MBBS OSCE · Obstetrics & Gynaecology
OSCE — Menopause & Hormone Replacement Therapy
Eight-minute OSCE station on Menopause & Hormone Replacement Therapy: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Menopause & Hormone Replacement Therapy.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Menopause is the permanent cessation of menstruation, defined retrospectively as 12 months of amenorrhoea without any other cause (average age 50 to 52; premature ovarian insufficiency before 40). It results from depletion of ovarian follicles producing loss of oestradiol and inhibin, so FSH and LH rise. Symptoms cluster into vasomotor (hot flushes, night sweats — over 75 percent), the genitourinary syndrome of menopause (vaginal dryness, dyspareunia, urinary symptoms) and psychological / sleep disturbance. Long-term oestrogen deficiency drives osteoporosis, cardiovascular disease and urogenital atrophy. Diagnosis is clinical in women over 45; measure FSH only if under 45, after hysterectomy
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Menopause before 40 (premature ovarian insufficiency) — autoimmune/genetic/iatro |
| Safety | Postmenopausal bleeding — endometrial cancer until proven; urgent transvaginal U |
| Safety | Severe vasomotor symptoms disrupting life — HRT most effective if no contraindic |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.