Handbook of Gynecology Management
Handbook of Gynecology Management
1 HORMONAL CONTRACEPTION AND STERILISATION, 1
The oral contraceptive pill, 1
Types of injectable contraception, 23
Intrauterine devices, 25
Barrier methods of contraception, 29
Sterilisation, 30
Vasectomy, 30
Stopping contraception, 32
Hormone replacement therapy and contraception, 32
The premenstrual syndrome, 32
2 EARLY PREGNANCY, 37
Diagnosing pregnancy, 37
Bleeding in early pregnancy (threatened miscarriage or missed miscarriage), 39
First trimester miscarriage, 39 Second trimester miscarriage, 50
Ectopic pregnancy, 56
Termination of pregnancy, 63
Gestational trophoblastic disease, 69
3 CERVICAL SCREENING AND PREMALIGNANT DISEASE OF THE CERVIX, 80
Prevention, 80
Screening for cervical cancer, 80
Diagnoses, 84
4 GYNAECOLOGICAL ENDOCRINOLOGY, 94
Polycystic ovary syndrome, 94
Hirsutism, 96
Ovulation induction in anovulatory women with PCOS, 100
Amenorrhoea, 101
Premature ovarian failure, 102
Anorexia nervosa, 104
Hyperprolactinaemia, 105
5 INFERTILITY AND ASSISTED REPRODUCTIVE TECHNIQUES, 118
Fecundity, 118
Treatment of male infertility, 130
Ovulation disorders and ovulation induction, 136
In vitro fertilisation, 146
Tubal surgery, 151
6 ULTRASOUND AND THE USE OF IMAGING IN GYNAECOLOGY, 155
Wendy Hadden Pelvic ultrasound, 155
Early pregnancy — first trimester ultrasound, 167
Uterine pathology, 173
Ultrasound assessment of the endometrium, 177
The adnexa — ovarian lesion, 188
Polycystic ovaries, 196
Adnexal abnormalities, 200
Fallopian tube pathology, 203
Pelvic pain, 204
Mimics of gynaecological disease, 206
Paediatric age group, 206
Fertility, 208
Cervical abnormalities, 209
Urogynaecological ultrasound, 210
Ultrasound and the diagnosis of breast disease, 211
Conclusion, 217
7 MENORRHAGIA, 221
Dysfunctional uterine bleeding, 223
Medical management of menorrhagia, 228
Surgical treatment for menorrhagia, 237
8 THE MENOPAUSE AND HORMONE REPLACEMENT THERAPY, 245
The menopause, 245
Effects of oestrogen deficiency, 247
History taking prior to commencing HRT, 249
Effects of oestrogens, 250
Types of oral oestrogen, 253
Non-oral administration of oestrogen, 255
Progestogens, 258
Oestrogen and progestogen regimens, 261
Side effects of HRT, 265
Endogenous ovarian activity and exogenous hormone treatment, 268
The theoretical benefits of HRT, 270
Osteoporosis, 271
Cardiovascular disease and oestrogen replacement therapy: mechanisms of protection, 278
HRT and the risk of breast cancer, 281
HRT and those with established breast cancer, 283
Oestrogen replacement therapy and venous thromboembolism, 283
Oestrogen replacement therapy and fatal colorectal cancer, 285
Dementia, 285
Androgen replacement, 286
Other effects of oestrogen, 286
Oestrogens and diet, 286
HRT and diabetes, 287
Hyperlipidaemia, 287
HRT and endometrial cancer, 288
Summary of use of HRT, 289
9 UROGYNAECOLOGY, 292
Rose Elder and Cornelius Kelleher Urinary incontinence, 292
History, 297
Quality of life, 299
Examination, 299
Investigations, 301
Genuine stress incontinence, 305
Detrusor instability, 313
Overflow incontinence/difficulty voiding, 316
10 SEXUAL HEALTH AND DISEASE, 321
Janet Say Sexual health, 321 Sexually transmitted infections, 324
Lower genital tract bacterial infections, 330
Upper genital tract bacterial sexually transmitted infections -pelvic inflammatory disease, 335
