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  <head>
    <title>053-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Gynaecology, menstruation, fertility, and contraception">
      <outline text="Orientation">
        <outline text="Endocrine physiology meets bleeding, pain, infection, cancer"/>
        <outline text="Explain, consent, offer chaperone, allow stopping"/>
        <outline text="Urgent: instability, ectopic, torsion, infection, haemorrhage"/>
      </outline>
      <outline text="Menstrual physiology and history">
        <outline text="Follicular oestradiol proliferates endometrium">
          <outline text="Sustained high oestradiol triggers luteinising-hormone surge">
            <outline text="Ovulation"/>
          </outline>
        </outline>
        <outline text="Corpus luteum progesterone makes endometrium secretory">
          <outline text="No implantation: hormone withdrawal causes menstruation"/>
        </outline>
        <outline text="Ovulation inconsistent after menarche and before menopause"/>
        <outline text="History: interval, volume, pain, pregnancy, goals"/>
        <outline text="Product counts imperfect">
          <outline text="Anaemia, leakage, restriction, experience matter"/>
        </outline>
      </outline>
      <outline text="Abnormal uterine bleeding">
        <outline text="Causes: structural lesions, coagulopathy, ovulatory, drugs"/>
        <outline text="Adolescents: anovulation, but consider bleeding disorders"/>
        <outline text="Perimenopause: anovulation, but cancer risk rises with age"/>
        <outline text="Stability and pregnancy first">
          <outline text="Blood count and iron define consequence"/>
        </outline>
        <outline text="Biopsy with age, unopposed oestrogen, obesity, tamoxifen"/>
        <outline text="Acute: resuscitation, tranexamic acid, hormones, surgery"/>
        <outline text="Chronic: intrauterine system, hormones, non-steroidal drugs"/>
        <outline text="Ablation is not contraception">
          <outline text="Unsuitable if future pregnancy desired"/>
        </outline>
      </outline>
      <outline text="Pelvic pain and endometriosis">
        <outline text="Acute differentials: ectopic, torsion, cyst, infection"/>
        <outline text="Pregnancy test routine when biologically possible"/>
        <outline text="Sudden unilateral pain with nausea suggests torsion">
          <outline text="Normal Doppler misses intermittent or partial torsion"/>
        </outline>
        <outline text="Endometriosis: endometrium-like tissue outside cavity">
          <outline text="Inflammation, fibrosis, adhesions">
            <outline text="Pain and infertility"/>
          </outline>
          <outline text="Burden does not track lesion extent"/>
          <outline text="Clinical diagnosis; laparoscopy not always required"/>
        </outline>
        <outline text="Adenomyosis: endometrium within myometrium">
          <outline text="Painful heavy bleeding, tender enlarged uterus"/>
        </outline>
        <outline text="Leiomyomas: benign smooth-muscle tumours">
          <outline text="Effects depend on size and location"/>
        </outline>
      </outline>
      <outline text="Infection and discharge">
        <outline text="Discharge: physiological, infective, atrophy, malignancy">
          <outline text="History alone unreliable; test by syndrome"/>
        </outline>
        <outline text="Pelvic inflammatory disease: ascending, often polymicrobial">
          <outline text="Pain plus cervical, uterine, adnexal tenderness"/>
          <outline text="Delay raises infertility, ectopic, abscess, pain"/>
          <outline text="Treat broadly, test, manage partners, reassess"/>
        </outline>
        <outline text="Human papillomavirus drives several cancers">
          <outline text="Vaccination and screening reduce, not remove, risk"/>
        </outline>
        <outline text="Trauma-informed care follows the person&#x27;s choices"/>
      </outline>
      <outline text="Polycystic ovarian syndrome and amenorrhoea">
        <outline text="Ovulatory dysfunction, androgen excess, ovarian morphology">
          <outline text="Insulin resistance commonly contributes"/>
          <outline text="Unopposed oestrogen causes endometrial hyperplasia"/>
        </outline>
        <outline text="Management follows the person&#x27;s priorities">
          <outline text="Cycle protection with combined pill or progestogen"/>
        </outline>
        <outline text="Cysts not required; ultrasound alone insufficient"/>
        <outline text="Amenorrhoea: exclude pregnancy first">
          <outline text="Hormone tests and imaging localise the axis"/>
          <outline text="Low-energy suppression threatens bone and fertility">
            <outline text="Restore energy availability"/>
          </outline>
        </outline>
      </outline>
      <outline text="Infertility">
        <outline text="Assess earlier with age, irregular cycles, known disease"/>
        <outline text="Evaluate both partners concurrently"/>
        <outline text="Female factors: ovulation, reserve, tubes, uterus, age"/>
        <outline text="Confirm ovulation by cycle or timed progesterone"/>
        <outline text="Reserve tests predict stimulation, not natural fertility"/>
        <outline text="Treatment from timing to IVF, donor gametes, adoption"/>
      </outline>
      <outline text="Contraception">
        <outline text="Condoms reduce infection transmission"/>
        <outline text="Implants and intrauterine devices: low user failure"/>
        <outline text="Combined methods suppress ovulation">
          <outline text="Oestrogen raises thrombosis risk"/>
        </outline>
        <outline text="Progestogen-only avoids oestrogen, varied side effects"/>
        <outline text="Copper device: hormone-free, more bleeding and pain"/>
        <outline text="Emergency contraception does not end implanted pregnancy"/>
        <outline text="Enzyme inducers reduce some hormonal methods"/>
      </outline>
      <outline text="Menopause and pelvic-floor health">
        <outline text="Diagnosed retrospectively after sustained amenorrhoea"/>
        <outline text="Hormone therapy most effective for vasomotor symptoms">
          <outline text="Systemic oestrogen needs endometrial protection"/>
        </outline>
        <outline text="Local vaginal oestrogen: low systemic exposure"/>
        <outline text="Prolapse and incontinence: childbirth, ageing, tissue">
          <outline text="Physiotherapy, pessary, surgery by burden and goals"/>
        </outline>
      </outline>
      <outline text="Gynaecological cancer">
        <outline text="Postmenopausal bleeding needs endometrial assessment"/>
        <outline text="Cervical screening detects precancer before symptoms"/>
        <outline text="Ovarian cancer: persistent nonspecific symptoms"/>
        <outline text="Persistent warning features need biopsy and referral"/>
        <outline text="Tumour markers are not general screening tests"/>
      </outline>
    </outline>
  </body>
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