Department of Obstetrics and Gynaecology University of Hong Hong. Outline ... Many common gynaecological problems can be managed by GP ... – PowerPoint PPT presentation
relieved after childbirth but may recur after some years
30 Dysmenorrhoea
History
Physical examination
Is pelvic examination needed
Recommended in all cases except in teenagers who are not sexually active with typical primary dysmenorrhoea
31 Dysmenorrhoea
Investigations needed
Ultrasound pelvis if
clinical pelvic examination abnormal
symptoms suggestive of secondary dysmenorrhoea but PV not conclusive or not possible
Laparoscopy
seldom needed
32 Dysmenorrhoea role of laparoscopy
Subfertility
Chronic pelvic pain
Relieve the anxiety of patients
Treatment
endometriotic cyst
medical treatment fail
subfertility
33 Dysmenorrhoea
Medical treatment for dysmenorrhoea
Simple analgesics paracetamol NSAID
indicated for primary and secondary dysmenorrhoea without associated subfertility or ovarian cysts
Hormonal therapy as a second line when simple analgesia fails
34 Dysmenorrhoea
Hormonal therapy
Primary dysmenorrhoea
combined OC pills (low EE)
Endometriosis
progestogen only
combined OC pills (low EE)
35 Uterine fibroids
Common
25-30 of women over 35
Often asymtomatic
Incidentally detected on pelvic ultrasound
36 Uterine fibroids
When to refer
symptoms related to fibroids
size gt 12 weeks (palpable per abdomen)
pain
uncertain diagnosis ovarian cyst
subfertility recurrent miscarriage
37 Uterine fibroids
Symptoms related to fibroids
menorrhagia
irregular menstruation (only for submucosal fibroids)
urinary (frequency retention)
abdominal distention
38 Uterine fibroids
How to follow up asymptomatic fibroids
Ultrasound
Usually no needed
Check symptoms and uterine size clinically every 6 months or ask patient to return if symptomatic
39 Uterine fibroids treatment
Surgical treatment remains the mainstay
myomectomy (laparotomy laparoscopy hysterocopy)
hysterectomy
Medical treatment with GnRH analogue
shrink fibroids before surgery
buy time before menopause
Embolization inadequate evidence on effectiveness and safety
40 Uterine fibroids
Post-myomectomy follow up
fibroids can recur after myomectomy
advice for pregnancy
When
Caesarean delivery needed
41 Useful resources
References used for this presentation
HKCOG Guidelines on investigation of women with abnormal uterine bleeding under the age of 40 HKCOG Guidelines 5 May 2001
Pretence A Medical management of menorrhagia BMJ 19993191343-5
Pretence A Endometriosis BMJ 200132393-5
42 Useful resources
Websites
hhtp//www.bmj.com
hhtp//www.rcog.org.uk/guidelines
hhtp//www.hkcog.org.hk
43 Thanks toSchering (Hong Kong) Ltd.Subsidiary of Schering AG Germany
About PowerShow.com
PowerShow.com is a leading presentation/slideshow sharing website. Whether your application is business, how-to, education, medicine, school, church, sales, marketing, online training or just for fun, PowerShow.com is a great resource. And, best of all, most of its cool features are free and easy to use.
You can use PowerShow.com to find and download example online PowerPoint ppt presentations on just about any topic you can imagine so you can learn how to improve your own slides and presentations for free. Or use it to find and download high-quality how-to PowerPoint ppt presentations with illustrated or animated slides that will teach you how to do something new, also for free. Or use it to upload your own PowerPoint slides so you can share them with your teachers, class, students, bosses, employees, customers, potential investors or the world. Or use it to create really cool photo slideshows - with 2D and 3D transitions, animation, and your choice of music - that you can share with your Facebook friends or Google+ circles. That's all free as well!
For a small fee you can get the industry's best online privacy or publicly promote your presentations and slide shows with top rankings. But aside from that it's free. We'll even convert your presentations and slide shows into the universal Flash format with all their original multimedia glory, including animation, 2D and 3D transition effects, embedded music or other audio, or even video embedded in slides. All for free. Most of the presentations and slideshows on PowerShow.com are free to view, many are even free to download. (You can choose whether to allow people to download your original PowerPoint presentations and photo slideshows for a fee or free or not at all.) Check out PowerShow.com today - for FREE. There is truly something for everyone!