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Session 2: General Gynaecology
Summary
The on-demand teaching session titled "Obs and Gynae in the spotlight" is an insightful learning resource for medical professionals that focuses on General Gynaecology. This second session in the series is led by Zuzanna Milewska. The course investigates three pivotal cases concerning menorrhagia, dysmenorrhoea, and oligomenorrhoea. The teaching resource provides interactive learning through problem-solving and diagnosis making, reflecting on patients' symptoms and medical history to derive the best treatment methods. Furthermore, attendees are asked to give feedback to improve the quality of future sessions. Attend this session to expand your knowledge on common gynaecological conditions, learn how to interpret symptoms accurately, and improve your patient management skills.
Description
Learning objectives
- By the end of the session, attendees will be able to identify and understand the symptoms and medical histories associated with common gynaecological conditions like Menorrhagia, Dysmenorrhoea, and Oligomenorrhoea.
- Attendees will be able to differentiate between various gynaecological conditions based on symptoms and patient histories, leading to accurate diagnoses.
- Attendees will learn appropriate questions to ask patients with potential gynaecological conditions to gain necessary diagnostic information.
- They will understand relevant risk factors for gynaecological conditions discussed in the teaching session and how these might influence diagnosis, management, and prognosis.
- Attendees will gain knowledge of possible treatment/management options for each discussed condition, in line with latest guidelines, understanding when to refer patients to secondary care.
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Obs and Gynae in the spotlight Session 2: General Gynaecology By Zuzanna Milewska Session outline - Case 1: Menorrhagia - Case 2: Dysmenorrhoea - Case 3: Oligomenorrhoea - SBAsThank youfor joiningthisweek’s sessionof the Obs & Gynae inthe spotlight series.We’re thrilled that you’re here with us& hope that you find the sessionuseful. Before you use our resources, kindly take noteof the following: •Contentin thispresentationhas been designedby ourcommitteemembers,whoare medical studentslike yourselves! Therefore, the questionsmay notbe representativeof what comesout in yourexamsand there maybe errors in the questions. •DoNOT rely solely upon these resources for your medicalpractice andexam revision.Please refer toyour local guidelinesand/orsupervisingclinicianif you need anyclarification. •We would be grateful if you could take the timeat the sendofthe sessionto fill out feedback form.Thankyou.Case 1: Mary, a 40-year-old woman comes to see the GP complaining of heavy menstrual bleeding and urinary frequency. What questions are important to ask her?Case 1: Mary, a 40 year old comes to see the GP complaining of heavy menstrual bleeding and urinary frequency. History of presenting complaint Menstrual History: last menstrual period, duration, regularity, flow,any clots/flooding, menarche Other symptoms: inter-menstrual bleeding, post-coital bleeding, abnormal discharge, dyspareunia, vulval itching/skin changes, abdominal pain, dysmenorrhoea, bowel/urinary changes Urinary symptoms: frequency, urgency, nocturia, dysuria, haematuria Contraceptive history: contraceptive use, plans for pregnancy Gynae and obstetric history: up to date with smears, gynae disorders Malignancy symptoms: weight loss, anorexia, night sweats, fevers, abdominal bloating Bleeding issues: easy bruising, bleeding disorders Hypothyroidism symptoms: weightgain, dry hair/hair loss, tirednessCase 1: Mary, a 40 year old comes to see the GP complaining of heavy menstrual bleeding and urinary frequency. Menstrual cycles are still regular but have become longer 7/28 and heavier over past 4 months. Using more sanitary pads per day and passing clots. Started periods at 10 years old. Urinary frequency has lasted 2 months. No other symptoms observed. No other urinary symptoms. Doesn’t use contraception and isn’tplanning for any more children. Up to date with smears and no gynae issues in the past. No malignancy or other bleeding symptoms. Patient is of African-Caribbean background and has a BMI >35. What is the most likely diagnosis ? What are the risk factors for this condition?Case 1: Mary, a 40-year-old comes to see the GP complaining of heavy menstrual bleeding and urinary frequency. Menstrual cycles are still regular but have become longer 7/28 and heavier over past 4 months. Using more