18.1 Gynaecological Disorders

18.1 Gynaecological Disorders

Quick Answer: For AIAPGET gynae stems, lock the definition first (primary vs secondary amenorrhoea; AUB pattern; Rotterdam PCOS), then the complication (Fitz-Hugh–Curtis, TOA, submucosal fibroid infertility), then the couple work-up (ovulation + tubes + cavity + semen). Remedy selection belongs in therapeutics only after this map is clear.

Gynaecology questions in AIAPGET Homoeopathy mix classical definitions with clinical decision points: when bleeding is abnormal, when infection has ascended, when a mass explains infertility, and when endocrine syndromes (especially PCOS) reshape long-term risk. Master definitions first, then complications and differentials—these drive both allopathic stem questions and remedy-selection vignettes in later sections.

Menstrual Disorders

Normal menstruation typically lasts 3–5 days, recurs every 21–35 days, and loses roughly 30–80 mL blood. Deviations are classified by pattern, not by patient self-labels alone.

Amenorrhoea

• Primary amenorrhoea: no menarche by age 16 with secondary sexual characters, or by age 14 without them.
• Secondary amenorrhoea: cessation for ≥3 cycles or ≥6 months after previously regular menses.

Key causes to map in exams:

Cryptomenorrhoea (hidden menstruation with cyclic pain and haematocolpos) is classic with imperforate hymen—remember bulging bluish membrane and primary amenorrhoea with secondary sexual development.

Dysmenorrhoea

• Primary: cramping without pelvic pathology; typically starts soon after menarche; prostaglandins drive uterine hypercontractility.
• Secondary: associated with endometriosis, adenomyosis, fibroids, PID, or IUCD; often begins later and may worsen progressively.

Abnormal Uterine Bleeding (AUB)

Use descriptive terms precisely:

• Menorrhagia (heavy menstrual bleeding): excessive volume/duration with regular cycle.
• Metrorrhagia: irregular intermenstrual bleeding.
• Menometrorrhagia: heavy + irregular.
• Oligomenorrhoea: cycles >35 days.
• Polymenorrhoea: cycles <21 days.
• Hypomenorrhoea: scanty flow.

The PALM-COEIN framework organises structural (Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia) versus non-structural (Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified) causes—useful for structured differentials even when the stem is short.

Pelvic Inflammatory Disease (PID)

PID is infection of the upper genital tract (endometrium, tubes, ovaries, pelvic peritoneum), usually ascending from the lower tract. Organisms are often polymicrobial; Neisseria gonorrhoeae and Chlamydia trachomatis are classic initiators, with anaerobes and enteric flora contributing.

Clinical clues

Lower abdominal pain, abnormal vaginal discharge, fever, dyspareunia, cervical motion tenderness, adnexal tenderness, and sometimes irregular bleeding. Onset often follows menses.

Complications (high-yield)

1. Tubo-ovarian abscess (TOA)
2. Infertility from tubal damage/adhesions
3. Ectopic pregnancy risk↑
4. Chronic pelvic pain
5. Fitz-Hugh–Curtis syndrome — perihepatitis with violin-string adhesions; RUQ pain with PID history

Differentials include appendicitis, ectopic pregnancy, ovarian torsion, endometriosis flare, and UTI—pregnancy testing and careful localisation are exam staples.

Uterine Fibroids (Leiomyomas)

Fibroids are benign monoclonal smooth-muscle tumours of the myometrium, estrogen- and progesterone-responsive, more common in reproductive years; they regress after menopause.

Classification by location

Symptoms: menorrhagia, dysmenorrhoea, pelvic pressure, anaemia, infertility, recurrent pregnancy loss. Red degeneration in pregnancy causes acute pain and low-grade fever—remember in obstetric stems.

Endometriosis and Adenomyosis

Endometriosis: ectopic endometrial-like tissue outside the uterus (ovaries, pouch of Douglas, peritoneum). Classic triad: dysmenorrhoea, dyspareunia, infertility—often with cyclic pelvic pain that worsens over years. Chocolate cysts (endometriomas) appear on ultrasound stems. Diagnosis may ultimately need laparoscopy, but AIAPGET often stops at clinical–imaging suspicion.

Adenomyosis: endometrial tissue within the myometrium. Multiparous women in 40s; uniformly enlarged boggy uterus; heavy painful menses. Distinguish from fibroids (focal masses) when the stem stresses diffuse enlargement and secondary dysmenorrhoea.

Polycystic Ovary Syndrome (PCOS)

Rotterdam criteria (2003): any two of (1) oligo- and/or anovulation, (2) clinical and/or biochemical hyperandrogenism, (3) polycystic ovarian morphology on ultrasound—after excluding other aetiologies (thyroid, hyperprolactinaemia, CAH, Cushing, androgen-secreting tumours).

Associated features: insulin resistance, obesity (not universal), acanthosis nigricans, infertility, endometrial hyperplasia risk (unopposed estrogen), and metabolic syndrome. LH:FSH ratio may be elevated but is not required for diagnosis.

Management principles (conceptual for exam): lifestyle first; cycle regulation; ovulation induction when fertility desired; screen and counsel for long-term metabolic and endometrial risks.

Menopause and Climacteric

Menopause is permanent cessation of menses after 12 consecutive months of amenorrhoea, typically around 45–55 years (mean ~51). Perimenopause is the transition with irregular cycles and fluctuating hormones.

Symptoms: vasomotor (hot flushes, night sweats), genitourinary syndrome (vaginal dryness, dyspareunia, urinary urgency), sleep disturbance, mood changes, and accelerated bone loss. Premature menopause / premature ovarian insufficiency before age 40 needs distinct evaluation.

Postmenopausal bleeding is never “normal”—exclude hyperplasia and malignancy. Cervical screening / VIA or cytology language may appear as community–gynae crossover stems.

Infertility Basics

Infertility: failure to conceive after 12 months of regular unprotected intercourse (evaluate earlier after 6 months if woman ≥35, or sooner with known pathology).

Core female factors

• Ovulatory dysfunction (PCOS, hypothalamic, thyroid, hyperprolactinaemia)
• Tubal (PID sequelae, endometriosis, prior surgery)
• Uterine (Asherman, fibroids distorting cavity, Müllerian anomalies)
• Cervical/peritoneal factors (less common as sole cause)

Essential work-up concepts

1. Confirm ovulation (history, mid-luteal progesterone, ultrasound follicular tracking as needed)
2. Assess tubal patency (HSG classical screening test in stems)
3. Evaluate uterine cavity
4. Semen analysis early—male factor contributes in ~40–50% of couples alone or jointly

Homoeopathic case-taking still requires this physiologic map: menses pattern, pain, discharge, parity, surgeries, infections, and partner evaluation prevent remedy selection on incomplete cases.

High-Yield AIAPGET Drill Points

• Primary vs secondary amenorrhoea hinges on age cut-offs and presence of secondary sexual characters
• Submucosal fibroids punch above their size for bleeding and infertility
• PID + RUQ pain → Fitz-Hugh–Curtis
• PCOS is pattern plus exclusion, not LH:FSH alone
• Progressive secondary dysmenorrhoea + infertility → endometriosis lane
• Diffuse boggy uterus + menorrhagia → adenomyosis lane
• Infertility is a couple problem—never omit male evaluation in MCQs that trick you into only female tests or remedies

Memorise definition cut-offs and complication names first; therapeutics differentials (Sepia, Pulsatilla, Sabina, Secale) only score after the clinical frame is correct.