Gynecology Exam Review: Menstrual & Related Disorders for Physician Assistants

Prepare for your physician assistant certification exam with this concise review of menstrual and gynecologic disorders from A Comprehensive Review for the Certification and Recertification Examinations for Physician Assistants by Claire Babcock O'Connell and Thea Cogan-Drew. This summary covers diagnostic pearls, management strategies, and high-yield clinical concepts for menstrual irregularities, uterine and ovarian conditions, cervical pathology, breast disorders, and contraception.

Watch the podcast summary above and subscribe to Last Minute Lecture for in-depth clinical review and medical exam prep.

Menstrual Disorders

• Amenorrhea: Primary (no menses by age 15) or secondary (loss of menses after onset). Diagnose with hCG, hormone studies, and imaging. Management depends on cause (e.g., hormone therapy, lifestyle changes).
• Dysmenorrhea: Painful menstruation. Primary (due to prostaglandins) vs. secondary (from endometriosis, fibroids). Treated with NSAIDs, oral contraceptives, or surgery for underlying pathology.
• PMS & PMDD: Luteal phase physical and emotional symptoms. Managed with lifestyle interventions, SSRIs, or hormonal therapy.
• Abnormal Uterine Bleeding (AUB): Classified by PALM-COEIN system (structural/nonstructural). Diagnosis: pregnancy test, pelvic exam, labs. Treatment is cause-dependent.

Uterine & Ovarian Disorders

• Leiomyomas (Fibroids): Benign uterine tumors—cause bleeding, pain, pressure. Management: observation, myomectomy, hysterectomy, embolization.
• Endometriosis: Ectopic endometrial tissue—causes dysmenorrhea, pelvic pain, infertility. Managed with medical therapy or surgery.
• Endometrial Cancer: Most common gynecologic malignancy. Risk: obesity, unopposed estrogen. Diagnosed by biopsy; treated with surgery, radiation, chemotherapy.
• PCOS: Polycystic ovaries, hyperandrogenism, menstrual irregularity, metabolic risk. Managed with lifestyle, hormonal therapy, metformin.
• Ovarian Cancer: Presents late, high mortality. Diagnosis: imaging, CA-125. Managed with surgery, chemo.

Cervical & Breast Disorders

• Cervical Dysplasia/Cancer: Caused by HPV; screening with Pap/HPV tests. Graded as CIN I-III. Managed with surveillance or excision, depending on severity.
• Benign Breast Disorders: Fibrocystic changes, fibroadenoma, mastalgia, mastitis. Diagnosis: clinical, imaging, sometimes biopsy.
• Breast Cancer: Most common female cancer. Diagnosis: mammography, biopsy. Management: surgery, chemo, radiation, hormonal therapy.

Contraception, Infertility & PID

• Contraceptive Methods: Hormonal (OCPs, patch, ring), IUDs, barriers, sterilization.
• Infertility: Causes include ovulatory, tubal, uterine, and male factors. Treatment varies from meds to assisted reproduction.
• Pelvic Inflammatory Disease (PID): Infection of upper genital tract—pelvic pain, discharge, fever. Treated with antibiotics.

Glossary of Key Terms

• Amenorrhea: Absence of menstruation.
• Dysmenorrhea: Painful periods.
• Endometriosis: Endometrial tissue outside uterus.
• PCOS: Polycystic Ovary Syndrome.
• HPV: Human Papillomavirus.
• PID: Pelvic Inflammatory Disease.
• PALM-COEIN: Classification for AUB causes.

Conclusion: Key Takeaways for the Gynecology Exam

Success on the gynecology portion of the PA exam requires mastery of menstrual disorders, uterine and ovarian pathology, cancer screening, contraception, and management of infertility and PID. Review diagnostic algorithms and first-line therapies for the most common and testable conditions.

For a detailed review, watch the podcast summary and check out Last Minute Lecture for more high-yield PA study guides and medical exam prep.

If you found this breakdown helpful, subscribe to Last Minute Lecture for more chapter-based summaries and academic resources for physician assistants.