Obstetrics and gynaecology guidance material GM

1. Applicants who have undergone a major gynaecological operation shall be assessed as unfit. However, they may be assessed as fit after full recovery.
2. Pregnancy
   1. In the event of pregnancy, an applicant may continue to exercise their privileges until the end of the 26th week of gestation only if the Aeromedical Centre (AeMC) or Aeromedical Examiner (AME) considers that they are fit to do so.
   2. For holders of a class 1 medical certificate who are pregnant, an OML shall apply. Notwithstanding point MED.B.001, in that case, the OML may be imposed and removed by the AeMC or AME.
   3. An applicant may resume exercising their privileges after recovery following the end of the pregnancy.

CLASS 1 - AMC1 MED.B.045

(a) Gynaecological surgery
Applicants who have undergone a major gynaecological operation should be assessed as unfit. A fit assessment may be considered if recovery is complete, the applicant is asymptomatic, and the risk of secondary complication or recurrence is minimal.

CLASS 2 - AMC2 MED.B.045

(a) Gynaecological surgery
Applicants who have undergone a major gynaecological operation should be assessed as unfit until recovery is complete, the applicant is asymptomatic, and the risk of secondary complication or recurrence is minimal.

(b) Pregnancy

CLASS 1 - AMC1 MED.B.045

(1) A pregnant licence holder may be assessed as fit with an OML during the first 26 weeks of gestation, following review of the obstetric evaluation by the Aeromedical Centre (AeMC) or Aeromedical Examiner (AME) who should inform the medical assessor of the licensing authority.

(2) The AeMC or AME should provide written advice to the applicant and the supervising physician regarding potentially significant complications of pregnancy.

CLASS 2 - AMC2 MED.B.045

(1) A pregnant licence holder may be assessed as fit during the first 26 weeks of gestation following satisfactory obstetric evaluation.

(2) Licence privileges may be resumed upon satisfactory confirmation of full recovery following confinement or termination of pregnancy.

Polycystic Ovary Syndrome (PCOS)

Applicants with a diagnosis of polycystic ovary syndrome (PCOS) should inform the Authority (Class 1) or Aeromedical Examiner (AME) (Class 2). Ongoing medical certification is subject to a specialist gynaecologist report. This should include a cardiovascular and metabolic risk assessment and review of any symptoms of obstructive sleep apnoea (OSA). A diagnosis of cardiovascular, metabolic disease or OSA entails unfitness and risk factors should be addressed.

Hormone manipulation therapy is acceptable subject to confirmation of no side effects and adequate symptom control. Note: Metformin & thiazolidinediones are unlicensed for use in PCOS and may only be used in consultation with the Authority's Medical Department on a case-by-case basis.

Endometriosis

Applicants with a first diagnosis of endometriosis should be assessed as unfit. Recertification is considered subject to a specialist gynaecologist report. Recertification is considered if the applicant is symptom free, on minimal analgesics and/or has minimal side effects from hormone manipulation therapy. Surgery entails unfitness. (See below)

Menopause and Hormone Replacement Therapy (Appropriate to all certificate classes)

Applicants suffering symptoms of the menopause should consult their own GP or gynaecological specialist in the first instance, who should give consideration to whether treatment is appropriate or not. A potential side effect and cardiovascular risk review should be addressed as part of treatment option considerations.

Once a treatment and/or follow-up plan is instigated, the applicant should consult with their AME as to whether there are any current or predictable symptoms, particularly mental health and well-being, together with any common side effects of treatment experienced, that might affect the safe exercise of licence privileges. If such symptoms are experienced, and/or while treatment is commenced, a temporary period of grounding may be considered if necessary.

Gynaecological Surgery

The period of unfitness will vary according to the type of surgery and any post-operative complications. A minimum period of 1 week should elapse after a Dilatation and Curettage (D&C), 6 weeks after laparoscopic hysterectomy, 8 weeks after vaginal hysterectomy and 12 weeks after an abdominal hysterectomy. Laparoscopy involving insertion of gas in to the abdominal cavity may require 2 weeks prior to returning to flying. A gynaecological report should be obtained.

Menorrhagia

Applicants requiring specialist investigation for menorrhagia should be assessed as unfit. Recertification is considered subject to a satisfactory specialist gynaecologist report. The applicant should be symptom free and/or have minimal side effects from hormone manipulation therapy. Haemoglobin should be within normal limits. Surgery entails unfitness until symptom-free following recovery.

In Vitro Fertilisation

Applicants undergoing a first cycle of In Vitro Fertilisation (IVF) should be made unfit. Subsequent recertification may be considered subject to an acceptable specialist gynaecology / obstetric report. The report should confirm no evidence of continuing ovarian hyperstimulation or other associated side effects and intended future management plans including medication. If the cycle is successful, the Civil Aviation Authority (CAA) pregnancy guidance material should be followed, i.e., the applicant can be assessed as fit subject to confirmation of a healthy pregnancy supported by an acceptable medical report and continuing clinical follow-up plan.

Periods of unfitness for subsequent cycles should be determined according to the issues experienced during previous cycles. Applicants are advised to seek the advice of their specialist relating to the interaction of work activities on the likely outcomes. If previous cycles were uncomplicated and the treatment plan unchanged, then a period of unfitness from a flight safety perspective may not be necessary. Complex Class 1 and 3 applicant cases should be referred to the CAA.

Pregnancy 

Applicants should be advised to give a copy of the pregnancy information sheet for pilots and air traffic controllers to their midwife or doctor, for inclusion in their medical notes.

Miscarriage or Termination of Pregnancy

Applicants who suffer a miscarriage or have a termination of pregnancy should be assessed as unfit.

Recertification is considered subject to a GP or gynaecologist report. The report should confirm they have fully recovered, with no residual symptoms, a normal haemoglobin and comment on psychological status. Before returning to flying Class 1 applicants should undergo an assessment by their AME of their psychological state.