Abnormal Uterine Bleeding (AUB)
Clinical Features
- Heavy menstrual bleeding
- Passing blood clots
- Prolonged menstruation
- Intermenstrual bleeding
- Fatigue and weakness
- Iron deficiency anemia
Treatment
- Tranexamic Acid 500 mg–1 g orally three times daily during heavy bleeding for up to 5 days.
- Mefenamic Acid 500 mg orally three times daily during menstruation.
- If contraception required: Ethinylestradiol 30 mcg + Levonorgestrel 150 mcg, one tablet daily for 21 days.
- Iron supplementation if anemia is present.
Acute Heavy Uterine Bleeding
Clinical Features
- Sudden onset excessive bleeding
- Passage of large clots
- Dizziness
- Weakness
- Tachycardia
- Features of acute blood loss
Treatment
- Tranexamic Acid 1 g orally or IV three to four times daily.
- Medroxyprogesterone Acetate 10 mg orally three times daily for 7 days.
- Iron supplementation if required.
- Hospital admission if hemodynamically unstable.
Primary Dysmenorrhea
Clinical Features
- Lower abdominal cramps during menstruation
- Backache
- Nausea
- Vomiting
- Headache
- Pain beginning shortly before menstruation
Treatment
- Mefenamic Acid 500 mg stat then 250–500 mg orally three times daily.
- Ibuprofen 400 mg orally three times daily.
- Continue during painful menstrual days.
- Heat therapy and exercise may help.
Secondary Dysmenorrhea
Clinical Features
- Pelvic pain associated with menstruation
- Pain worsening with age
- Dyspareunia
- Heavy menstrual bleeding
- Associated endometriosis or adenomyosis
Treatment
- Ibuprofen 400 mg orally three times daily.
- Mefenamic Acid 500 mg orally three times daily.
- Treat underlying cause.
- Referral for imaging if indicated.
Polycystic Ovary Syndrome (PCOS)
Clinical Features
- Irregular menstrual cycles
- Oligomenorrhea
- Acne
- Hirsutism
- Obesity
- Infertility
Treatment
- Combined Oral Contraceptive Pill once daily for 21 days each cycle.
- Metformin 500 mg once daily initially.
- Gradually increase Metformin to 500 mg three times daily.
- Spironolactone 50 mg orally twice daily for hirsutism.
- Lifestyle modification and weight reduction.
Premenstrual Syndrome (PMS)
Clinical Features
- Mood swings
- Irritability
- Breast tenderness
- Bloating
- Fatigue
- Sleep disturbances
Treatment
- Fluoxetine 20 mg orally once daily.
- Alternative: Sertraline 50 mg orally once daily.
- Regular exercise.
- Stress reduction.
Vulvovaginal Candidiasis
Clinical Features
- White curdy vaginal discharge
- Severe itching
- Burning sensation
- Dyspareunia
- Vulval redness
Treatment
- Fluconazole 150 mg orally as a single dose.
- Alternative: Clotrimazole vaginal tablet 500 mg single insertion.
- Maintain genital hygiene.
Bacterial Vaginosis
Clinical Features
- Thin grey vaginal discharge
- Fishy odor
- Mild itching
- Positive whiff test
Treatment
- Metronidazole 400–500 mg orally twice daily for 7 days.
- Alternative: Metronidazole vaginal gel once daily for 5 days.
- Avoid vaginal douching.
Trichomoniasis
Clinical Features
- Frothy greenish vaginal discharge
- Vaginal itching
- Burning micturition
- Strawberry cervix
- Dyspareunia
Treatment
- Metronidazole 2 g orally as a single dose.
- Alternative: Metronidazole 400–500 mg orally twice daily for 7 days.
- Treat sexual partner simultaneously.
- Avoid sexual intercourse until treatment completed.
Cervicitis
Clinical Features
- Vaginal discharge
- Post-coital bleeding
- Dyspareunia
- Lower abdominal discomfort
- Inflamed cervix on examination
Treatment
- Azithromycin 1 g orally as a single dose.
- Alternative: Doxycycline 100 mg orally twice daily for 7 days.
- Partner treatment if STI suspected.
Pelvic Inflammatory Disease (PID)
Clinical Features
- Lower abdominal pain
- Fever
- Abnormal vaginal discharge
- Cervical motion tenderness
- Adnexal tenderness
- Dyspareunia
Treatment
- Ceftriaxone 500 mg IM single dose.
- Doxycycline 100 mg orally twice daily for 14 days.
- Metronidazole 400–500 mg orally twice daily for 14 days.
- Advise abstinence until treatment completion.
Urinary Tract Infection (UTI)
Clinical Features
- Dysuria
- Frequency of urination
- Urgency
- Burning micturition
- Suprapubic pain
Treatment
- Nitrofurantoin 100 mg orally twice daily for 5 days.
- Alternative: Fosfomycin 3 g oral single dose.
- Increase oral fluid intake.
