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Summary Gynaecology Revision Papers
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Gynaecology revision posters suitable for 4th year modules or revision purposes
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By: larakola98 • 4 year ago
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Menstrual CycleMenstrual cycle hormonal changes à ovula2on; induce changes in
endometrium that prepare it for implanta2on if fer2lisa2on occurs.
Days 1-4 = menstrua4on: endometrium shed as hormonal support
withdrawn. Myometrial contrac2on occurss (may be painful)
Days 5-13 = prolifera4on phase: GnRH pulses from hypothalamus s2mulate
LH and FSH release à induce follicular growth. Follicles produce oestradial +
inhibin: suppress FSH secre2on in ‘nega2ve F’ à only one follicle + oocyte
mature. As oestradiol levels con2nue to rise to max, a ‘posi2ve F’ effect on
the hypothalamus + pituitary cause sharp rise in LH: ovula2on occurs 36h
aNer LH surge. Oestrodiol causes endometrium to re-form + become
‘prolifera2ve’: thickens as stromal cells proliferate and glands elongate. Abnormal menst
Days 14-28 = luteal/ secretory phase: follicle becomes corpus luteum; this Menorrhagia: he
produces oestrodiol, but rel more progesterone, which peaks around a week Intermenstrual b
later (day 21 of 28-d cycle): induces ‘secretory’ changes in endometrium, periods
whereby stromal cells enlarge, glands swell and blood supply increases. Irregular periods
Towards end of luteal phase, CL starts to fail if egg not fer2lised, causing 23-35days with a
progesterone + oestrogen to fall. As hormonal support withdrawn, shortest and long
endometrium breaks down, menstrua2on follows + Cycle restarts. Postcoital bleedi
Con2nuous admin of exogenous progestogens maintains secretory Primary amenor
endometrium- can be used to delay menstrua2on Secondary amen
6months or more
Oligomenorrhoe
Puberty Normal menstrua4on days – 6months)
Onset of sexual maturity, marked by dev of secondary sex characteris2cs. Menarche <16y Postmenopausal
Menarche = onset of matura2on; normally last manifesta2on of puberty in female; av 13y. Menopause >45y the menopause
Normal puberty controlled centrally. The hypothalamic-pituitary axis (HPA) ‘wakens’ the Menstrua2on <8 days in length Dysmenorrhoea:
ovaries. ANer 8y, hypothalamic GnRH pulses increase in amplitude and frequency à FSH and Blood loss <80mL Premenstrual sy
then LH release increases; s2mulate oestrogen release from ovaries. Cycle length: 25-35days physical symptom
Oestrogen responsible for development of secondary sexual characteris2cs: No intermenstrual bleeding (IMB)
Thelarche: beginning of breast dev; 9-11y
Adrenarche: growth of pubic hair; dep on adrenal ac2vity; 11-12y
Menorrhagia (heavy menstrual bleeding: HMB)
Menarche: final stage; average 13y. Menstrua2on oNen ini2ally irregular; becomes more HMB: excessive bleeding in an otherwise normal menstrual
regular as oestrogen secre2on rises heavy periods, although most don’t seek medical help.
Changes accomp by growth spurt due to éGH. By 16y, growth finished + epiphyses fused
Clinical defini2on: excessive menstrual blood loss that inter
Precocious puberty: menstrua2on <10y; or 2 sexual characteris2cs evident <8y; very rare.
emo2onal, social and material QoL; can occur alone or in co
Growth spurt occurs early, but final height reduced due to early fusion of epiphyses. Objec2ve defini2on: blood loss >80mL in otherwise normal
Inves2ga2on essen2al. Rx: arrest sexual development and allow normal growth; GnRH can lose per cycle, without becoming iron deficient. Rarely m
agonists used to inhibit sex hormone secre2on à regression of 2 sex characteris2cs and Ae4ology: majority – no histological abormality; most are o
cessa2on of menstrua2on.. 80% no pathological cause found. Central causes + ovarian/
abnormali2es of endometrial haemostasis or uterine prosta
adrenal causes: hormone producing tumours of ovary/ adrenals; McCune Albright syndrome
- Uterine Fibroid (30% of women with HMB) and polyps (1
- Chronic pelvic infxn, ovarian tumours, endometrial/cerv
Irregular Menstrua4on + intermenstrual bleeding - Thyroid disease, haemosta2c disease (vW disease) and a
May coexist with heavy menstrual bleeding; more common at extremes of repro age. Clinical Features: history – amount and 2ming of bleeding;
Causes: indicates excessive loss; ascertain if any method of contrace
- Anovulatory cycles: common in early + late repro years anaemia, irregular enlargement of uterus (Fibroids); tender
- Pelvic pathology: on-malignant causes: fibroids, uterine, cervical polyps; adenomyosis, (adenomyosis); may feel ovarian mass/ fibroids.
