Repro- TBL Flashcards
Post menopausal bleeding?
aginal bleeding occurring after twelve months of amenorrhoea, in a woman of the age where the menopause can be expected
‘unscheduled bleeding’
non-cyclical bleeding still continuing six months after commencing HRT or after six months of amenorrhoea.
Postmenopausal bleeding could indicate what?
endometrial cancer
risk factors for endometrial cancer
- oestrogen only HRT
- early menarche or late menopause
- PCOS
- low parity or infertility
- Hypertension
- obesity combined with diabetes
protective factors for endometrial cancer
- smoking
- grand multiparity
- COCP
Aetiology of PMP vaginal bleeding
vaginal atrophy HRT endometrial hyperplasia endometrial cancer endometrial or cervical polyps cervical cancer ovarian cancer vaginal cancer (rare)
1st line investigation in PMP bleeding
transvaginal ultrasound scan
look at thickness
thickness in postmenopausal women that = ?endometrial cancer
> 5mm = 7.3% chance of endometrial cancer
if the thickness is less than 5mm but high clinical suspicion –> biopsy and hysteroscopy
what is Tamoxifen?
drug used to treat breast cancer that with long term use increases your risk of endometrial cancer.
people on this who have PMB –> normally have hysteroscopy and biopsy in addition to ultrasonography.
polycystic ovarian syndrome
very commonly seen in reproductive women, with 33% have polycystic ovaries on USS
majority of women with PCOS do not have symptoms and do not require intervention
PCOS AFFECTS 5-15% of people of reproductive age
pathophysiology of PCOS
multifactorial. essential changes are: Excess androgens produced by the theca cells of the ovaries insulin resistance raised LH raised oestrogen
when do people present with PCOS?
from peripubertal period - 20 years old
symptoms of PCOS?
Oligomenorrhoea (defined as <9 periods per year). Infertility or subfertility. Acne. Hirsutism. Alopecia. Obesity or difficulty losing weight. Psychological symptoms - mood swings, depression, anxiety, poor self-esteem. Sleep apnoea.
Clinical signs of PCOS?
The presence of hirsutism, (often on the upper lip, chin, around the nipples and in a line beneath the umbilicus). This occurs in 60% of women with PCOS.
Male-pattern balding, alopecia.
Obesity - this is common (usually central distribution).
Acanthosis nigricans - may be present and is thought to be a sign of insulin resistance.
Occasionally, clitoromegaly, increased muscle mass, deep voice (more usually, these are signs of more severe hyperandrogenism syndromes).
diagnostic criteria for PCOS
Polycystic ovaries (either 12 or more peripheral follicles or increased ovarian volume (greater than 10 cm3).
Oligo-ovulation or anovulation.
Clinical and/or biochemical signs of hyperandrogenism.
investigations
testosterone: normal or raised sex hormone binding globulin: normal or low LH: raised FSH: normal USS OGTT fasting lipids
risks?
CV risks (due to lipideamia, and insulin resistance)
how to help?
increase exercise and weight loss
low GI diet
COCP- to stop endometrial hyperplasia (–>cancer)
pharmacological treatment of PCOS
it is targeted at symptoms as no drugs can reverse hormone distribution
treatment for women not planning pregnancy
Co-cyprindrol: for hirsutism and acne COCP: to regulate period metformin: insulin orlistat: obese people Eflornithine: hirsutism
treatment for those wishing to conceive
metformin and clomifene (to induce ovulation)
complications in pregnancy can occur: gestational diabetes, pre-term birth and pre-eclampsia
Dysmenorrhea
term used to describe low anterior pelvic pain which occurs in association with periods.
pathogenesis of dysmenorrhea
excess or imbalance of prostaglandins and leukotrienes which causes vasoconstriction of uterine vessels.
prostaglandins can also cause diahorrea, nausea, headache
dysmenorrhea:
primary:
secondar:
primary:
Young females with no pelvic pathology.
occurs 6 months to 1 year after menarche
pain begins with onset of period and can last 24-72hrs
secondary:
some form of pelvic pathology
occurs years after menarche
can start well before period and last through out period
dyspareunia
causes of secondary: endometriosis, PID, fibroids, IUD
