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Block 42 - Women's Health > Period problems > Flashcards

Period problems Flashcards

(50 cards)

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1
Q

Symptoms of PMS

A 
Psych:
Irritable
Tense
Dysphoria (unhappy)
A severe form of this is premenstrual dysphoric disorder where there's episodes of depression each month that responds to AD treatment

Physical:
Breast tenderness
Bloating
Headache

Behavioural:
Reduced visuospatial and cognitive ability
More frequent accidents.

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2
Q

6x gynaecological causes of menorrrhagia

A 
Fibroids
Endometriosis
Adenomyosis
PID
Endometrial polyps
Cancer of the womb
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3
Q

Menorrhagia management

A 
IUS is first line 
One of the acid is first line non hormonal	
Mefenamic is their is pain
Tranexamic if no pain
All women should get FBC
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4
Q

Whihc hormones cause increased fibroid growth?

A

Oestrogen and progesterone

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5
Q

4 types of fibroids (classification)

A

intramural
subserosal
submucosal
cervical

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6
Q

intramural fibroids definition

A

within myometrium

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7
Q

subserosal fibroids…

A

below peritoneal surface of uterus

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8
Q

submucosal fibroids …

A

beneath endometrial cavity - can distort uterine anatomy -> infertility

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9
Q

Which types of fibroids lead to infertility and recurrent miscarriage

A

submucosal and intramural

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10
Q

Sx fibroids

A

cramping, menorrhagia, bladder and bowel disregulation,

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11
Q

pregnancy fibroids Sx

A

foetal malpresentation, preterm labour, pph

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12
Q

Inidications for treatment in uterine fibroids (4)

A

excessive menstrual blood loss, pressure Sx, uterine cavity distortion, rapid growth (can be sarcomatous change)

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13
Q

Heavy bleeding in uterine fibroids management

A

1st - levonorgestrel releasing ius (not if cavity distorted)

Combined pill, tranexamic acid

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14
Q

Surgical management of uterine fibroids

A

myomectomy (if want kids)

hysterectomy (if not)

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15
Q

Endometriosis

A

when endometrial cells grow outside uterus

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16
Q

RF endometriosis

A

FH, oestrogen excess (low parity, early menarchem late menopause)

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17
Q

Sx endometriosis

A

fluctuate and worsen during menstrual phase.
subfertility, dysmenorrhea, chronic pelvic pain, menorrhagia, deep dyspareunia, pain on defecation (if in pouch of douglas), urinary Sx, abdo pain

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18
Q

endometriosis pelvic examination findings

A

reduced uterine motility, often fixed retroverted uterus tender nodularity, visible vaginal lesions, tender adnexal mass

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19
Q

Dx endometriosis

A

laparascopy, confirmed w biopsy

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20
Q

Mx endometriosis pain

A

NSAIDS, if helps then add hormonal (COCP, progesterone analogues)
if odesn’t help GnRH analogue to surpress growth of existing mass - consider HRT as causes pseudomenopause

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21
Q

adenomyosis - def, sx, mx

Study These Flashcards
A

endometrial tissue within myometrium
causes painful heavy period and enlarged boggy uterus
managed GnRH agnoists/hysterectomy

22
Q

PID

Study These Flashcards
A

ascending infection of upper female genital tract - common complication of lower infections ie chlamydia

23
Q

RF PID

Study These Flashcards
A

under 25y, multiple sex partners, unprotected sex, copper IUD insertion recently

24
Q

PID Sx

Study These Flashcards
A

severe lower abdo pain - can radiate to back or upper thigh
dyspareunia
menorraghia, IM spotting, irregular periods, pc bleeding
mucopurulent/blood stained discharge
fever

