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1. Gynaecology cases Rehan Salim MD MRCOG
2. Case 1 34 year old
No significant gynaecological problems
3 day history of pelvic pain
3. Case 1 Observations normal
4. Case 1 Ultrasound scan
No evidence of intrauterine or extrauterine pregnancy
BHCG 400, progesterone 29
5. Case 1 2 days later
Small amount of blood in pelvis
6. Case 1 Theatre
7. Case1 What is the effect on my fertility?
Risk of another ectopic pregnancy?
Why did it happen?
8. Case 2 54 year old
Fit and well
Single episode of fresh vaginal bleeding
9. Case 2 Speculum
10. Case 2
11. Case 2 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.
12. Case 2 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.
may progress to atypical hyperplasia in 10% and to carcinoma in 4% of cases
13. Case 2 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.
14. Case 3 21 years old
Infrequent periods, hirsute
Fit and well otherwise
15. Case 3
16. Case 3
17. Case 3
18. Case 3 Oligomenorrhoea
Endometrial hyperplasia/ cancer
19. Case 3 Weight loss
500md OD/BD/TDS ? 850mg BD