STIs and sexual assault, 338
Syphilis (Treponema pallidum), 338
Genital herpes — herpes simplex types 1 and 2, 339
Genital warts — human papillomavirus, 343
Hepatitides, 348
Human immunodeficiency virus (HIV 1 and 2), 348
Other conditions affecting the external genital area, 349
11 ENDOMETRIOSIS AND CHRONIC PELVIC PAIN, 355
Definition of endometriosis, 355
Symptoms of endometriosis and diagnosis, 356
Clinical findings, 357
Investigation, 358
Aims of management, 358
Visual features of endometriotic lesions at laparoscopy, 359
Classification of endometriosis, 362
Treatment, 362
Medical therapy for endometriosis, 363
Surgical treatment, 370
Pelvic pain — irritable bowel syndrome, 375
Bladder-related pain, 377
Musculoskeletal pain, 377
Nerve-related pain, 378
12 VULVAL DISEASE AND GYNAECOLOGICAL DERMATOLOGY, 380
Vulval disease, 380
Dermatological vulval conditions, 386
Topical steroids and vulval disease, 389
Creams and emollients, 391
Management of Bartholin’s swelling, 393
Extramammary Paget’s disease, 393
Squamous hyperplasia, 394
Vulval intraepithelial neoplasia, 394
Vulval carcinoma, 397
13 GYNAECOLOGICAL SURGERY, 402
Consent for surgery, 402
Operating theatre set-up, 402
Anatomical considerations in gynaecological surgery, 402
Principles of laparoscopic surgery, 408
Hysterectomy, 424
Vaginal hysterectomy, 425
Prophylactic oophorectomy, 426
Laparoscopic hysterectomy, 428
Laparoscopic oophorectomy, 429
Supracervical hysterectomy, 430
Genital prolapse, 431
Operating for gynaecological cancer, 443
14 GYNAECOLOGICAL ONCOLOGY, 452
Cervical malignancies, 452
Ovarian malignancies, 462
Fallopian tube malignancies, 475
Endometrial carcinomas, 475
Uterine sarcomas, 484
Vulval malignancies, 486
Vaginal malignancies, 494
The oral contraceptive pill, 1
Types of injectable contraception, 23
Intrauterine devices, 25
Barrier methods of contraception, 29
Sterilisation, 30
Vasectomy, 30
Stopping contraception, 32
Hormone replacement therapy and contraception, 32
The premenstrual syndrome, 32
2 EARLY PREGNANCY, 37
Diagnosing pregnancy, 37
Bleeding in early pregnancy (threatened miscarriage or missed miscarriage), 39
First trimester miscarriage, 39 Second trimester miscarriage, 50
Ectopic pregnancy, 56
Termination of pregnancy, 63
Gestational trophoblastic disease, 69
3 CERVICAL SCREENING AND PREMALIGNANT DISEASE OF THE CERVIX, 80
Prevention, 80
Screening for cervical cancer, 80
Diagnoses, 84
4 GYNAECOLOGICAL ENDOCRINOLOGY, 94
Polycystic ovary syndrome, 94
Hirsutism, 96
Ovulation induction in anovulatory women with PCOS, 100
Amenorrhoea, 101
Premature ovarian failure, 102
Anorexia nervosa, 104
Hyperprolactinaemia, 105
5 INFERTILITY AND ASSISTED REPRODUCTIVE TECHNIQUES, 118
Fecundity, 118
Treatment of male infertility, 130
Ovulation disorders and ovulation induction, 136
In vitro fertilisation, 146
Tubal surgery, 151
6 ULTRASOUND AND THE USE OF IMAGING IN GYNAECOLOGY, 155
Wendy Hadden Pelvic ultrasound, 155
Early pregnancy — first trimester ultrasound, 167
Uterine pathology, 173
Ultrasound assessment of the endometrium, 177
The adnexa — ovarian lesion, 188
Polycystic ovaries, 196
Adnexal abnormalities, 200
Fallopian tube pathology, 203
Pelvic pain, 204
Mimics of gynaecological disease, 206
Paediatric age group, 206
Fertility, 208
Cervical abnormalities, 209
Urogynaecological ultrasound, 210
Ultrasound and the diagnosis of breast disease, 211
