Obs and gynae

• Polycystic Ovary Syndrome (PCOS)


  Symptoms: Irregular menstrual cycles, excess androgen levels leading to hirsutism (excessive hair growth), acne, weight gain, and difficulty losing weight
• Thyroid Disorders (e.g., hypothyroidism, hyperthyroidism)


  Symptoms: Changes in weight, fatigue, hair loss, intolerance to cold or heat, changes in bowel habits, changes in heart rate
• Pituitary Disorders (e.g., prolactinoma)


  Symptoms: Galactorrhea (milky discharge from nipples), headaches, visual disturbances, other signs of hormonal imbalance
• Hypothalamic Dysfunction (e.g., stress, excessive exercise, weight loss)


  Symptoms: Rapid weight loss or gain, excessive exercise, emotional stress, changes in appetite
• Premature Ovarian Failure (POF)


  Symptoms: Hot flashes, night sweats, vaginal dryness, irritability, difficulty concentrating, infertility
• Hyperprolactinemia


  Symptoms: Galactorrhea, headaches, visual disturbances, infertility
• Ovarian Tumors (e.g., granulosa cell tumor)


  Symptoms: Abdominal or pelvic pain, bloating, changes in urinary habits, feeling full quickly while eating
• Asherman's Syndrome (intrauterine adhesions)


  Symptoms: Previous history of uterine surgery (e.g., dilation and curettage), infertility, recurrent pregnancy loss, menstrual abnormalities
• Medications (e.g., certain antidepressants, antipsychotics, chemotherapy drugs)


  Symptoms: Known side effects of the specific medication, such as hormonal imbalance or disruption of the menstrual cycle
• Chronic Illnesses (e.g., diabetes, autoimmune diseases)


  Symptoms: Symptoms related to the specific chronic illness, such as fatigue, changes in appetite, and changes in weight
• Cushing's Syndrome (excess cortisol)


  Symptoms: Weight gain, particularly in the abdomen and face (moon face), easy bruising, muscle weakness, thinning of the skin
• Turner Syndrome (genetic disorder affecting females)


  Symptoms: Short stature, webbed neck, broad chest, heart defects, infertility, lack of puberty development
• Mastitis


  Inflammation of the breast
• Mastitis


  • Associated with breastfeeding
  • Milk stasis can cause an inflammatory response
  • May then get secondary infection, most commonly with staphylococcus aureus
• Mastitis


  Classified into non-infectious and infectious
• Infectious mastitis


  Could be related to trauma
• Non-lactating mastitis


  Can mimic breast cancer or breast abscess
• Management of mastitis


  1. Advise continue breastfeeding, ensuring the breast is fully emptied

  2. If symptoms do not improve after 24 hours of milk removal, give Flucloxacillin for 10-14 days
• Ductal infection


  Pain is going to be severe
• Management of mastitis


  1. Advise continue breastfeeding, ensuring the breast is fully emptied

  2. If symptoms do not improve after 24 hours of milk removal, give Flucloxacillin for 10-14 days

  3. If no improvement in 48 hours or signs of sepsis, admit to hospital

  4. Also clean breast area to eliminate bacteria
• Breast abscess


  Localized collection of pus
• Lactational abscess


  Found in peripheral region
• Non-lactating abscess


  Found in central region
• Management of breast abscess


  Urgent referral to surgeon for aspiration/drainage and antibiotics e.g. flucloxacillin
• Mammary duct ectasia


  Dilation and shortening of the subareolar ducts, causing ducts to become blocked and the secretions to stagnate
• Mammary duct ectasia


  Classically arises around menopause in women (>50 years) who have multiple children
• Management of mammary duct ectasia


  Refer to gynaecology and advise to stop smoking. The condition is usually self-limiting
• Periductal mastitis


  Inflammatory condition of the subareolar ducts
• Periductal mastitis


  Unlike mammary duct ectasia, it tends to occur in younger women
• Fat necrosis


  Necrosis of breast fat, usually occurs following injury to the fatty breast tissue (e.g. by minor trauma or breast biopsy, radiotherapy or surgery)
• Management of fat necrosis


  No treatment is needed once the diagnosis is confirmed
• Fibrocystic change/fibroadenosis


  Development of fibrosis and cystic changes in the breast which causes many breast lumps
• Fibrocystic change/fibroadenosis


  • Most commonly occurs in women in their 40s (premenstrual)
  • HRT causes lumps due to oestrogen replacement
• Management of fibrocystic change/fibroadenosis


  1. No treatment needed

  2. Conservative: comfort (sport bra), limit coffee and stop taking HRT if it's the underlying cause, stop smoking
• Intraductal papilloma


  Growth of a benign wart-like lump that develops in large mammary ducts
• Intraductal papilloma


  Completely benign but the most common cause of bloody nipple discharge in women ages 20-40
• Management of intraductal papilloma


  Surgical excision if symptomatic
• Fibroadenoma


  Benign tumour that forms from a breast lobule and is composed of both fibrous and glandular tissue
• MENORRHAGIA Management:

  If underlying cause found, follow management for that condition, else:

  1st line is Mirena progesterone coil

  2nd line options:

  – Hormonal = COCP or cyclical oral progestogen

  – Non-hormonal = tranexamic acid or NSAID (mefenamic acid)

  – If menorrhagia persists, refer to gynaecology for further investigation, endometrial ablation or hysterectomy. 
• Fibroadenoma


  • Commonly seen in premenopausal women (<30 years), but there is no increase in the risk of malignancy
  • Occurs before menstruation (oestrogen sensitivity is high)
  • Simple: 1-3cm
  • Complex: some of the cells have different features when under microscope, can slightly increase the risk of breast cancer
  • Giant juvenile: more than 5cm and increases chances of breast cancer