GP Vivas · womens-health
Abnormal uterine bleeding — structured viva
Structured oral on abnormal uterine bleeding: defending the impact-based definition, reasoning through PALM-COEIN, arguing investigation thresholds and biopsy triggers, ranking medical therapy from network meta-analysis, and closing on iron and surgical thresholds.
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Target exams
RACGP CCEFRACGP oralsMRCGP SCA
Prompt
The examiner opens: 'A partner in your practice still books every heavy period for ultrasound, bloods, and a course of norethisterone before anything else. Defend your pathway.' The viva branches through definition, classification, investigation, medical ladder, surgical thresholds, and iron.
Stem
You are the GP. The partner asks why you do not simply investigate everyone with heavy periods the same way. [21]
References13ShowHide
- [1]Munro MG, Critchley HO, Fraser IS et al. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years. International journal of gynaecology and obstetrics, 2018.PMID 30198563
- [2]Munro MG, Critchley HO, Fraser IS et al. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertility and sterility, 2011.PMID 21496802
- [3]Bofill Rodriguez M, Dias S, Jordan V et al. Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis. The Cochrane database of systematic reviews, 2022.PMID 35638592
- [4]Bofill Rodriguez M, Lethaby A, Jordan V Progestogen-releasing intrauterine systems for heavy menstrual bleeding. The Cochrane database of systematic reviews, 2020.PMID 32529637
- [5]Bofill Rodriguez M, Lethaby A, Farquhar C Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. The Cochrane database of systematic reviews, 2019.PMID 31535715
- [7]Lethaby A, Wise MR, Weterings MA et al. Combined hormonal contraceptives for heavy menstrual bleeding. The Cochrane database of systematic reviews, 2019.PMID 30742315
- [8]Bofill Rodriguez M, Lethaby A, Fergusson RJ Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. The Cochrane database of systematic reviews, 2021.PMID 33619722
- [9]Bofill Rodriguez M, Lethaby A, Grigore M et al. Endometrial resection and ablation techniques for heavy menstrual bleeding. The Cochrane database of systematic reviews, 2019.PMID 30667064
- [12]Oliveira JA, Eskandar K, Chagas J et al. Heavy menstrual bleeding in women with inherited bleeding disorders in use of LNG-IUS: A systematic review and single-arm meta-analysis. Contraception, 2024.PMID 38614274
- [13]Gupta S, Castaman G, Funkhouser K et al. Call to action: identifying an underlying bleeding disorder in adolescents with heavy menstrual bleeding. Research and practice in thrombosis and haemostasis, 2026.PMID 42598146
- [6]Bofill Rodriguez M, Lethaby A, Low C et al. Cyclical progestogens for heavy menstrual bleeding. The Cochrane database of systematic reviews, 2019.PMID 31425626
- [18]Jaya-Bodestyne SL, Goh MS, Gwan MCH et al. To do or not to do? - Endometrial biopsy in younger women with abnormal uterine bleeding. European journal of obstetrics, gynecology, and reproductive biology. X, 2025.PMID 39981415
- [21]Jain V, Munro MG, Critchley HOD Contemporary evaluation of women and girls with abnormal uterine bleeding: FIGO Systems 1 and 2. International journal of gynaecology and obstetrics, 2023.PMID 37538019