Content Objective: Gynecological Care

By the end of the Family Medicine Clerkship, the medical student will be able to:

Menstrual Irregularities

1. Conduct a patient-centred interview and appropriate focused physical examination to identify menstrual irregularities and their causes:
   • Amenorrhea (primary causes versus secondary causes including social factors pregnancy, endocrine, outflow/uterine disorders)
   • Menorrhagia (including inherited bleeding disorders and structural lesions)
   • Dysmenorrhea
     • Identify potential medical and social risk factors
2. Assess the impact of the menstrual irregularity on quality of life.
3. Suggest appropriate investigations and rule out pelvic infections, pregnancy, tumours, GU or GI causes in a timely fashion.
4. Develop an evidence-based treatment plan for menstrual irregularities which includes lifestyle counselling, non-pharmacological and pharmacological modalities.
5. In considering the initiation of a contraception method, obtain an appropriate medical and sexual history (e.g. migraines, unprotected intercourse, smoking, depression, contraindications for common contraceptive methodologies.)
6. Be able to list and explain the absolute contraindications for hormonal contraception.
7. Counsel patients on contraceptive options including:
   1. consideration of patient preferences and values
   2. risks and side effects
   3. contraceptive methods and devices, both permanent and non-permanent
   4. benefits & relative efficacy
   5. barriers to access (e.g. cost)
   6. proper use including initiation
   7. potential drug interactions
   8. emergency contraception
8. Counsel patients on STI prevention and screen when appropriate
9. Describe the role of family physicians in caring for patients with unintended pregnancy.
10. Conduct a patient-centred interview and focused physical exam to assess for signs and symptoms of menopause.
11. Elicit possible menopausal associated conditions such as mood disorder, sleep disturbance, etc.
12. Develop a management plan for a patient with menopause with investigations, if needed, and treatment modalities ensuring no contraindications exist.
13. Counsel menopausal women about preventative health measures (osteoporosis, mammography—see Preventive Health Care).

Mandatory Clinical Encounter

• Contraception counselling

Resources*

• Abnormal Uterine Bleeding in Pre-menopausal Women, SOGC Clinical practice guideline 2013
• Contraception clinical card, LearnFM
• Contraception pearls for practice, Dalhousie Academic Detailing Service 2015
• Menopause clinical card, LearnFM
• Managing Menopause, SOGC clinical practice guideline 2014

* Where a specific resource is not listed for a particular objective, please refer to recommended general texts/websites. Resources have often been selected from the Clinical Practice Guidelines and Protocols in British Columbia and Alberta’s Towards Optimized Practice Clinical Practice Guidelines. These are often concise summaries of national guidelines.