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Flashcards in Reproduction & Gynaecology Deck (202)
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1

Define primary amenorrhoea

Failure to have a period before age of 16

2

List aetiology/risk factors for primary amenorrhoea

Delayed puberty
Familial
Turner syndrome
Testicular feminisation

3

Define secondary amenorrhoea

Not had a period in 6 months in someone who previously has had a period

4

List aetiology/risk factors for secondary amenorrhoea

HPO axis dysfunction (emotions, stress, weight loss/anorexia, high prolactin, pituitary tumour, Sheehan syndrome)
Polycystic ovarian syndrome
Ovarian tumours
Ovarian failure
Asherman syndrome (uterine adhesions following D+C)

5

What investigations would you do for secondary amenorrhoea?

FSH (raised in premature ovarian failure)
LH, testosterone (raised in PCOS)
Prolactin
Thyroid function
MRI pituitary

6

Outline management of secondary amenorrhoea

Treat cause
GnRH injections
HRT
In vitro fertilisation/oocyte donation if wanting pregnancy

7

What is menorrhagia?

Increased menstrual blood loss (over 80ml per cycle) with prolonged menstrual flow

8

List local aetiology/risk factors for menorrhagia

Anovulatory disorder
Adenomyosis
Polyps/fibroids
Malignancy
Pelvic inflammation
Endometriosis
Intrauterine contraception
Trauma

9

List systemic aetiology/risk factors for menorrhagia

Hypothyroidism
Diabetes
Blood dyscrasia (vWD)
Anticoagulants
Dysfunctional uterine bleeding

10

What investigations would you do for menorrhagia?

FBC
Thyroid function
Clotting studies
Renal and liver function
Transvaginal USS +/- endometrial biopsy (pipelle, hysteroscopy, D+C)

11

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)

12

What is dysmenorrhoea?

Painful periods with/without nausea or vomiting

13

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

14

Describe "secondary" dysmenorrhoea

Painful periods with associated pathology (fibroids, adenomyosis, endometriosis, PID, sepsis)
More constant pain, pain during sex

15

List aetiology/risk factors for intermenstrual bleeding

Cervical polyps
Ectropion
Carcinoma (endometrial, cervical)
Vaginitis
IUD
"spotting" from hormonal contraception
Pregnancy

16

List aetiology/risk factors for post-coital bleeding

Cervical trauma
Polyps
Carcinoma (endometrial, cervical, vaginal)
Cervicitis, vaginitis
Chlamydia

17

List aetiology/risk factors for post-menopausal bleeding

Endometrial carcinoma
Vaginitis
Foreign bodies (pessaries)
Cervical/vulval carcinoma
Polyps
Oestrogen withdrawal

18

What is the most common ovulatory disorder?

Polycystic ovarian syndrome (PCOS)

19

List clinical features of PCOS

Acne
Male-pattern baldness
Hirsutism
Acanthosis nigricans
Infertility
Insulin resistance
Central obesity
Amenorrhoea

20

What is the Rotterdam criteria for diagnosing PCOS?

2 of
Menstrual disturbance
12+ 9mm cysts on USS
Hyperandrogenism

21

What would hormone levels be like in PCOS?

Raised LH:FSH ratio
Raised testosterone
May have raised prolactin

22

Outline management of PCOS

Smoking cessation, weight loss
Treat diabetes/hypertension/hyperlipidemia
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)

23

What is premenstrual syndrome?

Premenstrual change in mood or physical state

24

List clinical features of premenstrual syndrome

Tension, irritability
Depression
Bloating
Breast tenderness
Carb craving
Headache
Reduced libido

25

Outline management of premenstrual syndrome

Support, psych counselling/CBT, family therapy
Stress and relaxation techniques
Pyridoxine may improve mood
COCP
Fluoxetine
If cyclical mastalgia: reduce saturated fats, bromocriptine, danazol

26

What is menopause?

Cessation of menstrual periods following climacteric period (1 year of amenorrhoea)

27

Define premature, early and late menopause

Premature: before age of 40
Early: before age of 45
Late: after age of 54

28

List clinical features of menopause

Menstrual irregularity
Sweats, hot flushes
Palpitations
Insomnia
Joint ache
Vaginal dryness
Low libido
Mood swings
Anxiety
Bleeding
Late symptoms (frequency, dry hair/skin, breast atrophy, osteoporosis)

29

What would you find on investigations for menopause?

Low oestrogen
High FSH and LH

30

Outline conservative management of menopause and medications used for menorrhagia

Reduce caffeine, weight loss
Wear lighter clothes
Oestrogen if vaginal dryness
Mefenamic acid to reduce uterine blood flow
Tranexamic acid to reduce clots
Progesterone injections
IUS if wanting contraception
Endometrial ablation
Hysterectomy