OSCE Gynae HX

OSCE Gynae Hx

Causes bleeding in non-

1. Introduction + Consent pregnant woman:
2. Name and Age of Patient
General: thyroid dis, hepatic
3. History Presenting Complaint – Elicit patients ICE
disorders, leukaemia,
Duration, Associating sx’s, Alleviating factors etc
myeloproliferative,
thrombocytopaenia,
4. Gynae History
coagulopathies.
a) Periods – Age of Menarche, LMP, regularity, duration. If
Local: Vaginitis, Fibroids,
menorrhagia, clots? Flood?
polyps, adenomyosis,
b) Enquire re: Irregular Bleed & Post-Coital endometriosis, infection
(Chlamydia, gonnorhoea)
c) Establish if MENOPAUSAL. If so for how long and if tumours (ovarian, endometrial,
experienced any post-menopausal bleeding. cervical) foreign body, trauma.
Other: Dysfunctional uterine

d) PAIN. Dysmenorrhoea. Particularly timing in cycle,
bleeding DUB, trauma (abuse)
location of pain, severity, QoL, duration, associated sx;s.
5. Associated history
a) Sexual Hx – Is she sexually active? Suffering any dyspareunia? Superficial or Deep?
Regular Partner?
b) Discharge – Colour, clear white, purulent, bloodstained, Any pruritus? Partner

sxmatic?
c) Gynae Hx – Date and results of last SMEAR test, any previous abnormal results if
so what was done?
d) Is patient using contraceptive? Method?
e) Obstetric Hx – Ever pregnant? How many times? What gestations? Any TOP?
Stillbirths? Miscarriages?
f) Medical Hx – Previous surgery or serious illness? Diabetes? – Causes Post-menopausal

RF for endomet ca bleeding PMB:
g) Family Hx – Any hx or breast or ovarian CA? Enquire about 90% Atrophic Vaginitis
AGES of dx.
Infections – Chlamydia,
h) Drug Hx – taking any regular meds? (Tamoxifen, OCP, HRT) tricho TV, gonorrhoea
Allergies? Anatomical – Polyps
(cervical or endometrial),
i) Social Hx – drink or smoke? endometrial, cervical,
ovarian, vaginal carcinoma,
j) Systematic Review – Any constitutional sx’s such as weight uterine sarcoma
loss? Loss of appetite? Increased fatigue? Sweating? Hot
Flushes? Abdo Pain? Urinary sx’s? Freq, nocturia? Prolapse? Other – Hormone
replacement therapy HRT,
clotting disorder, trauma.
7. SUMMARISE AND CLOSE
Causes of intermenstrual bleeding ICB:
Physiological: 1-2% women spot around ovulation

Obstetric: Pregnancy, Ectopic, Gestational trophoblastic disease
Uterine: Endometrial polyps, carcinoma, adenomyosis, fibroids,
Vaginal: Vaginitis, vaginal malignancy
Cervical: Cervical carcinoma, (commonly PCB), cervical polyps, ectropion, cervicitis, polyp
Iatrogenic: Contraceptive pills, Tamoxifen, Anticooagulants, SSRI’s, corticosteroids
_______________________________________________________________________________________________________________
Causes of Post-coital bleeding PCB:
Cervicitis, cervical and endometrial polyps, vaginal cancer, cervical cancer,
infections ( Chlamydia, gonorrhoea, trichomaniasis, yeast), trauma
RF’s for Endometrial Carcinoma:
E - Elderly
N – Nulliparity
D - Diabetes
O - Obesity
M – Menstrual Irregularity
E – Estrogen therapy
T – HyperTension
Causes of Amenorrhoea:
Primary Absence of menses by 14yrs with lack of secondary 2 sexual

characteristics or by 16 with normal 2 sexual characs.
Familial Constitutional Delay
Structural Imperforate hymen, haematocolpos
Genetic Turner syndrome, Prader-Willi syndrome
Congenital Testicular feminisation
Organic Hypo/Hyperthyroidism, Adrenal tumours / hyperplasia, PCOS
Other Anorexia, Pyschological, Athletics, Drugs (OCP)
Secondary Cessation menstruation with no periods > 6 months.

Hypothalamic Hypogonadism (Kallmann’s syndrome), Anorexia nervosa
Pituitary Hyperprolactinaemia (pituitary hyperplasia, adenoma), Sheehan’s syndrome
Ovary Premature menopause, PCOS, Ovarian dysgenesis (Turner’s)
Other Thyroid, Adrenal (hyperplasia, Cushings, advanced Addison’s), pancreas (DM)
Menorrhagia: “Loss of blood >80ml blood per cycle”
Often used to describe blood loss that lasts longer than 7 days. Enquire about symptoms
of anaemia. In around 60% no cause can be found and = DUB.
Structural Fibroids, Endometriosis, Adenomyosis, Cervical and endometrial polyps,

Endometrial carcinoma
Infection Pelvic Inflamm Dis, STI’s
Drugs Aspirin, Warfarin, Chemotherapy
Systemic Hypothyroidism, Clotting disorders (von Wilebrands)
Other IUCD, Sterilisation
Dysmenorrhoea: Affects 50% menstruating women

Incidence is greatests in women in late teens and early twenties.
Primary dysmenorrhoea = Painful periods in healthy women NO PATHOLOGY
Secondary dysmenorrhoea = Pain due to dis s.as PID, endometriosis, adenomyosis,
fibroids, adhesions.
Superficial Dysparaeunia Pain felt in introitus
Psychological Fear, Vaginismus
Infection Candidiasis, Chlamydia, Trichomonas, UTI
Atrophy Post-menopause (oestrogen deficient), Infrequent intercourse
Organic Vaginal cancer, rectal cancer, endometriosis
Deep dyspareunia
PID, Cervicitis, Endometriosis, Adenomyosis.

OSCE Gynae HX

Uploaded by

Copyright:

Available Formats

OSCE Gynae HX

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

OSCE Gynae HX

Uploaded by

Copyright:

Available Formats

What are some common causes of abnormal uterine bleeding?

What are some common causes of abnormal uterine bleeding?

What are some common causes of dysmenorrhoea?

What are some common causes of dysmenorrhoea?

OSCE Gynae Hx

Causes bleeding in non-

Other: Dysfunctional uterine

b) Discharge – Colour, clear white, purulent, bloodstained, Any pruritus? Partner

d) Is patient using contraceptive? Method?

f) Medical Hx – Previous surgery or serious illness? Diabetes? – Causes Post-menopausal

Physiological: 1-2% women spot around ovulation

RF’s for Endometrial Carcinoma:

Primary Absence of menses by 14yrs with lack of secondary 2 sexual

Secondary Cessation menstruation with no periods > 6 months.

Structural Fibroids, Endometriosis, Adenomyosis, Cervical and endometrial polyps,

Infection Pelvic Inflamm Dis, STI’s

Drugs Aspirin, Warfarin, Chemotherapy

Systemic Hypothyroidism, Clotting disorders (von Wilebrands)

Other IUCD, Sterilisation

Dysmenorrhoea: Affects 50% menstruating women

Superficial Dysparaeunia Pain felt in introitus

Psychological Fear, Vaginismus

Infection Candidiasis, Chlamydia, Trichomonas, UTI

Atrophy Post-menopause (oestrogen deficient), Infrequent intercourse

Organic Vaginal cancer, rectal cancer, endometriosis

PID, Cervicitis, Endometriosis, Adenomyosis.

You might also like