFx for PID
```
STD
Young age
Multiple partners
Intercourse without protection
IUD insertion
```
67
Ix for PID
Swabs - endocervical (chlamydia and gonorrhoea) and high vaginal swab Bacterial vaginosis
Urine dip +/- MSSU
Pregnancy test
68
Mx PID
Abx - Doxycycline and Metronidazole
Paracetamol
Contact tracing
Avoid intercourse until patient and partner treated
69
When to admitt someone with PID
Pregnant
Septic
Peritonitic
70
Complications of PID
```
Abscess
Infertility
Chronic pain
Chronic salpingitis - adhesions
Fitz-Hugh Curtis syndrome - Liver capsulitis secondary to PID
```
71
What is an Ovarian Cyst?
Fluid filled sack within ovary
| Common - especially pre-menstrual patients
72
How to tell if Ovarian Cyst will be malignant?
RMI (Risk of Malignancy Index)
- USS x Menopausal Status x Ca-125
- >250 should be referred to specialist
- 1 point if pre-menopausal; 3 if post
- USS features = 1 point; 3 points if 2 or more
73
Presentation of Ovarian Cyst?
```
Incidental and asymptomatic
Chronic pain - secondary to pressure bladder/bowel
Dysparenueria/cyclical pain
ACute pain in rupture or haemorrhage
PV bleeding
```
74
Presentation of Ovarian Cyst Rupture?
Sudden onset, unilateral, lower abdo pain
Fluid and blood loss - Shock
Acute abdo
Occurring during exercise
Dx - Pelvic USS - free fluid Pouch of Douglas
75
Rx Ruptured Ovarian Cyst?
Stable: Supportive - Obs and analgesia
Unstable: Laparoscopy
76
Presentation of Ovarian Cyst Torsion?
Sudden onset, unilateral, lower abdo pain
N&V
Pain improves over 24h as ovary dies
Venous return impaired - disruption arterial supply
Occurs during exercise or ovarian enlargement
77
Mx Ovarian Torsion?
USS - Enlarged, oedematous ovary
| Laparoscopy and flip - should turn pink
78
Mx Ovarian Cyst?
Post-menopausal - Low RMI, follow up for year if <5cm with Ca-125 and USS;
Moderate RMI - Bilateral oopherectomy w/ Ca-125
Severe RMO: Laparotomy and staging
```
Pre-menopausal
LDH, aFP, B-HCG
Re-scan 6wk after finding - still there --> USS and Ca-125
3-6m then RMI
>5cm --> Cystectomy
```
79
Cell Type Ovarian Cancer?
Mostly epithelial subtype
| Serous > mucinous cystadenocarcinoma
80
What do Granulosa cell tumours produce?
Oestrogen
81
What do Sertoli-Leydig cell tumours produce?
Androgens
82
What is Meigs Syndrome?
Triad of benign ovarian tumour, ascites, and pleural effusion (transudate)
83
What on USS is included in RMI?
```
Bilateral
Ascites
Metastases
Solid areas
Multilocular cysts
```
84
Presentation of Ovarian Cancer?
Vague symptoms delay Dx
Abdo/pelvic pain
Bloating
Change bowel habit
O/E: Mass, ascites, cervical excitation
85
RFx for Ovarian Cancer?
```
More ovulation = Increased risk
Nulliparity
Early menarche
Late menopause
Oestrogen-only HRT
Smoking
```
86
What are 2 genetic mutations predisposing to Ovarian Ca?
BrCa 1/2
Patients < 30y
HNPCC - Lynch syndrome
87
3 Tumour markers in Ovarian Ca
Ca-125
CEA (Carcinoembryonic antigen)
Ca-19.9
88
If < 40, what additional tests for Ovarian Ca?
LDH, AFP, B-HCG
89
DDx for Ovarian Ca
IBS
| Diverticular disease
90
Ix for Ovarian Ca
USS
CT abdo/pelvis
CXR for pleural effusion/ lung mets
MRI - staging?
91
How is Ovarian Ca Staged?
FIGO
92
Mx Ovarian Ca?
Full staging laparotomy with midline incision
Hysterectomy, BSO, Omentectomy, LN sampling, Peritoneal washings
Platinum-based Chemotherapy (carboplatin)
Letrozole
93
Role of screening in Ovarian Ca?
If gene mutation identified - yearly USS with Ca-125
BrCa +ve - BSO offered and warned of risk finding incidental disease
94
What does sexual offences act of 2009 say?
