Gynaecology cases. Rehan Salim MD MRCOG Consultant Gynaecologist. Case 1. 34 year old Irregular periods No significant gynaecological problems 3 day history of pelvic pain. Case 1. Observations normal Urinalysis normal. Pregnancy test positive Ectopic pregnancy unless proven otherwise.
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Rehan Salim MD MRCOG
- 34 year old
- Irregular periods
- No significant gynaecological problems
- 3 day history of pelvic pain
- Observations normal
- Urinalysis normal
Pregnancy test positive
Ectopic pregnancy unless proven otherwise
- Ultrasound scan
- No evidence of intrauterine or extrauterine pregnancy
- BHCG 400, progesterone 29
- Called same day by EPU
- Come for a repeat bloods in 2 days
- 2 days later
- More pain
- Repeat scan
- Small amount of blood in pelvis
- Right ectopic
- HCG 755
- Uneventful recovery
- What is the effect on my fertility?
- Risk of another ectopic pregnancy?
- Why did it happen?
- 54 year old
- Fit and well
- Single episode of fresh vaginal bleeding
Up to 50% of patients with CAH have co-existent endometrial carcinoma detected at histology of subsequent hysterectomy
- Simple cystic hyperplasia without atypia
- progestagens such as norethisterone 5 mg bd for three out of four weeks.
- The treatment should last at least three months, then the biopsy should be repeated.
- In young women with polycystic ovaries, treatment with cyclical progestogens should continue or it can be replaced by long term combined oral contraceptive pill.
- In postmenopausal women the treatment may be stopped if the result of second biopsy is normal, but they should be advised to return if their symptoms recur.
- Adenomatous hyperplasia
- more likely to progress to cancer than cystic hyperplasia.
- However, the treatment is the same as in cystic hyperplasia.
- If abnormality persists after the therapy hysterectomy may be considered in older women.
- Complex hyperplasia
- may progress to atypical hyperplasia in 10% and to carcinoma in 4% of cases
- Atypical hyperplasia
- is believed to progress to cancer in up to 30% of cases depending on the degree of atypia.
- Severe atypia is often impossible to differentiate from cancer even on hysterectomy specimens.
- In postmenopausal women hysterectomy should be considered, whilst in young women treatment with oral progestagens or Mirena IUS are preferred options. All women managed conservatively should be followed up very closely.
- 21 years old
- Infrequent periods, hirsute
- BMI 34
- Fit and well otherwise
- Endometrial hyperplasia/ cancer
- Long term
- Weight loss
- Endometrial protection
- Incremental dose
- 500md OD/BD/TDS → 850mg BD
- Ovulation induction