Flashcards in Reproduction & Gynaecology Deck (202)
Define primary amenorrhoea
Failure to have a period before age of 16
List aetiology/risk factors for primary amenorrhoea
Define secondary amenorrhoea
Not had a period in 6 months in someone who previously has had a period
List aetiology/risk factors for secondary amenorrhoea
HPO axis dysfunction (emotions, stress, weight loss/anorexia, high prolactin, pituitary tumour, Sheehan syndrome)
Polycystic ovarian syndrome
Asherman syndrome (uterine adhesions following D+C)
What investigations would you do for secondary amenorrhoea?
FSH (raised in premature ovarian failure)
LH, testosterone (raised in PCOS)
Outline management of secondary amenorrhoea
In vitro fertilisation/oocyte donation if wanting pregnancy
What is menorrhagia?
Increased menstrual blood loss (over 80ml per cycle) with prolonged menstrual flow
List local aetiology/risk factors for menorrhagia
List systemic aetiology/risk factors for menorrhagia
Blood dyscrasia (vWD)
Dysfunctional uterine bleeding
What investigations would you do for menorrhagia?
Renal and liver function
Transvaginal USS +/- endometrial biopsy (pipelle, hysteroscopy, D+C)
Outline management of menorrhagia
IUS 1st line if wanting contraception/no pregnancy
Antifibrinolytic (tranexamic acid)
Antiprostaglandin (mefenamic acid)
IM progestogen (northisterone)
Surgery (endometrial ablation, uterine artery ablation, hysterectomy)
What is dysmenorrhoea?
Painful periods with/without nausea or vomiting
Describe "primary" dysmenorrhoea
Painful periods in absence of organ pathology, often associated with anovulation
Occurs earlier in life
Crampy, back/groin ache, worse on days 1-3
Describe "secondary" dysmenorrhoea
Painful periods with associated pathology (fibroids, adenomyosis, endometriosis, PID, sepsis)
More constant pain, pain during sex
List aetiology/risk factors for intermenstrual bleeding
Carcinoma (endometrial, cervical)
"spotting" from hormonal contraception
List aetiology/risk factors for post-coital bleeding
Carcinoma (endometrial, cervical, vaginal)
List aetiology/risk factors for post-menopausal bleeding
Foreign bodies (pessaries)
What is the most common ovulatory disorder?
Polycystic ovarian syndrome (PCOS)
List clinical features of PCOS
What is the Rotterdam criteria for diagnosing PCOS?
12+ 9mm cysts on USS
What would hormone levels be like in PCOS?
Raised LH:FSH ratio
May have raised prolactin
Outline management of PCOS
Smoking cessation, weight loss
Metformin if insulin resistant esp if BMI over 25
Check for rubella immunity
Ovulation induction if wanting to conceive (clomifene, tamoxifen, gonadotropin injfections, laparoscopic ovarian drilling)
What is premenstrual syndrome?
Premenstrual change in mood or physical state
List clinical features of premenstrual syndrome
Outline management of premenstrual syndrome
Support, psych counselling/CBT, family therapy
Stress and relaxation techniques
Pyridoxine may improve mood
If cyclical mastalgia: reduce saturated fats, bromocriptine, danazol
What is menopause?
Cessation of menstrual periods following climacteric period (1 year of amenorrhoea)
Define premature, early and late menopause
Premature: before age of 40
Early: before age of 45
Late: after age of 54
List clinical features of menopause
Sweats, hot flushes
Late symptoms (frequency, dry hair/skin, breast atrophy, osteoporosis)
What would you find on investigations for menopause?
High FSH and LH