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Fourth year Gynaecology

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This Gynaecology study guide will provide you with knowledge on the cause, diagnosis and management on many common, and less-common, gynaecological pathologies. It will assist you in fourth and final year exams and is written in an easy to understand format.

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  • October 10, 2020
  • 32
  • 2019/2020
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Medical school Gynaecology notes




KNOWLEDGE FOR FINALS


, Gynaecology


Normal layout of any history with 7 sections then specifically:

 Menstrual history
Age of menarche, age of menopause, last period, normal cycle for them,
details of bleeding (IM bleeding to distinguish pathological from normal heavy
periods), any post-coital bleeding?
 Pain
Dysmenorrhoea, dyspareunia (vaginismus etc.), pelvic pain
 Urodynamic
Questions about continence, new onset incontinence, stress incontinence,
frequency, Nocturia, dysuria and prolapse causing retention
 Fertility
Pregnancies, conceptions, fertility treatments, frequency of intercourse,
contraception use, Sexual health.
 Sexual history

A useful acronym for gynaecological histories: MOSCC
Menstruation
Obstetrics
Sexual history
Contraception
Cervical history (smears if over 25)

,Menstruation

1. Ovarian cycle (follicle development and release)
2. Uterine cycle (thickening and shedding of tissue)

The pre-ovulatory phase is 14 days long, also known as the follicular
phase/menstrual phase (this is the time when a woman is losing blood)

The Post-ovulatory phase is 14 days long, also known as the luteal/secretory
phase.




Weeks 1 and 2

 GNRH (gonadotrophin releasing hormone) is released to cause FSH and LH
to be released from the anterior pituitary gland.

 GNRH is released from the hypothalamus in pulses after puberty. This travels
to the pituitary gland and stimulates it.

Development of a follicle

 Layers of the follicle: Primary Oocyte in the centre, granulosa cells
surrounding the Oocyte and theca cells on the most outer part
 During the first 10 days theca cells develop LH receptors – in response to LH
they release Androstenedione
 During the first 10 days Granulosa cells develop FSH receptors – in response
to FSH they release aromatase, which converts androstenedione to
oestrogen.
 As the follicles grow more oestrogen is hence produced, which acts as a
negative feedback to the hypothalamus to produce less GTRH and hence less

, FSH: decreasing to a level so that there is only enough to stimulate one
follicle.
 On Days 10-14 granulosa cells also develop LH receptors




 At this point the oestrogen produced causes a positive feedback response
on the pituitary gland, causing the released of more GNRH, FSH and LH
 This causes rupture of the follicle and the release of the primary oocyte.
 A Spike in oestrogen optimises the chance of fertilization between days 11
and 15, because it makes the vaginal mucosa more hospitable to sperm.

Weeks 3 and 4

 After ovulation while LH is still high, the remains of the follicle turn into the
corpus luteum (made up of theca and granulosa cells)
 The theca cells respond to decreased levels of LH by producing
progesterone.
 The granulosa cells respond by producing inhibin, which negatively
feedback to prevent the production of oestrogen in the menstrual cycle.
 Progesterone causes spiral arteries to grow and uterine glands to secrete
more mucus. This encourages thickening of the endometrium.
 After day 15 the cervical mucus thickens, decreasing hospitability.
 The corpus luteum is subsequently replaced by the corpus albicans, and
no longer produces hormones.
 Oestrogen and progesterone decrease
 The spiral arteries collapse and the endometrium prepares to slough off.




Menstrual abnormalities (menorrhagia and PCOS)

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