How women's health is examined
Women's health is 12.5% of the AMC MCQ blueprint, about 19 of 150 questions. Questions are usually set in general practice or the antenatal clinic, with some in the birth suite or emergency department. Expect timing questions (which test at which week), safety questions (which medicine in pregnancy) and recognition of obstetric emergencies.
Antenatal care by week
| Timing | Routine care |
|---|---|
| First visit (ideally before 10 weeks) | Blood group and antibodies, FBC, rubella and varicella immunity, syphilis, HIV, hepatitis B and C, urine culture, offer chlamydia test, cervical screening if due, discuss aneuploidy screening options |
| 10 to 14 weeks | Combined first-trimester screening or cell-free DNA (NIPT) if chosen; dating ultrasound |
| 18 to 20 weeks | Morphology ultrasound |
| 24 to 28 weeks | 75 g oral glucose tolerance test for gestational diabetes; FBC |
| 28 and 34 weeks | Routine anti-D for RhD-negative women |
| 35 to 37 weeks | Group B streptococcus screening (or risk-based approach by local policy) |
Recommended vaccines in pregnancy are influenza (any trimester), pertussis (ideally 20 to 32 weeks of each pregnancy) and RSV vaccine or infant immunisation according to the current program. Live vaccines are avoided.
From the Australian Pregnancy Care Guidelines and the Australian Immunisation Handbook. Schedules vary slightly between states and change over time.
Pregnancy complications
- Hypertension and pre-eclampsia: blood pressure 140/90 or more after 20 weeks with proteinuria or organ involvement. Low-dose aspirin from before 16 weeks for women at high risk. Severe hypertension needs urgent treatment; magnesium sulphate prevents eclamptic seizures; delivery is the cure.
- Gestational diabetes: diagnosed on a 75 g OGTT with fasting 5.1 or more, 1-hour 10.0 or more, or 2-hour 8.5 mmol/L or more. Diet first, then insulin or metformin. Recheck with an OGTT after birth.
- Antepartum haemorrhage: painless bright bleeding suggests placenta praevia (no vaginal examination until excluded); painful bleeding with a tense uterus suggests abruption.
- Ectopic pregnancy: positive pregnancy test with pain or bleeding and no intrauterine pregnancy on ultrasound; unstable women need surgery.
- Preterm labour and PPROM: corticosteroids before 34 weeks, magnesium sulphate for neuroprotection before 30 weeks, and antibiotics after preterm rupture of membranes.
- Hyperemesis gravidarum: rehydrate, give thiamine before dextrose, and use antiemetics such as doxylamine-pyridoxine, metoclopramide or ondansetron.
Labour, birth and the postpartum period
- Postpartum haemorrhage: think of the 4 Ts (tone, trauma, tissue, thrombin). Uterine massage, oxytocin, IV access, tranexamic acid and escalation.
- CTG: know features of a normal trace and what makes it abnormal: baseline, variability, accelerations and decelerations.
- Shoulder dystocia: call for help, McRoberts manoeuvre and suprapubic pressure first.
- Perineal injury: recognise third- and fourth-degree tears that need repair in theatre.
- Postpartum: screen for perinatal depression with the Edinburgh Postnatal Depression Scale; discuss contraception before discharge.
- Breastfeeding: encourage and support; know which common medicines are compatible.
Contraception
| Method | Typical-use effectiveness | Key points |
|---|---|---|
| Etonogestrel implant | Over 99% | Lasts 3 years; irregular bleeding is the main side effect |
| Hormonal and copper IUDs | Over 99% | The copper IUD is also the most effective emergency contraception within 5 days |
| Combined pill or ring | About 93% | Avoid with migraine with aura, recent VTE, some cardiovascular risks and within 6 weeks postpartum if breastfeeding |
| Progestogen-only pill | About 93% | Suitable when oestrogen is contraindicated |
| Condoms | About 87% | Also protect against STIs |
Australia uses the UK Medical Eligibility Criteria (UKMEC) categories to judge safety. Long-acting reversible contraception (LARC) is promoted as first-line for most women.
Gynaecology
- Abnormal uterine bleeding: exclude pregnancy, check FBC and iron, and arrange pelvic ultrasound. The LNG-IUD is first-line for heavy menstrual bleeding without structural cause.