Atrophic Vaginitis
Clinical Features
- Postmenopausal vaginal dryness
- Dyspareunia
- Vaginal burning
- Itching
- Spotting after intercourse
- Recurrent urinary symptoms
Treatment
- Vaginal estrogen cream 0.5 g daily for 2 weeks.
- Thereafter 0.5 g twice weekly for maintenance.
- Vaginal lubricants during intercourse.
- Adequate hydration and genital hygiene.
Endometriosis
Clinical Features
- Chronic pelvic pain
- Progressive dysmenorrhea
- Dyspareunia
- Infertility
- Pain during defecation
- Pain during menstruation
Treatment
- Mefenamic Acid 500 mg orally three times daily.
- Combined Oral Contraceptive Pills continuously.
- Dienogest 2 mg orally once daily.
- Gynecology referral if symptoms persist.
Functional Ovarian Cyst
Clinical Features
- Lower abdominal pain
- Pelvic discomfort
- Irregular menstruation
- Often asymptomatic
- Adnexal fullness on examination
Treatment
- Observation in most cases.
- Ibuprofen 400 mg orally three times daily for pain.
- Follow-up ultrasound as advised.
- Surgical referral if large or persistent.
Mittelschmerz (Ovulation Pain)
Clinical Features
- Mid-cycle pelvic pain
- Usually unilateral pain
- Short duration pain
- Mild spotting occasionally
Treatment
- Paracetamol 500–650 mg orally three times daily.
- Ibuprofen 400 mg orally three times daily if required.
- Reassurance.
Infertility (Anovulatory)
Clinical Features
- Failure to conceive after one year
- Irregular menstrual cycles
- Features of PCOS may be present
- Absent ovulation
Treatment
- Letrozole 2.5–5 mg orally daily from Day 2–6 of cycle.
- Alternative: Clomiphene Citrate 50 mg orally daily from Day 2–6.
- Weight reduction in obese women.
- Further infertility evaluation if unsuccessful.
Iron Deficiency Anemia due to Menorrhagia
Clinical Features
- Fatigue
- Weakness
- Pallor
- Breathlessness on exertion
- Heavy menstrual bleeding history
Treatment
- Ferrous Ascorbate equivalent to 100 mg elemental iron once or twice daily.
- Folic Acid 5 mg orally once daily.
- Diet rich in iron.
- Treat underlying cause of bleeding.
Chronic Pelvic Pain
Clinical Features
- Pelvic pain lasting more than 6 months
- Dyspareunia
- Backache
- Pain unrelated to menstruation
- May affect daily activities
Treatment
- Ibuprofen 400 mg orally three times daily.
- Paracetamol 650 mg orally three times daily.
- Investigate and treat underlying cause.
- Gynecology referral if persistent.
Bartholin Cyst
Clinical Features
- Vulval swelling
- Usually painless
- Discomfort while walking
- Discomfort during intercourse
Treatment
- Warm sitz bath several times daily.
- Paracetamol 500–650 mg orally three times daily if painful.
- Observation for small asymptomatic cysts.
- Gynecology referral if persistent.
Bartholin Abscess
Clinical Features
- Painful vulval swelling
- Difficulty walking
- Difficulty sitting
- Fever may be present
- Tender fluctuant swelling
Treatment
- Amoxicillin-Clavulanate 625 mg orally three times daily for 5–7 days.
- Paracetamol 650 mg orally three times daily.
- Incision and drainage if abscess present.
- Warm sitz bath.
Genital Herpes
Clinical Features
- Painful genital ulcers
- Burning sensation
- Fever
- Inguinal lymphadenopathy
- Recurrence may occur
Treatment
- Acyclovir 400 mg orally three times daily for 7–10 days.
- Adequate hydration.
- Avoid sexual contact during active lesions.
- Counsel regarding recurrence.
Genital Warts
Clinical Features
- Multiple genital growths
- Cauliflower-like lesions
- Itching
- Discomfort during intercourse
- Usually painless
Treatment
- Podophyllotoxin 0.5% solution applied twice daily for 3 days.
- Repeat cycles as advised.
- Cryotherapy if required.
- HPV vaccination counseling.
Menopausal Syndrome
Clinical Features
- Hot flushes
- Night sweats
- Mood changes
- Sleep disturbances
- Vaginal dryness
- Reduced concentration
Treatment
- Venlafaxine 37.5–75 mg orally once daily.
- Hormone Replacement Therapy where indicated.
- Regular exercise.
- Adequate calcium and vitamin D intake.
- Lifestyle modification.
Postmenopausal Bleeding
Clinical Features
- Any vaginal bleeding occurring after menopause
- Spotting or frank bleeding
- May be associated with endometrial pathology
- Possible weight loss or pelvic pain in malignancy
Treatment
- Urgent gynecological evaluation.
- Transvaginal ultrasonography.
- Endometrial biopsy if indicated.
- Treatment depends upon underlying cause.
Vaginal Discharge Syndrome
Clinical Features
- Abnormal vaginal discharge
- Vaginal itching
- Foul smell
- Burning sensation
- Dyspareunia
Treatment
- Cefixime 400 mg orally single dose.
