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7 results

  • Chapter 6 - Paediatric and Adolescent Gynaecology

  • from Section 2 - Menstrual Disorders
  • Edited by Tahir Mahmood, Charles Savona-Ventura, Ioannis Messinis, Sambit Mukhopadhyay
  • Book:
    The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
    Published online:
    24 November 2021
    Print publication:
    02 December 2021, pp 47-54

  • Summary

    Children and adolescents presenting with common and rare gynaecological conditions are described in this chapter. Communication needs to be sensitive and appropriate for age and development to retrieve as much information as possible.

    Puberty heralds the development of secondary sexual characteristics, gonadal maturation, and start of reproductive capacity. Pubertal disorders can be divided into precocious and delayed puberty. Menarche is an important marker of puberty and menstruation should be seen as a vital sign. Oligomenorrhoea is pathological over time and most girls with oligomenorrhoea develop polycystic ovary syndrome (PCOS).

    Sex development in the human is the result of a complex interaction involving production and response to sex hormones which is regulated by genetic and environmental factors. Disorders of sex development occur when an individual’s sex development takes a different path.

  • Chapter 19 - Premature Ovarian Insufficiency

  • from Section 3 - Reproductive Endocrinology and Infertility
  • Edited by Tahir Mahmood, Charles Savona-Ventura, Ioannis Messinis, Sambit Mukhopadhyay
  • Book:
    The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
    Published online:
    24 November 2021
    Print publication:
    02 December 2021, pp 152-160

  • Summary

    Ovarian insufficiency is the inability of the ovary to function effectively in a woman under the age of 40 years. It is considered primary if it fails to respond to appropriate gonadotrophic stimulation and secondary when there is failure on the part of the hypothalamus and pituitary axis to produce appropriate gonadotrophic stimulation. There are various risk factors and associated diseases that can lead to ovarian insufficiency, leading to menstrual irregularities, anovulation, reproductive failure and premature menopause. When POI is suspected, diagnosis is confirmed by measuring serum hormone concentrations of FSH and oestradiol twice ≥1 month apart; levels indicate menopausal range, specifically FSH > 40 units/L and oestradiol < 50 pg/ml. Chromosomal analysis should be performed in all women with non-iatrogenic POI. Management includes counselling with appropriate information and use of appropriate terminology. Treatment is directed towards ovarian hormone replacement, restoration of fertility, and psychological wellbeing. There exists a variety of interventions to prevent iatrogenic ovarian insufficiency resulting from chemo- or radiotherapy.

  • 11 - Premature ovarian failure

  • Mary Ann Lumsden, University of Glasgow, Margaret Rees, University of Oxford
  • Book:
    Menstrual Problems for the MRCOG and Beyond
    Published online:
    05 June 2014
    Print publication:
    27 February 2014, pp 119-128

  • Summary

    The purpose of uterine cavity evaluation is to make an accurate diagnosis of the cause of abnormal uterine bleeding, in order that therapy can be appropriately tailored to the woman. This chapter reviews the accuracy and efficacy of currently available tests used to evaluate the uterine cavity. Uterine size can be assessed on bimanual examination; if the uterus is greater in size than 12 weeks of gestation, it may be palpable abdominally. Women with amenorrhoea (no menstrual bleeding for 6 months) should have a full history and examination. Dilatation and curettage (D&C) used to be the method of choice for assessing the uterine cavity. Other methods for assessing the uterine cavity include hysteroscopy, ultrasound, Doppler ultrasound, and outpatient endometrial biopsy. Women presenting with postmenopausal bleeding require urgent referral for pelvic ultrasound and further testing, with endometrial biopsy and/or hysteroscopy undertaken depending on the initial ultrasound result.

  • 20 - Medicaltermination of pregnancy

  • Edited by Paula Briggs, Gabor Kovacs, Monash University, Victoria
  • Edited in consultation with John Guillebaud, University College London
  • Book:
    Contraception
    Published online:
    05 August 2013
    Print publication:
    11 July 2013, pp 181-191

  • Summary

    This chapter presents a case study of a 42 year old female (Alison), who suffered from heavy painful periods. Alison's situation is far from unusual for this age group, where the risk of relationship breakdown is high. It is apparent that Alison's first priority is a highly effective contraceptive method. However, she requires much more from her method: effective control of bleeding and dysmenorrhoea; restoration of menstrual predictability and/or amenorrhoea. A bimanual examination for Alison is undertaken to assess for uterine enlargement (fibroids, adenomyosis), uterine mobility and adnexal masses and/or tenderness. Alison was advised about how the levonorgestrel-releasing intrauterine system (LNG-IUS) works by profound endometrial glandular and stromal suppression, cervical mucus changes and a foreign body effect within the endometrium. Progestogen-only pills (POPs) would be an option for Alison if she has contraindications to taking oestrogens.

  • 17 - Assessment and treatment of chronic medical complications

  • from Part IV - Evidence-based care
  • Edited by Tony Jaffa
  • Brett McDermott, University of Queensland
  • Book:
    Eating Disorders in Children and Adolescents
    Published online:
    02 December 2009
    Print publication:
    14 December 2006, pp 212-224

  • Summary

    Patients with chronic medical complications associated with an eating disorder (ED) often elicit negative counter-transference from medical care providers. From a clinical standpoint, the primary area of the brain affected by EDs, especially with weight loss, is the hypothalamus, with important influence on the endocrine regulatory function. Amenorrhea related to decreased hypothalamic function is one of the most clinically relevant chronic medical complications of EDs. It is a diagnostic feature of anorexia nervosa (AN) and is associated with both infertility and low levels of sex steroids. The primary focus of treatment for adolescent patients with EDs who experience menstrual irregularities and amenorrhoea should be weight recovery and normalization of eating habits. Although chronic dysfunctional weight control habits practised by children and adolescents with EDs have recognized effects on all tissues, the primary foci with respect to chronic medical complications are the heart, brain, gonads and bones.

  • 3 - Substance use and abuse in women

    • By Clare Gerada, Hurley Clinic, Kennington Lane, London, UK, Kristy Johns, Alcohol and Other Drugs Service, Central Coast Health, NSW, Australia, Amanda Baker, Centre for Mental Health Studies, University of Newcastle, NSW, Australia, David Castle, Mental Health Research Institute and University of Melbourne, Parkville, Victoria, Australia
  • Edited by David Castle, University of Melbourne, Jayashri Kulkarni, Monash University, Victoria, Kathryn M. Abel
  • Foreword by Jill Goldstein
  • Book:
    Mood and Anxiety Disorders in Women
    Published online:
    13 August 2009
    Print publication:
    23 February 2006, pp 39-58

  • Summary

    This chapter describes how and why women may also be gaining ground on their male counterparts in the consumption of alcohol and illicit substances. Surveys of substance abuse and dependence in the general population fairly consistently show overall rates in females to be lower than those in males. Women with affective and anxiety disorders are more likely to present with alcohol or drug abuse/dependence than are women without such disorders. Antisocial personality disorder (APD) is another psychiatric condition strongly associated with substance abuse and dependence. The impact of substance abuse on reproductive fitness in women is evidenced by higher rates of amenorrhoea and anovulatory cycles. The high rate of treatment dropout for women with drug and alcohol problems is of great concern to clinicians and researchers as there is a powerful association between dropping out and negative outcome.