Master Women’s Health (Obs & Gyn)
for AMC Cat 1

Core Concepts

Women's Health encompasses reproductive, sexual, and maternal health. Key concepts include the **menstrual cycle** (hormonal regulation: Hypothalamic-Pituitary-Ovarian axis), **contraception** (emphasizing Long-Acting Reversible Contraceptives - LARCs), and **cervical screening** for HPV. Common conditions involve **PCOS**, **endometriosis**, **uterine fibroids**, **pelvic organ prolapse**, and **menopause**. Pregnancy involves antenatal care, screening, and management of common complications like gestational diabetes and pre-eclampsia, alongside intrapartum and postpartum care.

Clinical Presentation

• Abnormal Uterine Bleeding (AUB): Heavy, prolonged, intermenstrual, post-coital, post-menopausal.
• Pelvic Pain: Acute (sudden, severe, unilateral/bilateral e.g., ectopic, PID, torsion), chronic (cyclical, non-cyclical dysmenorrhoea, dyspareunia, e.g., endometriosis, adenomyosis).
• Vaginal Discharge/Itch: Malodorous, discoloured, pruritus, dysuria, dyspareunia (infections: candida, BV, trichomonas, chlamydia, gonorrhoea).
• Subfertility: Inability to conceive after 12 months (or 6 months if >35 years).
• Pelvic Organ Prolapse/Incontinence: Vaginal bulge, pressure, sensation of something "falling out," urinary/bowel symptoms; stress or urge incontinence.
• Menopausal Symptoms: Vasomotor (hot flushes, night sweats), urogenital atrophy (vaginal dryness, dyspareunia), mood changes.
• Pregnancy Complications (Early): Vaginal bleeding, abdominal pain (miscarriage, ectopic pregnancy).
• Pregnancy Complications (Late): Hypertension, proteinuria (pre-eclampsia), vaginal bleeding (placenta praevia, abruption), decreased fetal movements, preterm labour.
• Postpartum Complications: Heavy bleeding (PPH), fever (endometritis, mastitis), perineal pain.
• Breast Symptoms: Palpable lumps, pain, nipple discharge, skin changes.

Diagnosis (Gold Standard)

Diagnosis starts with thorough history and physical examination. **Transvaginal Ultrasound (TVUS)** is crucial for investigating AUB, pelvic pain, ovarian pathology, and early pregnancy. **PCOS** is diagnosed by Rotterdam criteria (2 of: oligo/anovulation, clinical/biochemical hyperandrogenism, polycystic ovaries on USS). **Endometriosis** is definitively diagnosed via **laparoscopy with biopsy**. **Cervical dysplasia/cancer** requires **colposcopy and targeted biopsy** following an abnormal cervical screening test. **Endometrial cancer** is confirmed with **endometrial biopsy/curettage** for post-menopausal bleeding. **Ovarian cancer** workup involves TVUS and tumour markers (e.g., CA-125, especially post-menopause). **Gestational Diabetes Mellitus (GDM)** is diagnosed by **Oral Glucose Tolerance Test (OGTT)**. **Ectopic pregnancy** requires serial quantitative β-hCG and TVUS. **Pre-eclampsia** is new-onset hypertension with proteinuria or end-organ dysfunction after 20 weeks gestation. **STIs** are diagnosed by Nucleic Acid Amplification Tests (NAATs).

Management (First Line)

First-line management is condition-specific. For **contraception**, Long-Acting Reversible Contraceptives (**LARCs**) like the Mirena IUS or implant are highly effective. **AUB** is managed with hormonal methods (e.g., COCPs, Mirena IUS), NSAIDs, or antifibrinolytics; surgical options (endometrial ablation, hysterectomy) for definitive cases. **PCOS** management involves lifestyle modifications, **COCPs** for symptomatic control, **Metformin** for insulin resistance, and **Clomiphene citrate** or Letrozole for anovulatory infertility. **Endometriosis** pain is managed with **NSAIDs, COCPs, or progestins**; surgical excision for severe disease. **Pelvic Inflammatory Disease (PID)** requires broad-spectrum **antibiotics** (e.g., ceftriaxone + doxycycline + metronidazole). **Ectopic pregnancy** can be managed with **methotrexate** (if stable and small) or **laparoscopic salpingectomy**. **Menopausal vasomotor symptoms** with **Hormone Replacement Therapy (HRT)**, and urogenital atrophy with **topical estrogen**. **Pre-eclampsia** management includes **antihypertensives** (e.g., labetalol, nifedipine) and **Magnesium Sulfate** for seizure prophylaxis, with **delivery** as the definitive treatment. **Postpartum Haemorrhage (PPH)** first-line includes **uterine massage and oxytocin**, followed by other uterotonics (e.g., carboprost, misoprostol). **Pelvic Organ Prolapse** is managed with **pelvic floor muscle training** or **pessaries**, with surgery as an option. **Cervical dysplasia** may be managed with **LLETZ (Large Loop Excision of the Transformation Zone)**.

Exam Red Flags