is contraindicated in myasthenia grav is
-Oxynbutin
as can exacerbate symptoms
gynaecology
, ADENOMYOSIS ATROPHIC VAGINITIS
Presence of endometrial tissue within myometrium Occurs in women who are post-menopausal women
Common in multiparous women towards end of reproductive years
Symptoms
Features • Vaginal dryness
• Dysmenorrhoea • Dyspareunia
• Menorrhagia • Occasional spotting post-costal bleeding
,
• Enlarged, boggy uterus • Vagina may appear pale and dry
Investigations Management
• Transvaginal US = 1ST LINE • Vaginal lubricants and moisturisers
• MRI is an alternative • Topical oestrogen cream can be used
• DEFINITIVE investigation - hysterectomy WITH histopathology
Most common cause
of bleeding in post-menopausal women
Management
• Tranexamic acid - manage menorrhagia
• GnRH agonists
• Uterine artery embolisation
• Hysterectomy
, AMENORRHOEA
Primary = failure to menstruate by 15 with normal secondary sexual characteristics, or by 13 with no secondary sexual characteristics
Rare complication of PPH leading to avascular
Secondary = cessation of menstruation for 3-6 months in women with normal menses, or 6-12 months in women with oligomenorrhoea
necrosis of the anterior pituitary gland
Symptoms
• Reduced lactation - low prolactin
secondary hypogonadism- anosmia • Amenorrhoea - low LH and FSH
• Adrenal crisis - low cortisol and ACTH
↓FSH o estrogen
Kallman
syndrome
Initial investigations
LH
=
, , • Hypothyrodisim
? (failure to Secrete GnRH) Management
Risk
developing
• Exclude pregnancy with urinary or serum b-hCG of Osteoporosis • Oestrogen and progesteron HRT
• Hydrocortisone
↑ • Levothyroxine
• FBC, U&E, coeliac screen, TFTs > LHd , FSHL, ostradiot
- Primary hypogonadism - • Growth hormone
L
Constitutional delay
• Gonadotrophins
·
(late has characteristics)
bloomer , and
Adhesions form within the uterus, following
• Prolactin damage to the uterus
FSHMH
Usually occurs after pregnancy-related
estrogent
webbed
• Androgen levels esspidaatie
·
,
procedures
• Curettage for retained products of
conception
↑ FSH/LH L oestrogen
• Oestradiol value , • Uterine surgery (myomectomy)
• Pelvic infection (endometriosis)
Symptoms
• Secondary amenorrhea
7 • Lighter periods, dysmenorrhoea
Management • Infertility
Management
• Investigate and treat any underlying cause
S
• GOLD STANDARD = hysteroscopy
Cyclicalabdominalclassic
-
• Hormone replacement therapy ↳ normal FSH & LH blueish bulging membrane
-
-
Women < 40 , period Cessation ,
2
,
FSH
measurements > 25 IV/
↳
↳
complications =
peritonitis, endometriosis management =
HRT 4 weeks apart
ANDROGEN INSENSITIVITY SYNDROME
X-linked recessive condition caused by mutations, genotypically male (46XY) - confirmed through karyotype or chromosomal analysis
Complete AIS
Partial AIS
• Normal female external genitalia
• Variable external genitalia
• Short, blind-ending vagina, absent uterus and fallopian tubes
• Reduced but not absent pubic/axillary hair
• Little or no axillary and pubic hair, breast development at puberty • Variable breast development
• Inguinal/abdominal testes, elevated testosterone • Infertility is typical
• Testes often undescended or ectopic
Management
• In CAIS, usually raised as female
• In PAIS, sex assignment requires careful specialist input
• Bilateral orchidectomy is recommended
• Oestrogen therapy after orchidectomy
• Surgical correction may be required in PAIS
-Oxynbutin
as can exacerbate symptoms
gynaecology
, ADENOMYOSIS ATROPHIC VAGINITIS
Presence of endometrial tissue within myometrium Occurs in women who are post-menopausal women
Common in multiparous women towards end of reproductive years
Symptoms
Features • Vaginal dryness
• Dysmenorrhoea • Dyspareunia
• Menorrhagia • Occasional spotting post-costal bleeding
,
• Enlarged, boggy uterus • Vagina may appear pale and dry
Investigations Management
• Transvaginal US = 1ST LINE • Vaginal lubricants and moisturisers
• MRI is an alternative • Topical oestrogen cream can be used
• DEFINITIVE investigation - hysterectomy WITH histopathology
Most common cause
of bleeding in post-menopausal women
Management
• Tranexamic acid - manage menorrhagia
• GnRH agonists
• Uterine artery embolisation
• Hysterectomy
, AMENORRHOEA
Primary = failure to menstruate by 15 with normal secondary sexual characteristics, or by 13 with no secondary sexual characteristics
Rare complication of PPH leading to avascular
Secondary = cessation of menstruation for 3-6 months in women with normal menses, or 6-12 months in women with oligomenorrhoea
necrosis of the anterior pituitary gland
Symptoms
• Reduced lactation - low prolactin
secondary hypogonadism- anosmia • Amenorrhoea - low LH and FSH
• Adrenal crisis - low cortisol and ACTH
↓FSH o estrogen
Kallman
syndrome
Initial investigations
LH
=
, , • Hypothyrodisim
? (failure to Secrete GnRH) Management
Risk
developing
• Exclude pregnancy with urinary or serum b-hCG of Osteoporosis • Oestrogen and progesteron HRT
• Hydrocortisone
↑ • Levothyroxine
• FBC, U&E, coeliac screen, TFTs > LHd , FSHL, ostradiot
- Primary hypogonadism - • Growth hormone
L
Constitutional delay
• Gonadotrophins
·
(late has characteristics)
bloomer , and
Adhesions form within the uterus, following
• Prolactin damage to the uterus
FSHMH
Usually occurs after pregnancy-related
estrogent
webbed
• Androgen levels esspidaatie
·
,
procedures
• Curettage for retained products of
conception
↑ FSH/LH L oestrogen
• Oestradiol value , • Uterine surgery (myomectomy)
• Pelvic infection (endometriosis)
Symptoms
• Secondary amenorrhea
7 • Lighter periods, dysmenorrhoea
Management • Infertility
Management
• Investigate and treat any underlying cause
S
• GOLD STANDARD = hysteroscopy
Cyclicalabdominalclassic
-
• Hormone replacement therapy ↳ normal FSH & LH blueish bulging membrane
-
-
Women < 40 , period Cessation ,
2
,
FSH
measurements > 25 IV/
↳
↳
complications =
peritonitis, endometriosis management =
HRT 4 weeks apart
ANDROGEN INSENSITIVITY SYNDROME
X-linked recessive condition caused by mutations, genotypically male (46XY) - confirmed through karyotype or chromosomal analysis
Complete AIS
Partial AIS
• Normal female external genitalia
• Variable external genitalia
• Short, blind-ending vagina, absent uterus and fallopian tubes
• Reduced but not absent pubic/axillary hair
• Little or no axillary and pubic hair, breast development at puberty • Variable breast development
• Inguinal/abdominal testes, elevated testosterone • Infertility is typical
• Testes often undescended or ectopic
Management
• In CAIS, usually raised as female
• In PAIS, sex assignment requires careful specialist input
• Bilateral orchidectomy is recommended
• Oestrogen therapy after orchidectomy
• Surgical correction may be required in PAIS
