Gynaecology
Abnormal uterine bleeding, pelvic pain, endometriosis, PCOS, fibroids, menopause and pelvic floor disorders.
High-yield points
Abnormal uterine bleeding: always do a pregnancy test; classify with PALM-COEIN; check FBC and ferritin.
Heavy menstrual bleeding: the levonorgestrel IUD is highly effective; tranexamic acid and NSAIDs during periods.
Ovarian torsion: sudden unilateral pain with vomiting and adnexal mass; urgent laparoscopy to save the ovary.
Endometriosis: cyclical pain, dysmenorrhoea, dyspareunia, infertility; average diagnostic delay is years; laparoscopy is the definitive diagnosis.
PCOS (Rotterdam criteria, 2 of 3): oligo/anovulation, hyperandrogenism, polycystic ovaries; manage weight, cycle control and metabolic risk.
Menopausal hormone therapy is the most effective treatment for vasomotor symptoms; women with a uterus need a progestogen.
Postmenopausal bleeding needs transvaginal ultrasound and endometrial sampling if the endometrium is thickened (over 4 mm).
PID: treat empirically on clinical suspicion (ceftriaxone plus doxycycline plus metronidazole).
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Endometriosis | Often diagnosed late, usually at laparoscopy. | National Action Plan and high awareness. Can be diagnosed clinically and on imaging, and treated empirically before surgery. |
| PCOS | Rotterdam criteria. | The international evidence-based PCOS guideline is led from Australia; know its lifestyle-first, whole-person approach. |
| Infertility causes | Genital TB is an important cause. | Genital TB is rare; think of it only in migrants from high-TB countries. |
| Menopause | Hormone therapy is used cautiously and less often. | Menopausal hormone therapy is generally supported for symptomatic women under 60 or within 10 years of menopause, after individual risk assessment. |
Endometriosis
India (MBBS)
Often diagnosed late, usually at laparoscopy.
Australia (AMC): what the exam expects
National Action Plan and high awareness. Can be diagnosed clinically and on imaging, and treated empirically before surgery.
PCOS
India (MBBS)
Rotterdam criteria.
Australia (AMC): what the exam expects
The international evidence-based PCOS guideline is led from Australia; know its lifestyle-first, whole-person approach.
Infertility causes
India (MBBS)
Genital TB is an important cause.
Australia (AMC): what the exam expects
Genital TB is rare; think of it only in migrants from high-TB countries.
Menopause
India (MBBS)
Hormone therapy is used cautiously and less often.
Australia (AMC): what the exam expects
Menopausal hormone therapy is generally supported for symptomatic women under 60 or within 10 years of menopause, after individual risk assessment.
The Australian context
Australia has a National Action Plan for Endometriosis, and awareness is high. The international evidence-based PCOS guideline is led from Australia (Monash University).