Lesson 1Medical management of AUB: progestins, combined hormonal therapy, tranexamic acid, levonorgestrel intrauterine system — mechanisms, dosing, contraindicationsOutlines medical therapies for abnormal uterine bleeding, including progestins, combined hormonal methods, tranexamic acid, and the levonorgestrel intrauterine system, with mechanisms, dosing, contraindications, and monitoring for adverse effects.
Mechanisms of progestin-based regimensCombined hormonal therapy choicesUse of tranexamic acid and cautionsLevonorgestrel IUS indications and insertionContraindications and drug interactionsMonitoring response and adjusting therapyLesson 2Surgical and procedural options: hysteroscopy, polypectomy, myomectomy, endometrial ablation, hysterectomy — indications and perioperative considerationsDescribes surgical and procedural options for abnormal uterine bleeding, including hysteroscopy, polypectomy, myomectomy, endometrial ablation, and hysterectomy, with emphasis on indications, contraindications, and perioperative risk assessment.
Diagnostic and operative hysteroscopyPolypectomy techniques and follow-upMyomectomy routes and patient selectionEndometrial ablation indications and limitsHysterectomy approaches and counsellingPerioperative optimisation and consentLesson 3Endometrial sampling techniques: office endometrial biopsy, pipelle, dilation and curettage—indications and interpretationDetails indications, techniques, and limitations of office endometrial sampling, including pipelle biopsy and dilation and curettage, with emphasis on specimen adequacy, pathology terms, and how to interpret results in clinical context.
Patient selection for office biopsyPipelle technique and pain controlWhen to choose dilation and curettageHandling insufficient or failed samplesPathology of hyperplasia and carcinomaPost-procedure counselling and follow-upLesson 4Contemporary classification of abnormal uterine bleeding (PALM-COEIN) and applying it clinicallyExplains the PALM-COEIN classification of abnormal uterine bleeding, distinguishing structural from nonstructural causes, and demonstrates how to apply this framework to history, examination, and investigations in everyday clinical practice.
Overview of PALM structural categoriesCOEIN nonstructural aetiologiesMapping symptoms to PALM-COEIN causesIntegrating imaging and labs into diagnosisCase examples using the frameworkDocumentation and coding considerationsLesson 5First-line investigations: pregnancy test, CBC, coagulation if indicated, transvaginal ultrasound (endometrial thickness thresholds)Covers initial evaluation of abnormal uterine bleeding, emphasising pregnancy exclusion, anaemia and coagulopathy screening, and transvaginal ultrasound with age- and risk-adjusted endometrial thickness thresholds to guide further investigation.
Rule out pregnancy and ectopic gestationCBC, iron studies, and anaemia assessmentWhen to order coagulation and platelet testsTransvaginal ultrasound technique basicsEndometrial thickness thresholds by risk groupImaging findings prompting urgent workupLesson 6Genetic risk assessment and referral pathways for suspected hereditary cancer syndromes (Lynch): criteria, appropriate genetic testing referral triggersExplores recognition of hereditary endometrial cancer risk, focusing on Lynch syndrome criteria, family history patterns, appropriate genetic testing referrals, and coordination with genetics services and high-risk surveillance programmes.
Key features of Lynch-associated cancersUsing Amsterdam and revised Bethesda criteriaRed flags in family and personal historyWhen and how to refer for genetic testingCounselling before and after test resultsImplications for relatives and cascade testingLesson 7Focused physical exam findings in AUB and signs suggesting gynecologic malignancy (uterine enlargement, adnexal mass, abnormal discharge)Reviews focused pelvic and systemic examination in abnormal uterine bleeding, highlighting findings that suggest gynecologic malignancy, such as uterine enlargement, adnexal masses, and abnormal discharge, and how to document and triage them.
Structured pelvic exam in AUBAssessing uterine size and contourEvaluation of adnexal massesCharacterising cervical and vaginal lesionsAbnormal discharge and odour patternsSystemic signs suggesting advanced diseaseLesson 8Red flags requiring urgent evaluation: postmenopausal bleeding, intermenstrual bleeding with mass, rapid uterine enlargement, systemic symptoms suggesting malignancyIdentifies bleeding patterns and associated symptoms that require urgent evaluation, including postmenopausal bleeding, intermenstrual bleeding with a mass, rapid uterine enlargement, and systemic features concerning for underlying malignancy.
Postmenopausal bleeding assessmentIntermenstrual bleeding with mass signsRapid uterine growth and sarcoma concernSystemic symptoms suggesting malignancyEmergency imaging and lab prioritiesCriteria for urgent referral or admissionLesson 9Counselling on surveillance, fertility preservation options, lifestyle modifiers, and follow-up plansAddresses counselling for patients at increased endometrial cancer risk, including surveillance strategies, fertility preservation options, lifestyle modification, and structured follow-up plans tailored to age, comorbidities, and reproductive goals.
Individualising surveillance intervalsFertility preservation in high-risk patientsWeight, exercise, and metabolic controlHormonal risk reduction strategiesDesigning clear follow-up plansShared decision-making and documentationLesson 10Focused history and risk factor assessment for endometrial hyperplasia and cancer including family history of Lynch syndrome and breast/colon cancersFocuses on targeted history taking for abnormal uterine bleeding and endometrial cancer risk, including menstrual patterns, metabolic factors, medication use, and detailed family history of Lynch syndrome and related breast or colon cancers.
Characterising bleeding pattern and chronicityAssessing obesity, PCOS, and diabetesHormone therapy and tamoxifen exposurePersonal history of gynecologic pathologyFamily history of Lynch-related cancersRisk stratification and documentation