- Azithromycin 1 g orally single dose.
- Metronidazole 2 g orally single dose.
- Partner treatment when STI suspected.
Chronic Cervicitis
Clinical Features
- Persistent vaginal discharge
- Post-coital bleeding
- Pelvic discomfort
- Inflamed cervix on examination
Treatment
- Doxycycline 100 mg orally twice daily for 7 days.
- Alternative: Azithromycin 1 g orally single dose.
- Treat sexual partner if STI suspected.
Mastalgia (Breast Pain)
Clinical Features
- Breast pain
- Cyclical or non-cyclical pain
- Breast tenderness
- Discomfort affecting daily activities
Treatment
- Paracetamol 650 mg orally three times daily.
- Ibuprofen 400 mg orally three times daily.
- Proper breast support.
- Reduce caffeine intake.
Fibroid Uterus
Clinical Features
- Heavy menstrual bleeding
- Pelvic pressure
- Pelvic pain
- Infertility
- Abdominal lump in large fibroids
Treatment
- Tranexamic Acid 500 mg–1 g orally three times daily during bleeding.
- Mefenamic Acid 500 mg orally three times daily.
- Iron supplementation if anemia present.
- Surgical referral when indicated.
Pelvic Organ Prolapse
Clinical Features
- Mass protruding per vagina
- Pelvic heaviness
- Difficulty in urination
- Backache
- Discomfort while walking
Treatment
- Pelvic floor exercises.
- Vaginal pessary insertion.
- Treat chronic cough and constipation.
- Gynecological surgery when required.
Vaginismus
Clinical Features
- Pain during attempted intercourse
- Involuntary vaginal muscle spasm
- Difficulty with vaginal examination
- Fear of penetration
Treatment
- Counseling and reassurance.
- Pelvic floor physiotherapy.
- Graduated vaginal dilator therapy.
- Sex therapy when indicated.
Dyspareunia
Clinical Features
- Pain during sexual intercourse
- Burning sensation
- Pelvic pain
- Vaginal dryness
Treatment
- Treat underlying cause.
- Water-based lubricants.
- Vaginal estrogen in postmenopausal women when indicated.
- Counseling and reassurance.
Adenomyosis
Clinical Features
- Heavy menstrual bleeding
- Progressive dysmenorrhea
- Chronic pelvic pain
- Enlarged tender uterus
Treatment
- Mefenamic Acid 500 mg orally three times daily.
- Tranexamic Acid 500 mg–1 g orally three times daily during menstruation.
- Hormonal therapy when indicated.
- Gynecology referral.
Amenorrhea
Clinical Features
- Absence of menstruation
- Infertility
- Weight changes
- Hormonal disturbances
- Possible galactorrhea
Treatment
- Identify and treat underlying cause.
- Correct nutritional deficiencies.
- Hormonal therapy depending on etiology.
- Referral for endocrine evaluation if required.
Oligomenorrhea
Clinical Features
- Infrequent menstrual periods
- Cycles longer than 35 days
- Often associated with PCOS
- Subfertility
Treatment
- Weight reduction if overweight.
- Combined Oral Contraceptive Pills for cycle regulation.
- Metformin 500 mg once daily gradually increased to 500 mg three times daily in PCOS.
- Treat underlying cause.
Hyperprolactinemia
Clinical Features
- Amenorrhea
- Galactorrhea
- Infertility
- Headache
- Visual disturbances in pituitary tumors
Treatment
- Cabergoline 0.25 mg orally twice weekly.
- Alternative: Bromocriptine 1.25–2.5 mg orally daily.
- MRI pituitary if indicated.
- Endocrinology referral.
Premature Ovarian Insufficiency
Clinical Features
- Amenorrhea before 40 years
- Hot flushes
- Night sweats
- Infertility
- Vaginal dryness
Treatment
- Hormone Replacement Therapy where appropriate.
- Calcium supplementation.
- Vitamin D supplementation.
- Fertility counseling.
Leukorrhea
Clinical Features
- White vaginal discharge
- May be physiological or pathological
- Associated itching in infections
- Foul smell may be present
Treatment
- Treat underlying cause.
- Maintain genital hygiene.
- Antifungal or antibiotic therapy when indicated.
- Patient education and reassurance.
Recurrent Vulvovaginal Candidiasis
Clinical Features
- Repeated episodes of vaginal itching
- White curdy discharge
- Burning sensation
- Multiple recurrences per year
Treatment
- Fluconazole 150 mg orally on Days 1, 4 and 7.
- Maintenance Fluconazole 150 mg once weekly for 6 months.
- Control diabetes if present.
- Maintain genital hygiene.
Chronic Vulvitis
Clinical Features
- Persistent vulval itching
- Redness
- Burning sensation
- Skin excoriation
Treatment
- Avoid irritants and allergens.
- Topical emollients.
- Treat fungal or bacterial infection if present.
- Gynecology referral if persistent.
