Reproductive System
Cycle and hormones
Pulsatile GnRH drives FSH and LH; the LH surge triggers ovulation near day 14, and the corpus luteum produces progesterone for about 14 days. Estrogen produces midcycle ferning and proliferative endometrium; progesterone creates secretory endometrium and raises basal body temperature. Polycystic ovary syndrome: oligo-ovulation, hyperandrogenism, and polycystic ovaries; management includes weight loss, metformin, or combined oral contraceptives.
Pregnancy
Beta-hCG rises early. Suspect ectopic pregnancy with pain, bleeding, and no intrauterine sac; treat with methotrexate if stable and unruptured, and surgically if unstable. Preeclampsia: hypertension after 20 weeks with proteinuria or end-organ damage; severe features include platelets below 100,000, elevated transaminases, renal insufficiency, pulmonary edema, and visual symptoms. Magnesium prevents seizures; delivery is curative. HELLP is a hemolysis-elevated liver enzymes-low platelets variant. Placenta previa causes painless vaginal bleeding - avoid digital examination. Abruption causes painful bleeding with a tender, rigid uterus. Screen for gestational diabetes at 24–28 weeks.
Gynecology and oncology
Cervical cancer: HPV 16 and 18, squamous cell most common, prevented by vaccination and screening. Endometrial cancer: postmenopausal bleeding with unopposed estrogen and obesity. Ovarian cancer: CA-125, often advanced at diagnosis; germ cell tumors in younger women. Uterine fibroids: heavy bleeding. Endometriosis: cyclic pelvic pain, dyspareunia, dyschezia.
Male reproductive tract
Benign prostatic hyperplasia: lower urinary tract symptoms; PSA is nonspecific. Prostate cancer: adenocarcinoma with Gleason grading and bone metastases. Testicular torsion: acute painful testicle with absent cremasteric reflex - surgical emergency. Testicular germ cell tumors: painless mass; markers include AFP, hCG, and LDH.
Rule of thumb
Any pregnant patient beyond 20 weeks with new hypertension plus headache or visual change has severe preeclampsia until proven otherwise - check platelets and liver enzymes and start magnesium.