sanitary pads per day and passing clots. Started periods at 10 years old. Urinary frequency has lasted 2 months. No other symptoms observed. No other urinary symptoms. Doesn’t use contraception and isn’tplanning for any more children. Up to date with smears and no gynae issues in the past. No malignancy or other bleeding symptoms. Patient is of African-Caribbean background and has a BMI >30. What is the most likely diagnosis? Fibroids – Heavymenstrual bleeding, pressuresymptoms+/-abdodistention What arethe risk factorsfor this condition? st - Obesity,Early menarche,increasingage, Afro-Caribbean ethnicity,family history (1 degree relative)Fibroids - benignsmoothmuscle tumours of the uterus - develop in responseto oestrogen Examination: Abdominalexamination Bimanualexamination Finding:solidmassor enlarged uterus, non tender Investigations: Transvaginal/pelvicultrasound MRI (only ifsarcomasuspected)Case 1: Mary, a 40 year old comes to see the GP complaining of heavy menstrual bleeding and urinary frequency. Menstrual cycles are still regular but have become longer 7/28 and heavier over past 4 months. Using more sanitary pads per day and passing clots. Started periods at 10 years old. Urinary frequency has lasted 2 months. No other symptoms observed. No other urinary symptoms. Doesn’t use contraception and isn’tplanning for any more children. Up to date with smears and no gynae issues in the past. No malignancy or other bleeding symptoms. Patient is of African-Caribbean background and has a BMI >35. What managementwill you offer Mary?Case 1: Mary, a 40 year old comes to see the GP complaining of heavy menstrual bleeding and urinary frequency. Menstrual cycles are still regular but have become longer and heavier over past 4 months. Using more sanitary pads per day and passing clots. Started periods at 10 years old. Urinary frequency has lasted 2 months. No other symptoms observed. No other urinary symptoms. Doesn’t use contraception and isn’tplanning for any more children. Up to date with smears and no gynae issues in the past. No malignancy or other bleeding symptoms. Patient is of African-Caribbean background and has a BMI >35. What managementwill you offer Mary? Requirescontraception: Mirena IUS, COCP ,POP Doesnot require contraception: Tranexamicor mefenamicacid Referto secondary care as shehas compressivesymptomsSecondary care management: Medical - GnRH analogues Surgical - Myomectomy - hysteroscopicendometrial ablation - Uterine Artery Embolization(UAE)Case 2: Sandra, a 30 year old female presents with 6 months of severely painful periods which were not previously painful. Pain usually comes on 3 days before her period and nothing makes it better. Her periods are regular and light. She experiences deep dyspareunia and hasn’t been able to get pregnant even though she and her partner have been trying for 2 years. She gets painful and more frequent bowel movements around her period. What is her most likely diagnosis? 1. Pelvic inflammatory disease 2. Endometriosis 3. Fibroids 4. IBS 5. Ectopic pregnancyCase 2: Sandra, a 30 year old female presents with 6 months of severely painful periods which were previously not painful. Pain usually comes on 3 days before her period and nothing makes it better. Her periods are regular and light. She experiences deep dyspareunia and hasn’t been able to get pregnant even though she and her partner have been trying for 2 years. She gets painful and more frequent bowel movements around her period. What is her most likely diagnosis? 1. Pelvic inflammatory disease 2. Endometriosis 3. Fibroids 4. IBS 5. Ectopic pregnancyCase 2: Sandra, a 30 year old female presents with 6 months of severely painful periods which were previously not painful. Pain usually comes on 3 days before her period and nothing makes it better. Her periods are regular and light. She experiences deep dyspareunia and hasn’t been able to get pregnant even though she and her partner have been trying for 2 years. She gets painful and more frequent bowel movements around her period. What is endometriosis? 1. Endometrial tissue located in the pouch of douglas 2. Adhesions after surgery around the pelvic region 3. Endometrial tissue within the myometrium 4. Overgrowth of endometrial tissue in the uterusCase 2: Sandra, a 30 year old female presents with 6 months of severely painful periods which were previously not painful. Pain usually comes on 3 days before her period and nothing makes it better. Her periods are regular and light. She experiences deep dyspareunia and hasn’t been able to get pregnant even though she and her partner have been trying for 2 years. She gets painful and more frequent bowel movements around her period. What is endometriosis? 