Legal age consent is 16
Not intended to prosecute mutually consented sex between 13 and 16
< 13y is crime with no defence
95
What is Gillick Competence?
< 16y and their capacity to consent to their own sexual activity
96
What are the Fraser Guidelines?
```
Only concerned of contraception
UPSSI is criteria
- Must have understanding
- Parental involvement unless cannot be persuaded
- Sex ongoing regardless of advice
- Suffering will ensue
- In best interest
```
97
What is Endometriosis?
Relapse and remitting Condition where endometrial tissue located outside uterus
Ovaries, pouch of Douglas, Lung
98
What does adenomyosis mean?
Presence Endometrial tissue in uterine muscle
99
What are 3 proposed theories for Endometriosis?
1. Retrograde menstruation
2. Metaplasia of mesothelial cells
3. Impaired immunity
100
What hormone Endometriosis driven by?
Oestrogen - acts like would to cyclical hormones - growing and bleeding at times
101
What happens when there is endometrial tissue in ovaries?
Bleeds and forms chocolate cysts
102
What is the presentation of Endometriosis?
```
Cyclical pelvic pain
Occurs at time of menstruation
Can be chronic due to adhesions
Severe dysmenorrhoea
Deep dyspareneuria
Dysuria
Dyschezia (pain on defecation)
Cyclical rectal bleeding
Subfertility
```
O/E:
Fixed, retroverted uterus
Palpable uterosacral ligament
Tenderness and adnexal masses
103
What features on examination would suggest adenomyosis?
Enlarged, tender, boggy uterus
104
RFx for Endometriosis?
FHx
Short menstrual cycles
Heavy menstrual bleeding
Early menarche
105
DDx Endometriosis?
PID
Ectopic
Fibroids
IBS
106
Ix for Endometriosis?
Bloods - anaemia, urine dip (haematuria), MRI if bowel, transvaginal USS (cancer), pelvic USS (Severity - pre-surgery)
Gold standard is laparoscopy - chocolate cysts, adhesions, peritoneal deposits
107
Mx of Endometriosis?
Asymptomatic - nothing
Non-hormonal - pain management
Hormonal/Systemic:
- Pseudo-preg: COCP or POP
- Pseudo-menopause: GnRH analogues
Hormonal/Local:
- Mirena Coil
- Surgery: Diathermy or Hysterectomy
108
RFx for STIs
```
Unprotected sex
Young female
Multiple sexual partners
MSM
Metropolitan
```
109
What is most common Bacterial STI in UK?
Chlamydia trachomitis
110
How should chlamydia be screened?
Opportunistic and all sexually active people <25
| Repeat in 3-6m
111
Causative organism of chlamydia
Chlamydia trachomatis which is obligate intracellular bacteria
112
Symptoms of chlamydia
```
Women:
Asymptomatic in 80%
Post-coital and intramenstrual bleeding
Purulent discharge
Lower abdo pain
PRoctitis
Signs: Cervicitis, contact bleeding
```
```
Men:
Urethral discharge
Dysurea
Testicular/epididymal pain
Proctitis
```
113
How to Ix Chlamydia?
PCR testing from vulvovaginal swab
| Men: first void urine of day
114
Rx Chlamydia
Stat azithromycin
Then doxycycline
Avoid all sexual contact until 1 wk after both partners treated
115
Complications of Chlamydia
PID
Epididymitis
Fitz-Hugh Curtis Syndrome
116
What can Chlamydia cause in neonates/preg?
Neonatal conjunctivitis
Low BW
Post-partum endometreitis in mother
117
What is Gonorrhoea?
Neisseiria Gonorrhoea
118
How is Gonorrhoea transmitted?
Always sexually in adults
Neonates - eye involvement
Older children - sexual abuse
119
Symptoms of Gonorrhoea?
```
Depends on location
Often asymptomatic
Women:
Vaginal discharge
Lower abdo pain
Rectal infection in absence of anal intercourse - spread by fingering or rimming
```
Men:
Urethral infection with discharge and dysuria
120
Ix of Gonorrhoea?
PCR testing via vulvovaginal swab or first void urine in men
121
Mx of Gonorrhoea?
Ceftriaxone and Azithromycin
| OR Azithromycin and Doxycycline
122
Causative organism in HSV?
HSV-1/2
123
Symptoms of HSV?
Variable
80% no clinical symptoms
PRimary infection - febrile illness 5-7d, dysuria and ulcers
124
How is HSV Dx?
PCR
125
Causative organism Syphilis?
Treponium pallidum
126
Transmission of Syphilis?