25
us findings pid
dilated uterine tube or tubo ovarian abscess
26
Mx PID
broad spec ab for anaerobic and aerobic - oral ofloxacin + metronidazole or IM ceftiaxone +doxycycline +metronidazole consider removing IUD surgical removal of abscess if continues to grow despite ab
27
PID complications
10-20% chance infertility chronic pelvic pain pelvic adhesions increased risk ectopic
28
8 pathological causes of irregular bleeding and IM spotting
STI, recent miscarriage, hormone dysfunction (PCOS, menopause), vaginal dryness, cervical ectoprion/erosison, cancer (cervical, uterine, vaginal. vulval), polyps, fibroids
29
charecteristics of PCOS (hormones)
increased LH, suppressed FSH -> suppressed normal menstrual cycle
30
PCOS: implications of high LH
increased androgen production, converted by aldipose tissue to oestrogen - more commen in obese women with more aldipose tissue
31
PCOS: implications of high oestrogen
no LH surge or FSH for follicular development -> anovulation and a/oligomenorrhea. Follicle becomes cystic/degenerates
32
clinical features PCOS
menstual cycle disturbance, hyperandrogenism (hirsutism, acne, alopecia - bitemporal/male pattern baldness), obesity in 50% cases, acanthosis nigricans (increased insulin levels). mood swings/depression
33
Rotterdam criteria
2 of following present for PCOS diagnosis: infequent/absent periods clinical features of hyperandrogenism or raised serum testosterone USS evidence of >12 ovarian cysts
34
PCOS Ix
bloods - LH:FSH ratio > 3:1 within first 5 days of menstual cycle. raised serum oestrogen, testosterone, androstenedione. Imaging - pelvic USS
35
Mx PCOS
weight loss, for fertility - clomiphene citrate induces ovulation (risk of multiple pregnancies) if not then gonadotrophs, metformin, COCP for hirsutism. surgical - ovarian drilling (less common)
36
cervical ectropion definition
distal migration of cervical columnar epithelium outside cervix into normal squamous region, resulting in exposure to vagina acid
37
cervical ectroprion causes
elevated oestrogen - COCP, pregnancy, lots of cycles, commonest cause of bleeding in last stages of pregnancy
38
sx cervical ectroprion
spotting, vaginal discharge, post coital bleeding and pain
39
how is menopause diagnosed
retrospectively when no periods for 12 mnths
40
define perimenopause
from onset of Sx to 1 year after menopause, can happen up to 5 years before cessation of periods
41
what causes perimenopause
GnRH, LH, and FSH levels increasing due to loss of negative feedback from reduced levels of oestrogen and progesterone
42
Menopause physiology (hormone changes and reasons)
decrease in development of ovarian follicles -> reduced oestrogen production -> no negative feedback -> increased levels of FSH and LH failing follicle development -> anovulation -> irregular menstrual cycles No oestrogen -> endometrium doesnt develop -> amenorrhoea
43
Which hormone causes perimoenopausal symtoms
low oestrogen
44
Perimenopausal Sx
hot flushes, emotional lability/low mood, premenstrual syndrome, irregular periods, arthralgia/muscle pain, skin thinning and decreased elasticity, heavy/light periods, vaginal dryness/atrophy, reduced libido
45
risks of menopause and low oestrogen
osteoporosis, CV risk (low oestrogen -> body fat alterations, increased BP, reduced glucose tolerance, endothelial dysfunction and vascular inflammation), pelvic organ prolapse, urinary incontinence
46
When is FSH blood test recommended to diagnose menopause/perimenopause
women under 40 with suspected premature menopause, women aged 40-45 with menopausal Sx or change in menstrual cycle
47
HRT contraindications
current/pmh breast cancer, any oestrogen sensitive cancer, undiagnosed vaginal bleeding, untreated endometrial hyperplasia
48
Risks of HRT
VTE, stroke, IHD, breast/ovarian Ca
49
Risk reduction in HRT
only give unopposed oestrogen if previous hysterectomy, transdermal is pmh VTE or at risk
50
How long should

Block 42 - Women's Health (4 decks)

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