Common gynaecological challenges in primary care – a primary care refresher

This presentation provides clinicians with a clear, up-to-date framework for tailoring heavy menstrual bleeding (HMB) management to individual patient needs.

This presentation will provide a practical overview of the contemporary management of heavy menstrual bleeding (HMB) in women across the reproductive lifespan. 

It will begin with an introduction to the FIGO PALM-COEIN classification system, outlining the structural and non-structural causes of abnormal uterine bleeding. Structural causes include polyp, adenomyosis, leiomyomapolyp, adenomyosis, leiomyoma, and malignancymalignancy/hyperplasia (PALM). Non). Non-structural causes include coagulopathy, ovulatorycoagulopathy, ovulatory dysfunction, endometrialendometrial disorders, Iatrogenic causes, and not-not-yet-classified conditions (COEIN).

The session will then explore evidence-based assessment and investigation strategies, including history, examination, imaging, and laboratory testing. Management options will focus on patient-centred care, considering symptom severity, fertility desires, comorbidities, and quality of life.

Medical treatment options discussed will include non-hormonal therapies such as tranexamic acid and NSAIDs, hormonal therapies including combined hormonal contraception, oral progestogens, and the levonorgestrel intrauterine device. Surgical options will include hysteroscopy, endometrial ablation, myomectomy, uterine artery embolisation, and hysterectomy. The presentation aims to provide clinicians with a clear, up-to-date framework for tailoring HMB management to individual patient needs.

Speaker: Dr Sneha Parghi - Joan Kirner Women's Centre

Learning outcomes:

By the end of this session, participants will be able to:

• Apply the FIGO PALM-COEIN classification system to identify and differentiate structural and non-structural causes of heavy menstrual bleeding.
• Compare and select appropriate medical and surgical management options for heavy menstrual bleeding, including their indications, benefits, limitations, and suitability for individual patients.
• Develop and implement an evidence-based, patient-centred management plan for heavy menstrual bleeding incorporating fertility goals, symptom burden, and quality-of-life considerations.