Gynaecology: Bleeding, Pelvic Masses and Reproductive Endocrinology
Core concepts to master
Gynaecology questions test a systematic approach to abnormal uterine bleeding, pelvic pain and pelvic masses, anchored in age and reproductive status. Know the PALM-COEIN framework for abnormal uterine bleeding and the age-specific probability of endometrial pathology. Understand the investigation pathway for postmenopausal bleeding: transvaginal ultrasound endometrial thickness, when to biopsy, and the limitations of sampling. Be fluent in the presentation and management principles of fibroids, adenomyosis, endometriosis and ovarian masses, including risk-of-malignancy indices and the significance of simple versus complex cyst features. Reproductive endocrinology topics include polycystic ovary syndrome (Rotterdam criteria), primary and secondary amenorrhoea, premature ovarian insufficiency, and the physiology of the menstrual cycle. Contraception questions reward precise knowledge of failure rates, absolute contraindications and emergency options. Oncology basics - cervical screening, HPV, staging principles, and gestational trophoblastic disease follow-up - are commonly examined.
Traps in questions
The commonest error is ignoring age: a 55-year-old with irregular bleeding needs endometrial assessment, not reassurance. Distinguish symptoms of endometriosis from adenomyosis. Beware confusion between screening and diagnostic tests, and between absolute and relative contraindications. In ovarian mass questions, check menopausal status and whether features are simple or complex.
Worked example
A 58-year-old presents with a single episode of postmenopausal bleeding. Transvaginal ultrasound shows endometrial thickness of 12 mm. The rule of thumb: postmenopausal bleeding with endometrial thickness above 4 mm requires endometrial sampling, regardless of how minor the bleeding seemed; a single episode is never dismissed.