Menstrual & Gynaecological Disorders

Heavy Menstrual Bleeding and Period Pain: A Stepwise Toolkit

Two women sit in the same waiting room with the two commonest gynaecological complaints there are. One floods through pads every hour and is tired to the bone from the slow anaemia it causes. The other is doubled over on day one of every period, missing school and work. Both problems trace back, in large part, to the same small family of molecules — prostaglandins — and both have clean, evidence-based drug ladders. Learn the mechanisms and the whole management falls into place: an antifibrinolytic for the clot, an NSAID for the prostaglandin, and one small hormonal device that quietly solves both.

Endometriosis and Fibroids: Starving Oestrogen-Driven Disease

Two of the commonest reasons a woman is told her pain or her bleeding is "just part of being a woman" turn out to share one master switch: oestrogen. Endometrial tissue that has strayed outside the uterus, and knots of smooth muscle that grow inside its wall, are both fed by the same hormone that drives the normal cycle. That single fact hands us the entire treatment strategy — not to cut the disease out first, but to starve it. Lower the oestrogen, or block it, and the tissue quietens, the bleeding settles, the fibroid shrinks. The art is doing that without inflicting a premature menopause on a young woman.

PCOS and Hyperandrogenism: Treating by the Problem, Not the Diagnosis

Polycystic ovary syndrome frustrates students because it refuses to behave like a normal disease. There is no single pill that "cures" it, no one drug on every exam answer. That is because PCOS is not one problem but four that travel together — irregular periods, unwanted hair and acne, insulin resistance, and difficulty conceiving — and each is treated by a different lever. The trick is to stop asking "what is the treatment for PCOS?" and start asking "what does this particular woman most want fixed?" Answer that, and the pharmacology falls into place.

Menopause and HRT: Balancing Benefit and Risk

Few prescriptions have swung so violently between fashion and fear as hormone replacement therapy. For a generation it was handed out almost as an anti-ageing tonic; then one landmark trial in 2002 emptied the clinics almost overnight, and a cohort of women was left to sweat through the change untreated. The truth, as usual, was more subtle than either extreme. HRT is neither a poison nor a fountain of youth — it is oestrogen deficiency treated with oestrogen, tempered by a few rules about who has a uterus, which route you choose, and when you start. Master those rules and you can give a woman back her sleep, her comfort and her bones, while keeping the small risks genuinely small.