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EFOG-EBCOG Part 1 study materials
EFOG-EBCOG Part 1 study resources

EFOG-EBCOG Part 1: Gynaecology

EFOG-EBCOG Part 1 · Work through your exam, one topic at a time.

All guide sections

Gynaecology

Domain overview

The Gynaecology domain tests reproductive endocrinology, benign and malignant disease, emergency gynaecology, contraception and menopause. The exam favours structured classifications and safety-critical decisions: ectopic pregnancy, ovarian torsion, abnormal uterine bleeding, PCOS and endometrial cancer.

Core rules

  • Abnormal uterine bleeding: use PALM-COEIN. Palpable structural causes: polyp, adenomyosis, leiomyoma, malignancy/hyperplasia. Non-structural: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified. First-line tests: pregnancy test, full blood count and pelvic ultrasound; endometrial biopsy if >45 years or risk factors for hyperplasia.
  • Ectopic pregnancy: amenorrhoea, pain and bleeding. Transvaginal ultrasound plus serum hCG. If hCG is above the discriminatory zone (usually 1,500–3,500 IU/L) and no intrauterine pregnancy is seen, ectopic is likely. Expectant management only for low, falling hCG; methotrexate for stable, unruptured cases with hCG <5,000 IU/L and mass <4 cm; surgery if ruptured or unstable. Give anti-D if Rh-negative.
  • PCOS: Rotterdam criteria require two of oligo/anovulation, clinical/biochemical hyperandrogenism, and polycystic ovaries on ultrasound; exclude thyroid, prolactin and adrenal causes. Letrozole is first-line for ovulation induction.
  • Ovarian torsion: sudden unilateral pain with nausea; normal Doppler does not exclude it. Urgent laparoscopy with detorsion and ovarian preservation.
  • Postmenopausal bleeding: endometrial thickness >4 mm on transvaginal ultrasound warrants endometrial biopsy.

Worked example

A 28-year-old with 7 weeks' amenorrhoea, left iliac fossa pain and hCG 2,500 IU/L has an empty uterus and a 3-cm left adnexal mass on TVS; she is haemodynamically stable. The diagnosis is tubal ectopic pregnancy. She is within the methotrexate criteria (hCG <5,000, mass <4 cm, no fetal cardiac activity, stable), but laparoscopic salpingectomy is also valid and preferred if she has significant pain or wants definitive treatment. Reasoning: the hCG is above the discriminatory zone and no intrauterine pregnancy is visible; stability determines methotrexate versus surgery.

Traps

  • Do not exclude torsion because Doppler flow is present; do not use a single hCG to diagnose ectopic without ultrasound; do not forget anti-D in Rh-negative ectopic pregnancy; do not diagnose PCOS on ultrasound alone; do not use endometrial thickness <4 mm to exclude cancer in symptomatic women.