General Gynecology and Benign Disease
Core concepts
Benign gynaecology questions test a structured approach to abnormal uterine bleeding, pelvic pain, and pelvic masses. Know the PALM-COEIN classification of abnormal uterine bleeding, the investigation pathway (history, examination, pelvic ultrasound, endometrial sampling when indicated), and the management options for fibroids, adenomyosis, endometriosis, ovarian cysts, and pelvic inflammatory disease.
Endometriosis and adenomyosis require an understanding of symptoms, imaging, and the role of laparoscopy. Pelvic inflammatory disease is a clinical diagnosis; know the criteria, the antibiotic regimens, and the indications for admission. Ovarian torsion and ectopic pregnancy are surgical emergencies that must be recognised early. Understand the risk of malignancy indices used to triage adnexal masses.
Traps
- Treating abnormal uterine bleeding in a postmenopausal woman without endometrial sampling.
- Assuming a normal ultrasound excludes endometriosis.
- Missing the diagnosis of pelvic inflammatory disease because of mild symptoms.
- Forgetting that fibroids can cause both heavy bleeding and pressure symptoms, and that treatment depends on fertility wishes.
Worked rule of thumb
For abnormal uterine bleeding, use the PALM-COEIN framework: structural causes (polyp, adenomyosis, leiomyoma, malignancy) versus non-structural (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified). The first branch determines whether imaging or medical therapy is the next step. In a postmenopausal woman, always sample the endometrium before concluding the cause is benign.
Exam technique
Present the differential in a structured way, then justify the investigation and the management with reference to fertility and age.