Approach to Patient With Amenorrhoea

 Gynaecology  Comments Off
Nov 162012
 

It is common in general practice that patients may come with amenorrhoea and it needs a proper diagnostic approach.

Primary Amenorrhoea

Defined as when a girl have never started menstruation and sexual characteristics have not developed by the age of 14 years OR no menstruation by age 16 years when growth and sexual development is normal.

Causes

1. Outflow Abnormalities: Mullerian agenesis, transverse vaginal septum, androgen insensitivity, imperforate hymen.

2. Ovarian Disorders: Gonadal dysgenesis due to chromosomal abnormalities e.g Turner’s syndrome

3. Pitutary Disorders:  Prolactinoma

4. Hypothalamic disorders: Kallman’s syndrome.

Secondary Amenorrhoea

Defined as absence of menses for more than 6 months in a previously menstruating woman.

Causes

1. Always consider the possibility of pregnancy.

2. Stress

3. Starvation , anorexia or excessive exercise.

4. Hypo/ Hyperthyroidism

5. Hyperprolactinaemia

6. Polycystic ovarian syndrome

7. Premature menopause.

History And Physical Examination.

Rule out the possibility of pregnancy.

Ask for: Continue reading »

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Introduction To Sexually Transmitted Infections

 General Medicine, Gynaecology  Comments Off
Sep 202012
 

Sexually transmitted infections refers to the mode of transmission of infection and the the reproductive tract infection refers to the site where the infection occurs. All Reproductive tract infections cannot be sexually transmitted infections.

The STI are spread through sexual contact with infected partners and the common examples include:

  • Gonorrhoea
  • Chylamydia
  • Syphilis
  • Trichomoniasis
  • Chancroid
  • Genital herpes
  • Genital warts caused by HPV

Risk factors

  • Age less than 25 years
  • Young age at first sex
  • Non barrier contraception method
  • New, multiple or symptomatic sexual partners.

Incidence

The incidence of STD’s is increasing by 10% every year where safe sex practices are being ignored. 448 million new cases of curable STD’s occur annually through out the world in persons aged 15 to 49 years.

Women at more risk

Women are physiologically more vulnerable than men. If they are asymptomatic they might not seek proper medical care and later it may lead to serious complications. Use of traditional vaginal medications and douching may also increase the risk for acquiring the STD’s in women.  With the exception of HIV all STD’s have more threatening consequences in women than in men. In women it usually leads to infertility, ectopic pregnancy and cervical cancer.

Clinical Presentation

Patient with a STI usually presents with one of theses symptoms:

  • Vaginal or urethral discharge.
  • Genital lesions
  • Genital warts
  • HIV
  • Infertility

History and Physical Examination

During the history and physical examination it is important to ask about the timing of last intercourse, contraceptive method used, number of sexual partners, duration of relationship, past STD”S, menstrual and medical history as well as any antimicrobial treatment taken by the patient. Continue reading »

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Brief Summary of Polycystic Ovarian Syndrome

 Gynaecology  Comments Off
Sep 032012
 

Polycystic ovary syndrome (PCOS) is one of the most common female endocrine disorders.These patients have a steady state of relatively high estrogen, androgen and LH levels rather than the fluctuating levels seen in ovulating women.

Definition

There are two definitions or diagnostic criteria that are commonly used:

In 1990 a consensus workshop sponsored by the NIH(National Institutes of Health)/NICHD(National Institute of Child Health and Human Disease) suggested that a patient has PCOS if she has all of the following:

  1. Oligoovulation
  2. Signs of androgen excess (clinical or biochemical)
  3. Other entities are excluded that can result in menstrual irregularity and hyperandrogenism.
In 2003 a consensus workshop sponsored by ESHRE(European Society for Human Reproduction and Embryology)/ASRM(American Society for Reproductive Medicine) in Rotterdam indicated PCOS to be present if any 2 out of 3 criteria are met.
  1. Oligoovulation and/or anovualation manifested as oligomenorrhea or amenorrhea
  2. Excess androgen activity (clinical or biochemical evidence)
  3. polycystic ovaries (as seen on gynecologic ultrasound)

Pathophysiology

Increased level of estrogen comes from obesity due to conversion of ovarian and adrenal androgen to estrone in body fat. High estrogen level suppresses FSH and causes relative increase in LH. Constant LH stimulation of ovary results in anovulation, multiple cysts and theca cell hyperplasia with excess androgen production.

Clinical Presentation

A patient with polycystic ovary syndrome presents with following clinical features:

  • Hirsutism (male pattern of hair growth).
  • Obesity
  • Virilization (development of male-like characteristics).
  • Amenorrhea  (no menstrual periods).
  • Abnormal uterine bleeding.
  • Insulin resistance and hyperinsulinemia with increased risk of type II diabetes.
  • Infertility (This generally results directly from lack of ovulation)
  • Increased risk of cancer of breast and endometrium due to unopposed estrogen production.  Continue reading »
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