Gynaecology
The Gynaecology domain tests structured assessment of abnormal bleeding, reproductive endocrinology, cervical screening, contraception, and gynaecological oncology. The exam favours classification systems and first-line management over rare syndromes.
Core rules
- Abnormal uterine bleeding is classified by FIGO PALM-COEIN: Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia; Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified.
- PCOS uses the Rotterdam criteria: two of oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology, after excluding thyroid disease, hyperprolactinaemia, and congenital adrenal hyperplasia.
- Cervical screening is HPV-based: a positive HPV 16/18 result warrants colposcopy; other high-risk HPV types are triaged by cytology.
- First-line treatment for heavy menstrual bleeding without structural cause is the levonorgestrel intrauterine system; tranexamic acid and NSAIDs are alternatives.
- Menopausal hormone therapy is the most effective treatment for vasomotor symptoms; use the lowest effective dose and add progestogen if the uterus is present.
Worked example
A 29-year-old with 9-day heavy periods, cycles every 45–60 days, BMI 34, and acne has AUB-O likely due to PCOS. Exclude pregnancy, check full blood count, TSH, prolactin, and pelvic ultrasound; do not diagnose PCOS from ultrasound alone because follicular count varies with age and equipment. Offer the levonorgestrel intrauterine system for bleeding control and endometrial protection, alongside weight and metabolic review. Endometrial biopsy is not routine at this age unless there is atypical bleeding or risk factors.
Traps
- Labelling all AUB as fibroids without excluding hyperplasia or malignancy.
- Diagnosing PCOS on ultrasound morphology alone.
- Using CA-125 to screen asymptomatic women.
- Missing coagulopathy in adolescents with heavy bleeding since menarche.