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Abnormal Bleeding In Gynae, Polycystic-Ovarian-Syndrome, PCOS is syndrome…

- - - - Amenorrhoea / oligomenorrhoea
      - Polycystic ovaries
        
        increased ovarian stroma
        
        8 or more subcapsular follicular cysts <10mm in diameter
      - clinical or biochemical hyperandrogenism
  - - - obese
    - - unopposed oestrogen
  - - - Amenorrhoea
        
        absence of menstruation >6months in absence of pregnancy in woman of fertile age
      - Oligomenorrhoea
        
        irregular periods at intervals of more than 35 days, with only 4-9 period a year
    - - high BP
      - hirsutism
      - alopecia
      - acne
  - - - Combine Oral Contraceptive Pill (COCP)
        
        to regulate menstruation
      - Metformin
        
        DM
      - Cyclical oral progesterone
        
        regulate withdrawal bleed
    - - weight reduction (diet +exercise)
    - - Laparoscopic ovarian drilling
    - - laser
      - shave
      - wax
      - cyproterone acetate (anti androgen contraceptive pill)
      - eflornithine cream (vaniqua)
  - - - TRO endometrial ca
    - - DM
    - - high
    - - High
    - - TRO pregnancy
    - - TRO hypothyroidism & hyperthyroidism + TRO hyperprolactinaemia
    - - String of pearls appearance
    - - High LH compared to FSH
- - - - TAUSS- large intramural and subserosal fibroids
      - TVUSS- submucous and small intramurals
    - - morphology
      - size
      - location
    - - detect submucosal fibroids and endometrial polyps
      - plan for subsequent hysteroscopic surgical treatment
      - surgical hysteroscopy can remove polyps, adhesions and submucosal fibroids
  - - - for HMB- ineffective in presence of submucosal fibroid or enlarged >12 weeks size
        
        tranexamic acid
        
        mefenamic acid
        
        COCP
      - GnRH agonist
        
        induce menopausal state, shut down ovarian oestradiol production
      - selective progesterone receptor modulator (SPRM)- kena ban dt liver toxicity
        
        ulipristal acetate
        
        reduce fibroid volume
        
        alleviate HMB symptoms
        
        does not induce menopausal state
    - - minimally invasive hysteroscopic surgery
      - myomectomy- remove fibroid uterine conservation
- - - - Raised tumour marker: Ca125 (TRO Endometrioma)
  - - - Over-the-counter pain relievers (NSAIDs) for mild pain: 1st line, mefenamic acid.
      - Prescription medications (e.g., opioids) for severe pain
      - Hormonal therapy to suppress menstruation and reduce pain
    - - Birth control pills
      - Progestin-only therapy
      - GnRH agonists to induce temporary menopause
      - Danazol to suppress estrogen production
    - - Laparoscopic excision of endometrial tissue
      - Hysterectomy (removal of the uterus) in severe cases
    - - In vitro fertilization (IVF) for those with infertility
  - - - 2)
      - 3)
      - 1)
      - 4)
    - - 3)
      - 4)
      - 2)
      - 1)
  - - - Family Hx
    - - Menstrual factor
        
        Early menarche
        
        Short Menstrual cycle
        
        Heavy and long Menstrual Flow
      - Reproductive Hx
        
        Nulliparity
        
        Late Pregnancy
      - Obesity
    - - Usage of OCP
      - Regular Menstrual Cycle
      - Breastfeeding