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IMF-053-01-0001-en	Which gynaecological situations override routine assessment and require urgent action?	Haemodynamic instability, ectopic pregnancy, adnexal torsion, severe infection, haemorrhage, and genital trauma all require urgent action.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0002-en	How does follicular growth drive both endometrial proliferation and ovulation?	Growing follicles produce oestradiol, which proliferates the endometrium, and sustained high oestradiol triggers the luteinising-hormone surge that causes ovulation.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0003-en	What converts the endometrium to a secretory state, and why does menstruation follow when implantation fails?	Corpus luteum progesterone makes the endometrium secretory; without implantation, withdrawal of these hormones causes menstruation.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0004-en	Why are menstrual product counts insufficient for judging the significance of heavy bleeding?	Product counts are imperfect, so anaemia, leakage, activity restriction, and the patient's own experience must also be assessed.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0005-en	Anovulation is common in both adolescents and perimenopausal patients. What different concern must be considered in each group?	In adolescents, inherited bleeding disorders must be considered; in perimenopause, rising age also increases endometrial cancer risk.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0006-en	Which features make endometrial biopsy important in abnormal uterine bleeding?	Older age, persistent irregular bleeding, prolonged unopposed oestrogen, obesity, polycystic ovarian syndrome, tamoxifen exposure, or failed treatment.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0007-en	What two limitations of endometrial ablation matter for a patient considering future pregnancy?	Ablation is not contraception, and it is unsuitable when future pregnancy is desired.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0008-en	In sudden severe unilateral pelvic pain with nausea, why does normal Doppler flow not settle the question of torsion?	Normal flow does not completely exclude intermittent or partial torsion, so urgent specialist judgement is still needed.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0009-en	How does endometriosis produce both pain and infertility?	Endometrium-like tissue outside the uterine cavity produces inflammation, fibrosis, and adhesions, which cause pain and infertility.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0010-en	Why is endometriosis managed on a clinical diagnosis rather than waiting for laparoscopy?	Diagnosis is clinical, supported by examination and imaging; laparoscopy can diagnose and treat but is not required before all therapy.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0011-en	What distinguishes adenomyosis from leiomyomas in tissue and typical presentation?	Adenomyosis is endometrial tissue within myometrium causing painful heavy bleeding and a tender enlarged uterus; leiomyomas are benign smooth-muscle tumours whose effects depend on size and location.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0012-en	Why is vaginal discharge not diagnosed from history alone?	History is unreliable across physiological, infective, atrophic, fistula, foreign-body, and malignant causes, so examination and microscopy, pH, nucleic-acid testing, or culture are chosen by syndrome.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0013-en	Why is pelvic inflammatory disease treated empirically on clinical findings rather than after confirmation?	Lower abdominal pain with cervical motion, uterine, or adnexal tenderness supports treatment once pregnancy and emergencies are considered, because delay increases infertility, ectopic pregnancy, abscess, and chronic pain.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0014-en	Why does human papillomavirus vaccination with cervical screening not remove all concern about related cancers?	Oncogenic types drive cervical, vulval, vaginal, anal, penile, and oropharyngeal cancers, and vaccination and screening prevent disease without eliminating all risk.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0015-en	Why does polycystic ovarian syndrome management include cycle protection with combined contraception or a progestogen?	The syndrome can cause endometrial hyperplasia from prolonged unopposed oestrogen, which cycle protection addresses.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0016-en	Why can ultrasound alone not establish polycystic ovarian syndrome?	Diagnosis combines ovulatory dysfunction, clinical or biochemical androgen excess, and ovarian morphology after excluding alternatives, and ovarian cysts are not required.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0017-en	Why does low-energy hypothalamic suppression need treatment, and what is the treatment?	It threatens bone and fertility, so it is treated by restoring energy availability.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0018-en	When should infertility be assessed earlier than the usual period of trying, and who is evaluated?	With advanced reproductive age, irregular cycles, known pelvic or testicular disease, previous gonadotoxic treatment, or other risk; both partners are evaluated concurrently.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0019-en	What do ovarian-reserve tests predict well, and what do they predict poorly?	They estimate response to ovarian stimulation better than they predict natural fertility.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0020-en	Why are combined oestrogen-progestogen methods unsuitable in selected migraine, smoking, vascular, hepatic, postpartum, and cancer contexts?	Oestrogen increases thrombosis risk, even though combined methods suppress ovulation and improve bleeding, pain, acne, and endometriosis symptoms.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0021-en	What do progestogen-only and copper intrauterine methods gain by avoiding oestrogen, and what trade-offs remain?	They avoid oestrogen, but progestogen-only methods differ in bleeding, bone, weight, and return-to-fertility effects, and copper devices may increase bleeding and pain.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0022-en	How is an emergency contraceptive chosen, and does it affect an established pregnancy?	A copper device or oral agent is chosen by time, weight, interactions, ovulation timing, and access, and it does not disrupt an implanted pregnancy.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0023-en	What distinguishes local vaginal oestrogen from systemic menopausal hormone therapy?	Local vaginal oestrogen has low systemic exposure and treats urogenital symptoms; systemic therapy best treats vasomotor symptoms but needs endometrial protection when a uterus is present.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending
IMF-053-01-0024-en	Why is ovarian cancer easy to miss, and how should persistent warning features be handled?	It often causes persistent bloating, early satiety, pelvic pressure, urinary or weight change rather than one specific symptom; persistence warrants examination, imaging, biopsy, and referral.	Integrated Medical Foundations; chapter 53, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: a8aa7e8948755413efd905efb123b870a024eec296918396432ae9e353fff5a3; editorial review pending	imf lang::en chapter::053 module::053-01 review::pending