1. Endometrial tissue located in the pouch of douglas 2. Adhesions after surgery around the pelvic region 3. Endometrial tissue within the myometrium 4. Overgrowth of endometrial tissue in the uterusCase 2: Sandra, a 30 year old female presents with 6 months of severely painful periods which were previously not painful. Pain usually comes on 3 days before her period and nothing makes it better. Her periods are regular and light. She experiences deep dyspareunia and hasn’t been able to get pregnant even though she and her partner have been trying for 2 years. She gets painful and more frequent bowel movements around her period. What findings might there be on bimanual examination in a patient with endometriosis?Case 2: Sandra, a 30 year old female presents with 6 months of severely painful periods which were previously not painful. Pain usually comes on 3 days before her period and nothing makes it better. Her periods are regular and light. She experiences deep dyspareunia and hasn’t been able to get pregnant even though she and her partner have been trying for 2 years. She gets painful and more frequent bowel movements around her period. What findings might there be on bimanual examination in a patient with endometriosis? - Fixed, retroverteduterus - Uterosacral ligament nodules - General tendernessCase 2: Sandra, a 30 year old female presents with 6 months of severely painful periods which were previously not painful. Pain usually comes on 3 days before her period and nothing makes it better. Her periods are regular and light. She experiences deep dyspareunia and hasn’t been able to get pregnant even though she and her partner have been trying for 2 years. She gets painful and more frequent bowel movements around her period. What investigation is a gold standard for endometriosis? 1. Transvaginal ultrasound 2. No investigation necessary 3. Laparoscopy 4. Abdominal X-RayCase 2: Sandra, a 30 year old female presents with 6 months of severely painful periods which were previously not painful. Pain usually comes on 3 days before her period and nothing makes it better. Her periods are regular and light. She experiences deep dyspareunia and hasn’t been able to get pregnant even though she and her partner have been trying for 2 years. She gets painful and more frequent bowel movements around her period. What investigation is a gold standard for endometriosis? 1. Transvaginal ultrasound Findings: 2. No investigation necessary • Chocolate cysts • Adhesions 3. Laparoscopy • Peritoneal deposits 4. Abdominal X-RayManagementof Endometriosis: Asymptomatic– no treatment required Medical • Analgesia-paracetamoland NSAIDs • Supress ovulation- maycause atrophy of endometrialtissueand reduce symptoms • COCP • Norethisterone • LNG-IUS • Contraceptive injection • GnRH analogues-inducepseudomenopause Surgery – if affectingQOL andseveresymptoms • Excisionofectopicendometrialtissue • Laser ablation of ectopicendometrial tissue • Adhesiolysis Surgery is not a definitivetreatment asrelapsesoccurCase 3: Lola, a 23-year-old female comes to see her GP due to irregular menstrual cycles and difficulty losing weight. Her menstrual cycles have been irregular for the past few years ranging from 35-45 days. She has struggled with acne and unwanted facial hair growth on her upper lip and chin. Her self-esteem has been affected. The GP is suspecting a diagnosis of PCOS. What are the most common symptoms of PCOS ?Case 3: Lola, a 23-year-old female comes to see her GP due to irregular menstrual cycles and difficulty losing weight. Her menstrual cycles have been irregular for the past few years ranging from 35-45 days. She has struggled with acne and unwanted facial hair growth on her upper lip and chin. Her self-esteem has been affected. The GP is suspecting a diagnosis of PCOS. What are the most common signs and symptoms of PCOS? - Oligomenorrhoea or amenorrhoea - Infertility/subfertility - Hirsutism - Obesity - Acanthosis nigricansCase 3: Lola, a 23-year-old female comes to see her GP due to irregular menstrual cycles and difficulty losing weight. Her menstrual cycles have been irregular for the past few years ranging from 35-45 days. She has struggled with acne and unwanted facial hair growth on her upper lip and chin. Her self-esteem has been affected. The GP is suspecting a diagnosis of PCOS. What differential diagnoses would you consider?Case 3: Lola, a 23-year-old female comes to see her GP due to irregular menstrual cycles and difficulty losing weight. Her menstrual cycles have been irregular