Menopause before age of 40 is pathological menopause aka ovarian failure (primary or

secondary)

In the first 3 years of menopause, it is actually still quite common.

When all tests come back negative, with p/c of watery discharge w pink staining, beware of
faillopian tube cancer.

History related to Gynaecological Masses

 AUB
 New-onset dyspareunia
 Compressive symptoms
o Frequency
o Sensation of incomplete voiding
 LMP because of all swellings, the commonest is pregnancy

Physical Examination
 Lump + Sister Mary Joseph nodule in umbilicus
 Palpate laterally (when your hands cannot get further downwards because pubic rami
are blocking but you still have the mass between your hands  ‘cannot get below’)

Ddx
 Weight gain and obesity
 Visceral organomegaly
 Chronic bladder distension
 Ascites
 Intra-abdominal tumor or malignancy
 Pelvic tumour or malignancy
 Pregnancy in women of reproductive age
 Endocrinopathy such as Cushing’s

35 y/o woman
a) Diagnosis – fibroids
b) List 3 common symptoms associated – HMB, dysmenohrrhea,
c) 3 options of treatment – symptomatic vs curative
a. Symptomatic – treat flow + anemia
Epidemiology
 Fibroids commner amongst nulliparous women
 Risk increses w age and bmi
 Decreases with having a live-bron child and smoking
 Non-Mendelian inheritance
 Grows by 1cm/year – not a continuous steady increase rate. Rather, it is a stepwise
growth rate i.e. appears stable for a while
 Growth influenced by estrogen, progesterone and IGFs (because of IGF effect, fibroid
growth after menopause is not abnormal)

Ulipristal (Emsmya) is actually the 1st line

GnRH in books but should never use (SE)
The reason for symptomatic treatment is to buy time for menopause

Fibroid is the commonest cause for hysterectomy as myomectomy will not necessarily treat
p/c of HMB.

Name a possible nature of this pelvic lesion

- Ovarian tumour (benign vs malignant)
Epithelial ovarian cancers
1. Invasive
 2. Borderline (separate subtype)

Meig’s Syndrome (ovarian cancer + pleural effusion)

CA 125 – should be done only if a suspicious cyst is found (ONLY INDICATION)

Management
- Histologic confirmation of malignancy
- Accurate and complete staging
- Optimal cytoreductive surgery