Women's health
Women's health
This domain tests prevention, reproductive health and the recognition of time-critical presentations across the lifespan. Marks are lost by treating red flags as routine.
Core rules
- Cervical screening: HPV-based testing every five years from age 25 to 74 for people with a cervix; self-collection is an accepted pathway. Symptoms such as postcoital bleeding require examination and referral regardless of screening history.
- Breast screening: two-yearly mammography for women aged 50–74; any new lump, skin change or unilateral bloody discharge needs prompt triple assessment.
- Contraception: long-acting reversible methods are first-line for most women; exclude pregnancy before insertion; check blood pressure and migraine-with-aura history for combined hormonal contraception.
- Antenatal care: book in the first trimester; offer influenza vaccine in any trimester and dTpa in each pregnancy (typically 20–32 weeks); screen for gestational diabetes at 24–28 weeks with a 75 g oral glucose tolerance test; give anti-D to non-sensitised RhD-negative women at 28 and 34 weeks.
- Pre-eclampsia is hypertension after 20 weeks plus proteinuria or organ dysfunction; severe headache, visual disturbance or epigastric pain mandates same-day assessment.
Worked example
A 29-year-old, 7 weeks pregnant, presents with left iliac fossa pain and light vaginal spotting. Observations are normal; examination shows left adnexal tenderness.
Reasoning: pain plus bleeding in early pregnancy is an ectopic pregnancy until excluded. Arrange urgent transvaginal ultrasound with quantitative beta-hCG; if she is unstable or the scan is indeterminate with a plateauing hCG, refer immediately to an early pregnancy unit. Reassuring her that “spotting is common” is the wrong next step.
Traps that cost marks
- Attributing postcoital bleeding to cervicitis without examination.
- Reassuring early-pregnancy pain without excluding ectopic pregnancy.
- Forgetting contraception review in the postpartum or perimenopausal consultation.