- Endometriosis: dysmenorrhoea, dyspareunia and subfertility. NSAIDs and hormonal therapy first; ultrasound or laparoscopy for diagnosis.
- PCOS: Rotterdam criteria (2 of 3). Manage weight, cycles, androgen symptoms and fertility; letrozole for ovulation induction.
- Postmenopausal bleeding: transvaginal ultrasound; an endometrium over 4 mm or persistent bleeding needs sampling.
- Menopause: menopausal hormone therapy is effective for vasomotor symptoms; women with a uterus need a progestogen as well.
- STIs and PID: test for chlamydia and gonorrhoea with NAAT; PID is treated with ceftriaxone, doxycycline and metronidazole.
Cervical and breast screening
The National Cervical Screening Program offers an HPV test every 5 years from age 25 to 74 for anyone with a cervix who has ever been sexually active. Self-collection is available to everyone eligible. HPV 16 or 18 positive results go straight to colposcopy; other HPV types depend on the reflex cytology result.
BreastScreen Australia invites women aged 50 to 74 for a mammogram every 2 years. A breast lump at any age needs triple assessment, not screening.
See our guide to Australian screening for all the national programs in one place.
Medicines in pregnancy and breastfeeding
| Avoid in pregnancy | Usually safe alternatives |
|---|---|
| ACE inhibitors and ARBs | Labetalol, nifedipine or methyldopa for hypertension |
| Warfarin | Low molecular weight heparin |
| Sodium valproate | Specialist review; lamotrigine or levetiracetam are often preferred |
| Isotretinoin and other retinoids | Topical treatments after specialist advice |
| Tetracyclines after 16 weeks | Penicillins and cephalosporins |
Folic acid 0.5 mg daily before conception and in early pregnancy (5 mg for higher-risk women), and iodine 150 micrograms daily, are recommended.
Bleeding and pain in early pregnancy
| Finding | Likely situation | Next step |
|---|---|---|
| Positive hCG, pain, no intrauterine pregnancy on ultrasound | Ectopic pregnancy until proven otherwise | Serial hCG and ultrasound if stable; surgery if unstable; methotrexate in selected women |
| Bleeding, closed cervix, live intrauterine pregnancy | Threatened miscarriage | Reassurance and review |
| Bleeding, open cervix | Inevitable or incomplete miscarriage | Expectant, medical (misoprostol) or surgical management |
| Very high hCG, hyperemesis, "snowstorm" ultrasound | Molar pregnancy | Evacuation and serial hCG follow-up |
Give anti-D to RhD-negative women after miscarriage or ectopic pregnancy as recommended, and remember that a pregnancy of unknown location needs follow-up until resolved.
Infections in pregnancy
- Group B streptococcus: intrapartum benzylpenicillin for colonised women or by risk factors, depending on local policy.
- Asymptomatic bacteriuria: screened at booking and treated, because it can progress to pyelonephritis.
- Rubella and varicella: live vaccines are given after birth to non-immune women; varicella exposure in a non-immune pregnant woman needs zoster immunoglobulin or antiviral treatment.
- Syphilis: screen at booking and again later in pregnancy in higher-risk groups and outbreak areas; benzathine penicillin treats it.
- CMV and toxoplasmosis: advise hand hygiene with young children's saliva and urine, and avoidance of undercooked meat and cat litter.
- Listeria: avoid high-risk foods such as soft cheeses, deli meats and pre-prepared salads.
Amenorrhoea, infertility and early menopause
- Secondary amenorrhoea: pregnancy test first, then FSH, LH, prolactin, TSH and androgens; common causes are pregnancy, PCOS, hypothalamic amenorrhoea and hyperprolactinaemia.
- Infertility: investigate after 12 months of trying, or 6 months if the woman is 35 or over: confirm ovulation, assess the tubes and arrange semen analysis.
- Premature ovarian insufficiency: loss of ovarian function before 40; hormone therapy is recommended until the average age of menopause for bone and heart health.
- Hyperprolactinaemia: check medicines (such as antipsychotics) and arrange pituitary imaging; cabergoline treats prolactinomas.
