Common gynaecological challenges – a primary care refresher

This presentation provides clinicians with a clear, up-to-date framework for tailoring heavy menstrual bleeding (HMB) management to individual patient needs.

This presentation will provide a practical overview of the contemporary management of heavy menstrual bleeding (HMB) in women across the reproductive lifespan. 

It will begin with an introduction to the FIGO PALM-COEIN classification system, outlining the structural and non-structural causes of abnormal uterine bleeding. Structural causes include polyp, adenomyosis, leiomyomapolyp, adenomyosis, leiomyoma, and malignancymalignancy/hyperplasia (PALM). Non). Non-structural causes include coagulopathy, ovulatorycoagulopathy, ovulatory dysfunction, endometrialendometrial disorders, Iatrogenic causes, and not-not-yet-classified conditions (COEIN).

The session will then explore evidence-based assessment and investigation strategies, including history, examination, imaging, and laboratory testing. Management options will focus on patient-centred care, considering symptom severity, fertility desires, comorbidities, and quality of life.

Medical treatment options discussed will include non-hormonal therapies such as tranexamic acid and NSAIDs, hormonal therapies including combined hormonal contraception, oral progestogens, and the levonorgestrel intrauterine device. Surgical options will include hysteroscopy, endometrial ablation, myomectomy, uterine artery embolisation, and hysterectomy. The presentation aims to provide clinicians with a clear, up-to-date framework for tailoring HMB management to individual patient needs.

Speaker: Dr Sneha Parghi - Joan Kirner Women's Centre

Dr Sneha Parghi is a specialist Gynaecologist VMO at Joan Kirner Womens and Childrens and Director of Maven Centre - a private practice dedicated to multidisciplinary gynaecological care. She is committed to providing compassionate, patient-centred care that empowers women to make informed decisions about their health and wellbeing. With extensive experience across leading public and private hospitals in Victoria and Queensland, she has developed expertise in the management of a broad range of gynaecological conditions, with a particular focus on minimally invasive surgical procedures, pelvic pain and endometriosis.

After graduating from the University of Adelaide in 2006, Dr Parghi worked in metropolitan, regional and international healthcare settings, including humanitarian work with Médecins Sans Frontières in Haiti. She completed specialist training in Obstetrics and Gynaecology and subsequently undertook advanced fellowship training in minimally invasive gynaecological surgery before attaining Fellowship of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).

In addition to her clinical work, Dr Parghi is passionate about teaching and mentoring medical students and specialist trainees, as well as advocating for environmental sustainability in healthcare. As a mother, clinician and advocate, she understands the importance of clear communication, shared decision-making and providing personalised care for every patient.

Learning outcomes:

By the end of this session, participants will be able to:

• Apply the FIGO PALM-COEIN classification system to identify and differentiate structural and non-structural causes of heavy menstrual bleeding.
• Compare and select appropriate medical and surgical management options for heavy menstrual bleeding, including their indications, benefits, limitations, and suitability for individual patients.
• Develop and implement an evidence-based, patient-centred management plan for heavy menstrual bleeding incorporating fertility goals, symptom burden, and quality-of-life considerations.