Gynaecology notes detailing gynaecological pathologies and conditions as well as women's health and contraception. Notes made from multiple resources such as oxford handbook, question banks, university lectures and UK guidelines.
Look at specialty section and content list for the summary content...
Description
Menses begin (menarche) from ~10yrs onwards (mean ~12.7yrs and falling — earlier if low birth weight; African;
short & overweight in childhood; urban environment; various fascinating pheromone-related family events
mediating anti-inbreeding strategies). Investigate if no periods by ~16yrs (p250) or no signs of puberty by 14. A
growth spurt is the 1st change in puberty and is usually completed 2yrs after menarche when the epiphyses fuse.
Normal Menstruation
Description Hormonal Levels during Cycle
- HPO-Axis: Hypothalamic-Pituitary-Ovarian axis - FSH: ↑ FSH in first 4 days
- NB: GnRH FSH + LH Oestrogen + Progesterone - Effect: Stimulates 1o follicle; ↑ Oestrogen
Menstrual Cycle Basics - Oestrogen: ↑ Oestrogen via follicle production
- Basic: FSH Oestrogen LH Progesterone - Effect: ↑ Endometrium; Clear/stringy mucus
- Day 1: First day of menstruation - LH: Oestrogen ↑ LH 14 d before menstruation
- Length: Lasts 20-45 d in teens; (Only 12 % are 28 d) - Effect: Stimulates ovulation
- Irregular: Menstruation is common irregular shortly - Progesterone: ↑ After ovum is released
after menarche / before menopause - Effect: Prepares endometrium for implantation;
- Mucus: When ovulating mucus will ‘fern’ on a slide Mucus becomes viscid + hostile to sperm
but will lose this effect with ↑ progesterone - Not Fertilised: Hormone levels fail
- Menstruation: Lasts 2-7 d; 20-80 mL blood loss - Effect: Spiral a. construct + lining sloughs
,Premenstrual Syndrome
Description Management
- Path: Occurs during luteal phase of menstrual cycle - 1L: Exercise; CBT; VitB6; Carb-rich meals;
Presentation Fluoxetine
- Sx: Mood swings; Depression; Bloating; Mastalgia - 2L: Estradiol + Progesterone; Sertraline
- NB: SSRIs only have to be used in luteal phase
, Amenorrhoea
Description
Primary amenorrhoea is failure to start menstruating. It needs investigation in a 16-year-old, or in a 14-year-old who
has no breast development. For normal menstruation to occur she must be structurally normal with a functioning
control mechanism (hypothalamic–pituitary–ovarian axis). Secondary amenorrhoea is when periods stop for >6
months, other than due to pregnancy. Hypothalamic–pituitary–ovarian axis disorders are common, ovarian and
endometrial causes are rare.
Amenorrhoea
Presentation Investigations
- Primary: ≥16 YO or 14 YO with no breast development - Pregnancy: Exclude with urinary/serum β-HCG
- Secondary: Periods stopped <6 months (no pregnancy) - Basic: FBC; U&E; Coeliac screen; TFTs
Causes - Endo: LH; FSH; Prolactin; Androgens; Oestradiol
- Primary Amenorrhoea - ↓ LH/FSH: Indicates hypothalamic cause
o Common: Gonadal dysgenesis (E.g. Turner’s syn) - ↑ LH/FSH: Indicates gonadal dysgenesis
o Congenital: Androgen Insensitivity; Malformed GUT; - ↑ Prolactin: Hyperprolactinaemia (see endo
Imperforate hymen (amenorrhoea with cyclic pain) notes)
o Endo: Fxn hypothalamic amenorrhoea (Anorexia); - ↑ Androgens: May be seen in PCOS
Congenital Adrenal hyperplasia (see Paeds notes) - ↓ Oestrogen: Seen in premature ovarian failure
- Secondary Amenorrhoea Management
o Common: Hypothalamic amenorrhoea (↑ Exercise; - Primary Amenorrhoea
stress); Polycystic Ovarian Syndrome (PCOS) o Ix: Treat underlying cause and treat
o Endo: Hyperprolactinaemia; ↑↓ Thyroid fxn o Treat: HRT may be indicated
o Other: Premature ovarian failure; Sheehan’s Syn.; - Secondary Amenorrhoea
Asherman’s syn (uterine scarring post D&C) o Ix: Pregnancy; Lactation; Menopause (>40)
o Treat: Treat underlying cause
Hypothalamic-Pituitary Axis Malfunction
Description Management
- Mild: Enough oestrogen to produce endometrium but - Basic: Diet/stress advice; Psych referral if needed
the cycle timing is dysregulated - Contraception: Continue use as can restart itself
- Severe: HPO axis shuts down entirely - Mild: If wanting to restore fertility Clomifene
Causes - Severe: GnRH will be needed to stimulate HPG
- Mild: ↑ Stressed; Over-exercising; Mod. Weight loss before starting Clomifene
- Severe: Anorexia
Investigations
- Mild: Progesterone challenge for 10 d will cx period
- Severe: ↓ FSH + ↓ LH + ↓ Oestrogen
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