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Q1: PALM-COEIN (3 min)
"Describe the FIGO PALM-COEIN classification."
- PALM (structural): Polyps, Adenomyosis, Leiomyoma, Malignancy/hyperplasia
- COEIN (non-structural): Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not classified
- Guides systematic workup and treatment
Q2: HMB Management (3 min)
"How do you manage heavy menstrual bleeding?"
- First-line: LNG-IUS 52mg (Mirena) — blood-loss reduction of up to 90% (Cochrane); effective within 3-6 months
- Second-line: tranexamic acid 1g TDS + mefenamic acid 500mg TDS during menses
- COCP alternative
- Surgical: endometrial ablation (completed family), hysterectomy (definitive)
- Iron supplementation for anaemia.[1][2]
Q3: PMB (2 min)
"How do you investigate postmenopausal bleeding?"
- ALWAYS rule out endometrial cancer (pooled risk ~9%, 95% CI 8-11)
- Transvaginal US: endometrial thickness over 5 mm (5-mm threshold detects 96% of cancers) → hysteroscopy and biopsy
- Hysteroscopy + endometrial biopsy
- Urgent 2-week wait referral
Q4: Amenorrhoea (2 min)
"What are the causes of secondary amenorrhoea?"
- Pregnancy (always exclude first)
- Hypothalamic (stress, weight loss, exercise, eating disorder)
- PCOS (most common non-pregnancy cause)
- Hyperprolactinaemia (pituitary adenoma, drugs)
- Premature ovarian insufficiency (POI)
- Asherman's syndrome (intrauterine adhesions post-D&C)
References2ShowHide
- [1]National Institute for Health and Care Excellence Heavy menstrual bleeding: assessment and management (NICE guideline NG88) NICE, 2026.Source
- [2]Bofill Rodriguez M, Lethaby A, Jordan V. Progestogen-releasing intrauterine systems for heavy menstrual bleeding Cochrane Database Syst Rev, 2020.PMID 32529637