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A natural loss of the products of pregnancy. Miscarriage, also known as spontaneous abortion and pregnancy loss, is the natural death of an embryo or fetus before it is able to survive independently. Some use the cutoff of 20 weeks

Counselling. Lifestyle modification, e.g. weight optimisation, smoking cessation and regular sexual intercourse. Investigation of semen analysis and prolactin level. Mid-luteal (day 21) progesterone assay. > 30 nmol/L suggests adequate ovulation. Laparoscopy and/or hysterosalpingography (Specialist supervision). MEDICINE TREATMENT Treat the underlying

Hirsutism refers to terminal hair growth in amounts that are socially undesirable, typically following a male pattern of distribution. Virilisation refers to the development of male secondary sexual characteristics in a woman. This condition requires referral to a tertiary hospital

Primary amenorrhoea: no menstruation by 14 years of age in the absence of secondary sexual characteristics; or failure to menstruate by 16 years of age. Secondary amenorrhoea: amenorrhoea for at least 3 months in women with previous normal menses Investigations

The presence and proliferation of endometrial tissue outside the uterine cavity, usually within the pelvis. It may manifest as dysmenorrhoea, dyspareunia and chronic pelvic pain. Diagnosis is made by laparoscopy. GENERAL MEASURES For women who wish to conceive, referral for

DESCRIPTION PID includes salpingitis with or without oöphoritis and, as precise clinical localisation is often difficult, denotes the spectrum of conditions resulting from infection of the upper genital tract. Sequelae include: »     recurrent infections if inadequately treated, »     

INTRODUCTION Surgical procedures as dictated by the diagnosis. Perform a transvaginal ultrasound and endometrial sampling in all women over 45 years of age. Actively exclude organic causes, e.g. fibroids, for abnormal uterine bleeding. MEDICINE TREATMENT Dysfunctional uterine bleeding implies that

Lower abdominal pain that starts with the onset of menstruation, and subsides after menses have ended. It may be primary or secondary. Secondary dysmenorrhoea is associated with chronic pelvic infection, fibroids, endometriosis and adenomyosis. GENERAL MEASURES For secondary dysmenorrhoea, investigate

WARTS abnormal elevated blemish on the skin; caused by a virus Superficial muco-cutaneous infection caused by the human papilloma virus. GENERAL MEASURES Cryotherapy. Check patients with anogenital warts for the presence of other STIs. MEDICINE TREATMENT Cutaneous warts Treatment seldom

The skin may be infected by yeasts or fungi and the clinical presentation varies with organism, body site infected and the body’s response to the infection. Most infections are due to anthropomorphic species that infect humans primarily. Yeasts such as

A transient itchy inflammatory skin and mucosal condition recognised by a wheal and flare reaction. There are many causes. In most chronic cases the precipitant for the urticaria is never found. Lesions due to insect bite are often grouped, show

This is an inflammatory condition of the skin and joints of unknown aetiology. Scaly red, itchy papules and plaques over extensor surfaces and in the scalp are common. The nails and skin folds are often involved. In exceptional cases, it

A chronic relapsing disorder of the lower limbs, which usually occurs in middle-aged women. It has many causes and is often associated with lipodermatosclerosis (bound-down, fibrosed skin) and eczema. It is mainly associated with vascular, predominantly venous insufficiency and immobility.

Erythema multiforme An acute, self-limiting and commonly recurrent inflammatory skin eruption with variable involvement of the mucous membranes and without systemic symptoms. Symmetrically distributed crops of target lesions (dark centre, an inner, pale ring surrounded by an outer red ring) often