Skin to skin
| Mucosa to mucosa
127
Rx of HSV?
Acyclovir
128
Symptoms of Syphilis?
Ano-genital ulcers which may occur in mouth
| Classically - painless ulcers, known as chancres
129
How to Dx Syphilis?
Syphilis serology
| Swab for PCR
130
Rx for Syphilis?
Ben Pen IM
131
Complications of Syphilis
Secondary: Gumata
Tertiary: Neurosyphilis (may happen early if immunocompromised); CV
132
Causative organism of Anogenital warts?
HPV 6 and 11
133
Transmission of anogenital warts?
Close skin to skin - 40% carry (1-2% develop warts)
134
Symptoms of warts?
Appear round sites max trauma (introitous or penis)
| May be itchy or bleed
135
Mx warts
Home-based Rx with toxin cream solution
| Can give cryotherapy
136
4 common causes vaginal discharge?
Candida - thick and white; itch - Clotrimazole
BV - watery and fishy; pH >5 - Metronidazole
Trichamonis vaginalis - frothy, yellow and fishy; itch - Metronidazole
Physiological - clear white, no smell
137
Ix for vaginal discharge
pH
High vaginal swab - Candida, BV, TV
Vulvovaginal swab - Chlamydia, Gonorrhoea
138
What is female sterilisation?
Tubular ligation
Occlusion
Salpingectomy with rings or clips (99.5%)
139
What is male sterilisation?
Vasectomy:
- Ligation of vas deferens
- Cauterisation of the ends
- Insertion of a fascia between the two
140
Complications of a vasectomy?
```
Bleeding
Infection
Epididymitis
Pain
Granuloma
```
141
3 Types of non-hormonal contraception?
Male condom
Intrauterine
Sterilisation
142
Typical Failure rate of condom?
18%
143
What is a non-hormonal IU contraceptive?
Copper coil - 0.8% failure
144
MoA of combined hormonal contraceptives?
Inhibits ovulation
Alters mucous and endometrium
Can be given as pill, patch or ring
9% failure
145
Risks associated with combined hormonal contraceptive?
VTE and PE
Breast Ca
Migraine with aura
146
What is a POP?
Progestogen only
Thickens mucous
Thins myometrium
9% failure
147
Benefits of POP over COCP?
Can be used by women who smoke, >35y and breastfeeders
148
S/E of POP
Breakthrough bleeding
149
What is the implant?
```
Small, flexible rod
Under dermis of non-dominant arm
Contains progestogen
Inhibits ovulation
Thickens mucous
Failure 0.05%
```
150
How long implant in for?
3 years
151
S/E of implants?
1/3 no periods
1/3 irregular periods
1/3 normal periods
152
What is the contraceptive Depot
```
Injection into gluteal or abdo fat
Contains progestogen
Stops ovulation
Mucous thickening
Myometrium thinning
6% failure
Repeated 13 weeks - recall at 3 months
```
153
S/E depot injection?
Weight gain
Reduced BMD
Can take one week for women to ovulate again
154
What is IU hormonal contraception?
```
Progestogen
Stops ovulation
Mucous thickening
Myometrium thickening
In for 3-5y (Mirena)
T-shaped device
Failure 0.2%
```
155
S/E Hormonal IUD?
Irregular bleeding up to 6m
| Periods then become lighter and less painful
156
Emergency contraception
Best within 72h but can be up to 5d after (if ellaone)
Gold standard - copper coil
EllaOne/Levonorgestrel EHC
157
Reasons to avoid combined hormonal contraceptives?
VTE
PEs
Cancer - endometrial and Breast
Hepatitis or Liver tumours
158
What is Ovarian Hyperstimulation?
Complication of ovulation induction
| Superovulation
159
What is the pathology of Ovarian Hyperstimulation?
Ovarian enlargement
| Fluid shift from intra to extravascular space - peritoneal fluid and haemoconcentration (hypercoagulable)
160
Presentation of Ovarian Hyperstimulation?
Abdo discomfort
| SoB
161
Risk factors for Ovarian Hyperstimulation?
Young age
Low BMI
PCOS
Prev OHSS
162
Mx of Ovarian Hyperstimulation?
Analgesia
Fluid balance
Anti-embolic measures
163
Prevention of Ovarian Hyperstimulation?
Low dose Gonadotrophin
164
What is the definition of infertility?
Inability of a couple to conceive despite 1y of unprotective sex
Primary: Those who never conceived
Secondary: Previously conceived
165
Definition of recurrent pregnancy loss?
