Presentations
- Altered mood
- Delayed or incomplete puberty
- Depression
- Fatigue
- Genito-urinary symptoms
- Hirsutism
- Infertility
- Loss of libido
- Menstrual disturbance
- Sexual dysfunction
- Vasomotor symptoms
- Virilisation
Conditions
- Hyperandrogenism:
- Menopause:
- Polycystic ovarian syndrome (PCOS)
- Premenstrual syndrome:
- premenstrual dysphoric disorder
- Primary amenorrhea:
- cancer survivorship
- central:
- isolated GnRH deficiency
- Kallman syndrome
- pituitary dysfunction
- functional
- outflow tract disorders
- Secondary amenorrhea:
- functional hypothalamic amenorrhoea
- eating disorders
- exercise
- weight fluctuations
- ovarian dysfunction:
- autoimmune polyendocrinopathy
- chemotherapy
- ovarian tumours
- premature ovarian insufficiency:
- fragile X
- gonadal dysgenesis
- Turners syndrome
- radiation
- pituitary dysfunction:
- hyperprolactinaemia
- immunotherapy-related hypophysis
- infiltrative disease:
- histiocytosis
- Langerhans
- lymphoma
- malignancy
- sarcoidosis
- other endocrinopathies
- other tumours
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Congenital adrenal hyperplasia (non-classic)
- Infertility
- Malignancy:
- germ cell tumours
- ovarian tumours
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Pathophysiology
- Normal stages of pubertal development
- Regulation of the hypothalamic-pituitary-gonadal axis and hormonal variations in the menstrual cycle and menopause
Diagnostic work up
- Aetiology, pathology, and clinical manifestations of hypogonadism:
- evaluation of oestrogen-dependent and oestrogen-independent amenorrhoea
- Evaluation of delayed puberty, constitutional and pathological
- Evaluation of menopausal symptoms
- Impact of environmental, psychological, and comorbid conditions on the HPG axis:
- determine when hormonal replacement is and when it is not indicated
- Principles of assessing ovarian reserve and fertility preservation in elective and oncology cases
- Thorough history, physical examination and diagnostic work up of patient presenting with disorders of sexual development (e.g., delayed puberty), anovulation and/or infertility
Treatment
- Consideration of contraceptive needs
- Hormone deprivation therapy (often treatment of breast or ovarian cancer):
- bone preservation
- cardiovascular risk mitigation
- endocrine disruptors of the reproductive axis
- symptom management
- Hormone replacement therapy, including menopausal hormonal therapy (MHT) and monitoring
- Indications, contraindications and appropriate prescribing of hormone replacement therapy for patients in different life stages including, knowledge of pubertal induction
- Monitoring of hormone replacement therapy and its potential complications with dose and route of administration adjustment as needed
- Non-hormonal management of menopause
- Preventative screening as needed:
- bone health
- breast
- cardiovascular
- Treatment options for PCOS including ovulation induction and basic principles of artificial reproduction therapies (ART)
Investigations
-
Knowledge of timed measurement of reproductive hormones in relation to the menstrual cycle
-
Karyotype and genetic testing as applicable
-
Laboratory biochemistry:
- dynamic testing (e.g., short Synacthen in non-classic-CAH)
- specific understanding of the timing, patient preparation and assay platforms suited for sex steroid analysis and interfering factors
-
Radiology:
- bone mineral density
- MRI
- ultrasound
Procedures
- When indicated, facilitate referrals for:
- assisted reproduction services
- fertility preservation services
- peri-implantation genetic testing
Evidence-based practice
- Remain abreast of evidence for best practice and apply this using clinical judgement and individual circumstances in partnership with patients
General management considerations
- Impact of sexual dysfunction, infertility and/or genetic diagnoses on the patient, their partner and, where applicable, their family and carers:
- consider the sociocultural impact of infertility
- Impact of socioeconomic factors on equitable access to fertility preservation and treatment services
- Incorporate environmentally sustainable practices in clinical care
- Menopause management in the complex patient:
- premature ovarian insufficiency
- previous breast cancer
- prothrombotic comorbidities:
- deep vein thrombosis
- pulmonary embolism
- Referrals and access to genetic, sexual, and relationship counselling
- Referral for oocyte preservation prior to planned treatment potentially resulting in premature ovarian insufficiency (POI) or at diagnosis of POI with low AMH with residual oocytes
Health needs of specific patient groups
- Care of hormone deprivation therapy recipients
- Endocrine care of women with pituitary or adrenal dysfunction through pregnancy, labour, and postpartum
- Ethical considerations in discussing fertility preservation procedures with adolescents and their family
- Longitudinal and multidisciplinary care needs of women with genetic conditions such as Turner syndrome, such as:
- cardiovascular risk screening and mitigation
- collaboration with:
- counselling services
- education services
- primary care providers
- Screening in cancer survivorship
