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Ovarian enlargement: management
Premenopausal womena conservative approach may be taken for younger women (especially if < 35 years) as malignancy is less common. If the cyst is small (e.g. < 5 cm) and reported as 'simple' then it is highly likely to be benign. A repeat ultrasound should be arranged for 8-12 weeks and referral considered if it persists.
Postmenopausal womenby definition physiological cysts are unlikelyany postmenopausal woman with an ovarian cyst regardless of nature or size should be referred to gynaecology for assessmen
- asymptomatic in around 70% of women and 50% of menwomen:
- cervicitis (discharge, bleeding), dysuriamen: urethral discharge, dysuriaPotential
- epididymitispelvic inflammatory diseaseendometritisincreased incidence of ectopic pregnanciesinfertilityreactive arthritisperihepatitis (Fitz-Hugh-Curtis syndrome)
Hormone replacement therapy: adverse effects
Potential complicationsincreased risk of breast cancer: increased by the addition of a progestogenincreased risk of endometrial cancer: reduced by the addition of a progestogen but not eliminated completely. The BNF states that the additional risk is eliminated if a progestogen is given continuouslyincreased risk of venous thromboembolism: increased by the addition of a progestogenincreased risk of strokeincreased risk of ischaemic heart disease if taken more than 10 years after menopause
Hormone replacement therapy: indications
Indications vasomotor symptoms such as flushing, insomnia and headaches premature menopause: should be continued until the age of 50 years osteoporosis: but should only be used as second-line treatment
total blood loss > 80 ml per menses
Does not require contraception=mefenamic acid 500 mg tds or tranexamic acid 1 g tds.
Requires contraception= intrauterine system (Mirena) should be considered first-line. COCP long-acting progestogens
Norethisterone 5 mg tds can be used as a short-term option to rapidly stop heavy menstrual bleeding.
Endometrial cancer risks
obesity nulliparit yearly menarche late menopause unopposed oestrogen.
The addition of a progestogen to oestrogen reduces this risk (e.g. In HRT).
- The BNF states that the additional risk is eliminated if a progestogen is given continuously
- diabetes mellitus
- polycystic ovarian syndrome
painless vaginal bleeding occurring before 24 weeks, but typically occurs at 6 - 9 weeks cervical os is closed complicates up to 25% of all pregnancies
Missed (delayed) miscarriage
a gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsionmother may have light vaginal bleeding / discharge and the symptoms of pregnancy which disappearwhen the gestational sac is > 25 mm and no embryonic/fetal part can be seen it is sometimes described as a 'blighted ovum' or 'anembryonic pregnancy'
cervical os is openheavy bleeding with clots and pain