Conclusion, 217
7 MENORRHAGIA, 221
Dysfunctional uterine bleeding, 223
Medical management of menorrhagia, 228
Surgical treatment for menorrhagia, 237
8 THE MENOPAUSE AND HORMONE REPLACEMENT THERAPY, 245
The menopause, 245
Effects of oestrogen deficiency, 247
History taking prior to commencing HRT, 249
Effects of oestrogens, 250
Types of oral oestrogen, 253
Non-oral administration of oestrogen, 255
Progestogens, 258
Oestrogen and progestogen regimens, 261
Side effects of HRT, 265
Endogenous ovarian activity and exogenous hormone treatment, 268
The theoretical benefits of HRT, 270
Osteoporosis, 271
Cardiovascular disease and oestrogen replacement therapy: mechanisms of protection, 278
HRT and the risk of breast cancer, 281
HRT and those with established breast cancer, 283
Oestrogen replacement therapy and venous thromboembolism, 283
Oestrogen replacement therapy and fatal colorectal cancer, 285
Dementia, 285
Androgen replacement, 286
Other effects of oestrogen, 286
Oestrogens and diet, 286
HRT and diabetes, 287
Hyperlipidaemia, 287
HRT and endometrial cancer, 288
Summary of use of HRT, 289
9 UROGYNAECOLOGY, 292
Rose Elder and Cornelius Kelleher Urinary incontinence, 292
History, 297
Quality of life, 299
Examination, 299
Investigations, 301
Genuine stress incontinence, 305
Detrusor instability, 313
Overflow incontinence/difficulty voiding, 316
10 SEXUAL HEALTH AND DISEASE, 321
Janet Say Sexual health, 321 Sexually transmitted infections, 324
Lower genital tract bacterial infections, 330
Upper genital tract bacterial sexually transmitted infections -pelvic inflammatory disease, 335
STIs and sexual assault, 338
Syphilis (Treponema pallidum), 338
Genital herpes — herpes simplex types 1 and 2, 339
Genital warts — human papillomavirus, 343
Hepatitides, 348
Human immunodeficiency virus (HIV 1 and 2), 348
Other conditions affecting the external genital area, 349
11 ENDOMETRIOSIS AND CHRONIC PELVIC PAIN, 355
Definition of endometriosis, 355
Symptoms of endometriosis and diagnosis, 356
Clinical findings, 357
Investigation, 358
Aims of management, 358
Visual features of endometriotic lesions at laparoscopy, 359
Classification of endometriosis, 362
Treatment, 362
Medical therapy for endometriosis, 363
Surgical treatment, 370
Pelvic pain — irritable bowel syndrome, 375
Bladder-related pain, 377
Musculoskeletal pain, 377
Nerve-related pain, 378
12 VULVAL DISEASE AND GYNAECOLOGICAL DERMATOLOGY, 380
Vulval disease, 380
Dermatological vulval conditions, 386
Topical steroids and vulval disease, 389
Creams and emollients, 391
Management of Bartholin’s swelling, 393
Extramammary Paget’s disease, 393
Squamous hyperplasia, 394
Vulval intraepithelial neoplasia, 394
Vulval carcinoma, 397
13 GYNAECOLOGICAL SURGERY, 402
Consent for surgery, 402
Operating theatre set-up, 402
Anatomical considerations in gynaecological surgery, 402
Principles of laparoscopic surgery, 408
Hysterectomy, 424
Vaginal hysterectomy, 425
Prophylactic oophorectomy, 426
Laparoscopic hysterectomy, 428
Laparoscopic oophorectomy, 429
Supracervical hysterectomy, 430
Genital prolapse, 431
Operating for gynaecological cancer, 443
14 GYNAECOLOGICAL ONCOLOGY, 452
Cervical malignancies, 452
Ovarian malignancies, 462
Fallopian tube malignancies, 475
Endometrial carcinomas, 475
Uterine sarcomas, 484
Vulval malignancies, 486
Vaginal malignancies, 494