Obstetrics and Gynaecology
Prolapse, Genital Injuries and Menopause
Pelvic organ prolapse, perineal tears, obstetric fistula and menopause with HRT for MBBS, mapped to NMC codes OG26, OG31 and OG32.
MedNext Academy | 3 min read
Prolapse, Genital Injuries and Menopause
Pelvic organ prolapse, perineal tears, obstetric fistula and menopause with HRT for MBBS, mapped to NMC codes OG26, OG31 and OG32.
This chapter covers pelvic organ prolapse, genital tract injuries and the menopause. It explains the types and grading of prolapse and its management, the classification of perineal tears and obstetric fistula, and the physiology, symptoms and long-term consequences of menopause together with the benefits and risks of hormone replacement therapy.
High-yield: Prolapse, Genital Injuries and Menopause
- Pelvic organ prolapse is descent of the pelvic organs due to weakness of the supporting ligaments and pelvic floor.
- Cystocele is prolapse of the bladder, rectocele of the rectum, and uterine prolapse is descent of the uterus and cervix.
- Prolapse is graded by the POP-Q system, and the degree guides conservative or surgical management.
- Risk factors for prolapse include vaginal deliveries, chronically raised intra-abdominal pressure and oestrogen deficiency after menopause.
- Pelvic floor muscle exercises and a vaginal pessary are conservative options, with surgery for symptomatic or advanced prolapse.
- Genital tract injuries include perineal tears, which are graded from first to fourth degree by the tissues involved.
- A third-degree tear involves the anal sphincter and a fourth-degree tear extends into the rectal mucosa.
- An obstetric fistula is an abnormal communication, such as vesicovaginal, usually from prolonged obstructed labour.
- Menopause is the permanent cessation of menstruation, diagnosed after 12 consecutive months of amenorrhoea, at an average age around 50 years.
- Menopause results from ovarian follicular depletion, giving a low oestrogen and a high FSH.
- Menopausal symptoms include hot flushes, night sweats, vaginal dryness, mood changes and sleep disturbance.
- Long-term oestrogen deficiency raises the risk of osteoporosis and cardiovascular disease.
- Hormone replacement therapy relieves vasomotor symptoms; women with a uterus need combined oestrogen and progestogen to protect the endometrium.
- Hormone replacement therapy carries a small increased risk of breast cancer and venous thromboembolism, so it is individualised.
Prolapse and menopause essentials
- **Prolapse types:** Cystocele (bladder), rectocele (rectum), uterine prolapse. Graded by POP-Q.
- **Perineal tears:** Third degree involves anal sphincter; fourth extends into rectal mucosa.
- **Menopause:** 12 months of amenorrhoea; low oestrogen, high FSH; average around 50 years.
- **HRT:** Relieves vasomotor symptoms; add progestogen if uterus present; small breast cancer and VTE risk.
NMC competencies in this chapter
- **OG26.2:** Genital injuries, perineal tears and obstetric fistulae
- **OG31.1:** Pelvic organ prolapse: anatomy, classification and management
- **OG32.1:** Menopause: physiology, symptoms and health risks
- **OG32.2:** Hormone replacement therapy: indications, regimens, risks and alternatives
Frequently Asked Questions
How is pelvic organ prolapse graded?
By the POP-Q system, which quantifies the descent of the vaginal walls and cervix. The grade, along with symptoms, guides conservative or surgical management.
How are perineal tears classified?
From first to fourth degree. A third-degree tear involves the anal sphincter and a fourth-degree tear extends into the rectal mucosa, which affects repair and prognosis.
How is menopause diagnosed?
Clinically, after 12 consecutive months of amenorrhoea in a woman of appropriate age. Biochemically it shows a low oestrogen and a raised FSH from ovarian failure.
What are the risks of hormone replacement therapy?
It relieves menopausal symptoms but carries a small increased risk of breast cancer and venous thromboembolism, so it is individualised, and women with a uterus need added progestogen.
Continue reading
MBBSAll Obstetrics and Gynaecology chapters
Continue through the Obstetrics and Gynaecology chapter map.
Continue studying Obstetrics and Gynaecology
Explore clinician-written learning resources, structured revision and practice across the MedNext platform.
Open in the MedNext appSee plans