Gynaecological and breast cancers
| Cancer | Key presentation | Key fact |
|---|---|---|
| Cervical | Postcoital or intermenstrual bleeding | Examine and test regardless of screening history; HPV vaccination and screening prevent most cases |
| Endometrial | Postmenopausal bleeding | Risk rises with obesity, unopposed oestrogen, tamoxifen and Lynch syndrome |
| Ovarian | Persistent bloating, early satiety, pelvic pain | CA-125 and ultrasound; BRCA carriers are offered risk-reducing surgery |
| Breast | Lump, skin or nipple change | Triple assessment; BreastScreen from 50 to 74 |
Termination of pregnancy and consent
Termination of pregnancy is lawful in every Australian state and territory, with different gestational limits and requirements. Early medical termination with mifepristone and misoprostol can be prescribed by registered prescribers in primary care. A doctor with a conscientious objection must tell the patient and refer or provide information so access is not obstructed, and must still provide emergency care.
Worked examples
Worked example 1 · Antenatal care
A 31-year-old woman at 26 weeks has a 75 g OGTT with fasting glucose 5.3 mmol/L, 1-hour 9.6 and 2-hour 8.0 mmol/L. What is the correct interpretation?
- A Normal result, no follow-up needed
- B Gestational diabetes on the fasting value
- C Impaired glucose tolerance only
- D Repeat the test at 36 weeks
- E Pre-existing type 2 diabetes
Show the reasoning
Answer B. Using the Australian (ADIPS) criteria, one abnormal value is enough: fasting 5.1 or more, 1-hour 10.0 or more, or 2-hour 8.5 mmol/L or more. Her fasting value of 5.3 meets the threshold, so she has gestational diabetes.
Worked example 2 · Contraception
A 24-year-old woman with migraine with aura asks for contraception. She wants the most effective reversible method. What is most appropriate?
- A Combined oral contraceptive pill
- B Vaginal ring
- C Etonogestrel implant
- D Fertility awareness methods
- E Condoms alone
Show the reasoning
Answer C. Migraine with aura is a contraindication to oestrogen-containing methods (UKMEC category 4) because of stroke risk. The implant is progestogen-only and over 99% effective, making it the best choice for her.
Common women's health traps
- Ordering an annual Pap smear instead of 5-yearly HPV screening from 25.
- Missing ectopic pregnancy by not checking hCG in a woman with abdominal pain.
- Doing a vaginal examination before excluding placenta praevia.
- Prescribing the combined pill to a woman with migraine with aura.
- Forgetting anti-D after a sensitising event in an RhD-negative woman.
Free sample women's health questions
Questions from our AMC MCQ bank. Choose your answer, then open the explanation.
A 23-year-old woman with severe nodulocystic acne that has not responded to topical therapy is referred to a dermatologist to consider oral treatment. She is sexually active and uses condoms inconsistently. The dermatologist emphasises the need for reliable contraception before, during and after one particular drug because it is classified as TGA pregnancy category X. Which medicine is this?
- ADoxycycline
- BSpironolactone
- CErythromycin
- DIsotretinoin
- EMinocycline
Show answer and explanation
Answer D. Isotretinoin is TGA category X because it is a potent teratogen causing craniofacial, cardiac, thymic and central nervous system malformations. Women must use effective contraception before, during and for at least 1 month after treatment, and pregnancy must be excluded before starting. Tetracyclines such as doxycycline and minocycline are category D.
Learning point: Isotretinoin is TGA category X; women need reliable contraception before, during and after treatment.
A 19-year-old woman with primary dysmenorrhoea asks why ibuprofen helps her period pain. She has read online that the pain comes from her uterus and wants to understand the cause. The cramping pain starts with bleeding and lasts 2 days. Her pelvic ultrasound is normal and she has regular ovulatory cycles. Which mechanism best explains her pain and the benefit of ibuprofen?
- AEndometrial prostaglandin release causing contractions
- BEndometrial glands invading the myometrial wall
- CExcess oxytocin secretion from the posterior pituitary
- DOestrogen deficiency causing myometrial spasm
- EEctopic endometrial tissue bleeding into the pelvis
Show answer and explanation
Answer A. In primary dysmenorrhoea, progesterone withdrawal at the end of an ovulatory cycle leads to release of endometrial prostaglandins, especially PGF2-alpha, causing myometrial hypercontractility, reduced blood flow and ischaemic pain. NSAIDs inhibit cyclo-oxygenase and prostaglandin production. Hormonal contraception helps by suppressing ovulation and thinning the endometrium.