ovarial cysts; chronic pelvic infec2on. With older women, inc risk of malignancy (ovarian, Inves4ga4ons: Hb; coagula2on + thyroid func2on; exclude l
cervical, esp. endometrial) US- endometrial thickness, exclude uterine fibroid/ ovarian
Inves4ga4ons: assess effect of blood loss: check Hb; exclude malignancy (except in young – polyps). If endometrial thickness >10mm/ polyp is suspecte
malignancy rare); exclude local treatable pathology (smear); US of cavity if >35y or in onset menorrhagia, perform endometrial biopsy (hysterosc
younger if medical treatment failed (detects uterine fibroid/ ovarian mass); endometrial endometrial malignancy or pre-malignancy. Hysteroscopy a
biopsy with Pipelle if endometrium thickened/ suspect polyp/ women >40y; abla2ve surgery thus detec2on of polyps/ submucous fibroids that could be
or IUS are to be used Dilata2on and curepage (D&C) NOT for menorrhagia.
Management: Management
- Drugs: if no anatomical cause; IUS/ combined OCP (progestagens à amenorrhoea + - Medical: 1st line) intrauterine system (IU progestogens;
bleeding following withdrawal); HRT may regulate erra2c uterine bleeding during peri- not same as copper IUDs which increase menstrual loss;
menopause an4fibrinoly4cs (tranexamic acid; reduces fibrinoly2c ac
- Surgery: avulse + histology of cervical polyp; surgery as for amenorrhoea: abla2ve 50%); NSAIDs (e.g. mefanamic acid; inhibit PG synth; red
techniques (less useful than for amenorrhoea as some endometrium oNen remains) combined OCP; 3rd line): progestogens/ GnRH agonists
- Surgical: polyp removal; endometrial abla2on technique
Amenorrhoea + Oligomenorrhoea transvervical resec2on of endometrium + transcervical r
Primary amenorrhoea: menstrua2on not started by 16y (delayed puberty; no 2° sex probe/ thermal balloons (heat and destroy endometrium
characteris2cs by 14y); may be due to problem with menstrual outlow if 2° sexual transcervical resec2on of the fibroid (hysteroscopic equi
characterisics present. - More radical: myomectomy (removal of fibroids from m
Secondary amenorrhoea: previously nomrmal menstrua2on stops for >6months use GnRH agonists to shrink fibroids first), hysterectomy
Oligomenorrhoea: menstrua2on occurs every 35d – 6months. laparoscopic), uterine artery emboliza2on (UAE; if wish
Physiological amenorrhoea: rare congenital abnormali2es/ acquired
Pathological: problems in hypothalamus/ pituitary/ thyroid/ adrenals/ ovaries/ uterus/ Dysmenorrhoea
outlow tract; drugs (progestogens; GnRH analogues; an2psycho2cs via high prolac2n). Most Painful menstura2on. Assoc. with high prostaglandin levels
common: prem menopause, PCOS, hyperprolac2naemia contrac2on + uterine ischaemia.
Hypothalamic hypogonadism: oNen physiological (low weight, AN, exercise); tumours Primary dysmenorrhoea: no organic cause found; v commo
uncommon; low GnRH, FSH, LH and oestradiol. Suppor2ve Rx + oestrogen (OCP/HRT) women, 10% severe); usually coincides with start of menstr
Pituitary: hyperprolac2naemia (pit hyperplasia/ benign adenomas: Rx- bromocrip2ne, NSAIDs/ ovula2on suppression (OCP). Med Rx fails, pelvic pa
cabergoline, surgery); pit tumours +Sheehan’s syndrome Secondary dysmenorrhoea: pain due to pelvic pathology. O
Adrenal/ thyroid: over/ under-ac2vity of thyroid or congenital adrenal hyperplasia menstrua2on. Common with menorrhagia/ irregular menstu
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