Inability of a woman to carry a live birth even if conception possible AKA fibroid or antiphospholipid syndrome
166
What are the causes of infertility?
40% female
30% male
30% combination
167
What are the female causes of infertility?
PCOS
Ovarian insufficiency
Tubal adhesions
Sexual dysfunctions
168
How to Dx Male infertility?
Semen analysis after abstaining for 3-4d
169
How to Dx Male infertility?
Semen analysis after abstaining for 3-4d
More than 30% sperm morphology should be normal
170
Mx Male infertility
Surgical treatment anomalies
Reproductive technology AKA sperm donor
Testosterone or Clomiphine for medical therapy
171
Ix of Female infertility?
1. Ovulatory function - mid-luteal progesterone (Raised in infertility); FSH (elevated), Prolactin may be high
2. Patency fallopian tubes and uterus using hysterosalpingography (dye test)
3. Examine cervix
172
Mx of Female infertility?
Inducing OVulation:
- Weight loss/gain
- Clomiphine (increases FSH)
- Ovarian drilling in PCOS
- Letrazole (aromatase inhibitor - lowers oestrogen, increase FSH)
- ?Metformin (PCOS)
Egg Retrieval:
- HCG analogue given priorly
IUS - Intrauterine insemination
IVF - In vitro fertilisation
ICSI - Intra-cytoplasmic sperm injection
173
Define Heavy menstrual bleeding
Bleeding that has any adverse impact on quality of life
174
Causes of Heavy menstrual bleeding
Fibroids
Adenomyosis
Malignancy
175
Ix for Heavy menstrual bleeding
FBC - anaemia
B-hCG - pregnancy
USS - fibroids etc.
176
Mx of Heavy menstrual bleeding
```
No treatment
Methanamic or tranexamic acid
Pseudopregnancy or pseudomenopause
- Contraception
- GnRH analogues (pseudomenopause)
```
Surgical:
Hysteroscopy and resection (polyps)
Uterine artery ablation
Hysterectomy
177
What is Oligomenorrhoea?
Cycle > 35d
178
How to Examine for Amenorrhoea
Tanner staging
179
What is Asherman Syndrome?
Most common form of anovulatory infertility
| Caused by excessive curettage of endometrial cavity
180
What is dysmenorrhoea?
Characteristically cramping lower abdo pain, radiates to back and legs
Primary: idiopathic with high level prostaglandins
Secondary: due to pelvic pathology (usually endometreisis)
181
What is intermenstrual bleeding?
Bleeding incl brown discharge between periods
182
Definition of PMV
Bleeding 12m after last menstrual period
183
Causes of PMV
```
Vulval Ca
Cervical Ca
Vaginal Ca
Cervical Polyps
Endometrial Ca
```
184
What is the climateric?
Peri-menopause
| First instance of symptoms AKA infrequent menstruation
185
What is the menopause
Time when woman permanently stops menstruating
| 12m after amenorrhoea
186
What is post-menopause
Time beginning 12m after last menstrual cycle
187
Physiology of Menopause
Reduced ovarian function
Reduced -ve feedback
Increased GnRH
Anovulatory cycles
188
Presentation of Menopaue
3 Categories:
- Vasomotor - sweating, hot flushes, heat intolerance
- Mental - impaired sleep, depressed mood, loss libido
- Atrophic - Vulvovaginal atrophy, general weight gain and bloating
189
Dx for Menopause
>45y - clinical Dx
| < 45y - ?POI (prem ovarian insufficiency) - FSH measurements
190
Indications for Mx of menopause
```
Impacts QoL
Premature or surgical
Bleeding - coil
Atrophic vaginitis - Vaginal oestrogen creams
HRT
Paroxetine - hot flushes
```
191
Types of HRT
Oestrogen-only if hysterectomy
| Oestrogen and Progesterone if have uterus - protects from affect unopposed oestrogen
192
C/I to HRT
Pregnancy
DVT/PE
Chronic liver disease
Endometrial/Breast Ca
193
What is premature ovarian insufficiency
Cessation periods before 40
194
Pathology of premature ovarian insufficiency
Decreased oestrogen
Loss feedback
FSH and LH high
195
Causes of premature ovarian insufficiency
Idiopathic
Smoking
Post-oopherectomy
Induction multiple ovulations and infertility
196
Dx of premature ovarian insufficiency
High FSH after 3m amenorrhoea
197
Mx of premature ovarian insufficiency
HRT
IVF if want baby
Treat underlying disorders
