General Gynecology: Well-Woman Care and Benign Conditions
Core concepts
General gynecology spans preventive care and common benign pathology. Know cervical cancer screening and HPV vaccination recommendations, contraception counseling across age and risk groups, abnormal uterine bleeding classification (structural vs. nonstructural causes), fibroids, endometriosis, adenomyosis, ovarian cysts, pelvic inflammatory disease, and menopause management. Understand the evaluation of a pelvic mass, the approach to abnormal uterine bleeding by age, and when imaging or endometrial sampling is indicated.
Traps
- Abnormal uterine bleeding: in a postmenopausal patient, bleeding always warrants endometrial evaluation; in reproductive-age patients, pregnancy must be excluded first.
- Fibroids vs. adenomyosis: fibroids are discrete leiomyomas; adenomyosis is endometrial tissue within myometrium causing a bulky, tender uterus and heavy bleeding.
- Ovarian cysts: simple cysts in premenopausal patients are often physiologic; complex features (septations, solid components, ascites) raise concern.
- PID: treat empirically with broad coverage; consider inpatient therapy for pregnancy, tubo-ovarian abscess, or failure of outpatient therapy.
- Menopause hormone therapy: individualized, lowest effective dose, and not for primary prevention of chronic disease.
Worked example / rule of thumb
A 52-year-old with 6 months of heavy bleeding. Rule of thumb: any postmenopausal bleeding gets endometrial sampling, typically office biopsy or transvaginal ultrasound with biopsy if thickened; do not simply observe.
Study strategy
Organize benign gynecology by symptom (bleeding, pain, mass) and pair each with the first-line evaluation and the red-flag features.