Learning point: Primary dysmenorrhoea is driven by endometrial prostaglandin F2-alpha, which NSAIDs inhibit.
A 29-year-old woman with PCOS has been trying to conceive for 14 months. Her cycles occur every 60-90 days and mid-luteal progesterone confirms anovulation. Her BMI is 27 kg/m2 and she has already made lifestyle changes. Her partner's semen analysis is normal and HyCoSy shows patent tubes. What is the most appropriate first-line pharmacological treatment for ovulation induction?
- AGonadotrophin injections as first step
- BClomiphene citrate as monotherapy
- CMetformin as monotherapy
- DLetrozole in the follicular phase
- ELaparoscopic ovarian drilling first
Show answer and explanation
Answer D. The 2023 international PCOS guideline recommends letrozole as first-line pharmacological treatment for ovulation induction in anovulatory women with PCOS and no other infertility factors, due to higher ovulation, pregnancy and live birth rates than clomiphene. Treatment should be monitored with follicle tracking where available. Gonadotrophins and ovarian drilling are second-line, and IVF is third-line.
Learning point: Letrozole is first-line for ovulation induction in women with PCOS.
Practise more women's health questions free
Every women's health subtopic in our bank
The bank holds 386 women's health questions across 61 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- Abnormal uterine bleeding7
- Adenomyosis7
- Amenorrhoea7
- Amniotic fluid embolism5
- Aneuploidy screening8
- Antepartum haemorrhage8
- Bacterial vaginosis and candidiasis6
- Bartholin's abscess4
- Benign breast conditions7
- Booking visit & routine antenatal tests8
- Breast cancer presentations2
- Breast cancer screening and familial risk2
- Breastfeeding problems & mastitis6
- Cervical cancer5
- Chlamydia, gonorrhoea and trichomonas7
- Contraception10
- Cord prolapse5
- CTG interpretation6
- Dysmenorrhoea7
- Ectopic pregnancy7
- Endometrial cancer6
- Endometriosis7
- Fetal growth restriction8
- Fibroids7
- Genital herpes and warts6
- Gestational diabetes8
- Hypertension, pre-eclampsia & eclampsia8
- Induction of labour6
- Infections in pregnancy8
- Infertility work-up7
- Instrumental & caesarean delivery6
- Malpresentation & breech6
- Medications in pregnancy8
- Menopause and MHT7
- Miscarriage6
- Molar pregnancy5
- Multiple pregnancy8
- National Cervical Screening Program8
- Nausea & hyperemesis gravidarum7
- Normal labour stages & partogram6
- Ovarian cancer6
- Ovarian cysts and torsion6
- Pelvic inflammatory disease6
- Pelvic organ prolapse7
- Perinatal mental health screening5
- Perineal trauma5
- Polycystic ovary syndrome7
- Postnatal contraception6
- Postpartum haemorrhage6
- Postpartum infection & endometritis6
- Premenstrual disorders7
- Preterm labour & PPROM7
- Retained placenta5
- Rh isoimmunisation & anti-D8
- Sexual assault care5
- Shoulder dystocia5
- Termination of pregnancy6
- Urinary incontinence in women7
- Uterine rupture5
- VBAC5
- Vulval cancer4
Common questions
How many women's health questions are in the AMC MCQ?
Women's health (obstetrics and gynaecology) is 12.5% of the blueprint, about 19 of 150 questions.
When is gestational diabetes tested in Australia?
With a 75 g oral glucose tolerance test at 24 to 28 weeks, or earlier in women at high risk.
How often is cervical screening done in Australia?
An HPV test every 5 years from 25 to 74 if no HPV is detected. Self-collection is an option for everyone eligible.
When is routine anti-D given?
At 28 and 34 weeks to RhD-negative women, plus after sensitising events and after birth of an RhD-positive baby.
Sources
Clinical content is summarised from current Australian guidance at the date above. Guidelines change, so always check the latest edition.