OSCE — Menstrual Disorders · MBBS OSCE

Brief (to candidate)

You will assess a patient with a presentation consistent with Menstrual Disorders.^[2]
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Menstrual disorders encompass abnormalities in menstrual cycle frequency, duration, volume, or associated symptoms. FIGO PALM-COEIN classification (2011/2018) categorises abnormal uterine bleeding: Polyps, Adenomyosis, Leiomyoma, Malignancy/hyperplasia (structural); Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not classified (non-structural). Management follows NICE NG88: LNG-IUS first-line for HMB; tranexamic acid/mefenamic acid/COCP alternatives.^[1]^[2]

Candidate tasks

Clarify onset, severity, associated features, and red-flag symptoms.
State focused examination priorities.
List first-line investigations and any named score/criteria.
Give immediate resuscitation steps.
Outline definitive management with doses/routes where standard.
Name complications and disposition (ward / HDU / theatre / discharge safety-net).
Mention one special-population modifier (pregnancy, child, elderly, CKD).^[1]

Examiner checklist

Domain	Pass behaviours
Definition	Correct working diagnosis language
Assessment	Focused, prioritised, red flags sought
Investigations	Appropriate first-line + interpretation
Emergency care	ABC / time-critical actions first
Definitive care	Specific drugs/procedures, not generic phrases
Safety	Postmenopausal bleeding (PMB) — any bleeding 12 months after menopause; endometrial cancer ~9% (95% CI 8-11)
Safety	Postcoital bleeding (PCB) — persistent; exclude cervical cancer with speculum +
Safety	Heavy menstrual bleeding with iron-deficiency anaemia refractory to oral iron —
Communication	Clear plan and safety-netting

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[1]

References2Show

[1]National Institute for Health and Care Excellence Heavy menstrual bleeding: assessment and management (NICE guideline NG88) NICE, 2026.Source
[2]Munro MG, Critchley HO, Broder MS, et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age Int J Gynaecol Obstet, 2011.PMID 21345435

Clinical context

Candidate tasks

Clarify onset, severity, associated features, and red-flag symptoms.

State focused examination priorities.

List first-line investigations and any named score/criteria.

Give immediate resuscitation steps.

Outline definitive management with doses/routes where standard.

Name complications and disposition (ward / HDU / theatre / discharge safety-net).

Mention one special-population modifier (pregnancy, child, elderly, CKD).^[1]

Examiner checklist

Domain	Pass behaviours
Definition	Correct working diagnosis language
Assessment	Focused, prioritised, red flags sought
Investigations	Appropriate first-line + interpretation
Emergency care	ABC / time-critical actions first
Definitive care	Specific drugs/procedures, not generic phrases
Safety	Postmenopausal bleeding (PMB) — any bleeding 12 months after menopause; endometrial cancer ~9% (95% CI 8-11)
Safety	Postcoital bleeding (PCB) — persistent; exclude cervical cancer with speculum +
Safety	Heavy menstrual bleeding with iron-deficiency anaemia refractory to oral iron —
Communication	Clear plan and safety-netting

Model outline

References2Show

[1]National Institute for Health and Care Excellence Heavy menstrual bleeding: assessment and management (NICE guideline NG88) NICE, 2026.Source
[2]Munro MG, Critchley HO, Broder MS, et al. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age Int J Gynaecol Obstet, 2011.PMID 21345435