for the past few years ranging from 35-45 days. She has struggled with acne and unwanted facial hair growth on her upper lip and chin. Her self-esteem has been affected. The GP is suspecting a diagnosis of PCOS. What differential diagnoses would you consider? - Hypothyroidism – TSH - Hyperprolactinaemia – serum prolactin - Cushings disease – CortisolCase 3: Lola, a 23-year-old female comes to see her GP due to irregular menstrual cycles and difficulty losing weight. Her menstrual cycles have been irregular for the past few years ranging from 35-45 days. She has struggled with acne and unwanted facial hair growth on her upper lip and chin. Her self-esteem has been affected. The GP is suspecting a diagnosis of PCOS. What 3 criteria make up the Rotterdam Criteria for diagnosis of PCOS?Case 3: Lola, a 23-year-old female comes to see her GP due to irregular menstrual cycles and difficulty losing weight. Her menstrual cycles have been irregular for the past few years ranging from 35-45 days. She has struggled with acne and unwanted facial hair growth on her upper lip and chin. Her self-esteem has been affected. The GP is suspecting a diagnosis of PCOS. What 3 criteria make up the Rotterdam Criteria for diagnosis of PCOS? Testosterone- raised Sex binding globulin- low Trans-vaginal UltrasoundCase 3: Lola, a 23-year-old female comes to see her GP due to irregular menstrual cycles and difficulty losing weight. Her menstrual cycles have been irregular for the past few years ranging from 35-45 days. She has struggled with acne and unwanted facial hair growth on her upper lip and chin. Her self-esteem has been affected. The GP is suspecting a diagnosis of PCOS. Why is hormonal treatment (eg. with COCP)important in patients with PCOS? 1. Reduces risk of endometrial cancer 2. Reduces risk of ovarian cancer 3. Reduces risk of cardiovascular disease 4. Reduces risk of obesityCase 3: Lola, a 23-year-old female comes to see her GP due to irregular menstrual cycles and difficulty losing weight. Her menstrual cycles have been irregular for the past few years ranging from 35-45 days. She has struggled with acne and unwanted facial hair growth on her upper lip and chin. Her self-esteem has been affected. The GP is suspecting a diagnosis of PCOS. Why is hormonal treatment (eg. with COCP ,IUS) important in patients who are oligo/amenorrhoeic with PCOS? 1. Reduces risk of endometrial cancer 2. Reduces risk of ovarian cancer 3. Reduces risk of cardiovascular disease 4. Reduces risk of obesitySBA: Lily a 50 year old female comes in with symptoms of hot flushes, night sweats, mood changes and loss of libido. She thinks she is peri-menopausal. She is still having periods however less regularly. She wants to start HRT. Why would you prescribe combined HRT (oestrogens and progestrogen) to this patient and not unopposed oestrogen? 1. Reduce risk of stroke 2. Reduce risk of VTE 3. Reduce risk of endometrial cancer 4. Reduce risk of ovarian cancerSBA: Lily a 50-year-old female comes in with symptoms of hot flushes, night sweats, mood changes and loss of libido. She thinks she is peri-menopausal. She is still having periods however less regularly. She wants to start HRT. Why would you prescribe combined HRT (oestrogens and progestrogen) to this patient and not unopposed oestrogen? 1. Reduce risk of stroke 2. Reduce risk of VTE 3. Reduce risk of endometrial cancer 4. Reduce risk of ovarian cancerSBA: Lily a 50 year old female comes in with symptoms of hot flushes, night sweats, mood changes and loss of libido. She thinks she is peri-menopausal. She is still having periods however less regularly. She wants to start HRT. She wonders if she needs to stay on contraception while taking HRT. She has been having the depo-provera contraceptive injections for the past 3 years. What would you advise Lily? 1. She no longer requires contraception 2. She should stay on the depo-provera injections 3. She should be switched to another contraceptive method such as IUS, POPSBA: Lily a 50 year old female comes in with symptoms of hot flushes, night sweats, mood changes and loss of libido. She thinks she is peri-menopausal. She is still having periods however less regularly. She wants to start HRT. She wonders if she needs to stay on contraception while taking HRT. She has been having the depo-provera contraceptive injections for the past 3 years. What would you advise Lily? 1. She no longer requires contraception 2. She should stay on the depo-provera injections 3. She should be switched to another contraceptive method such as IUS, POP THANK YOU! Please take a minute to fill out this feedback form for us: