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3) Rayman RB, Hastings JD, Kruyer WB, Levy RA. Clinical Aviation Medicine.
3rd Edition.Castle Connolly Graduate Medical Publishing. New York. 2000
ICAO Preliminary Unedited Version — November 2009 III-6-20
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ICAO Preliminary Unedited Version — November 2009
Part III
Chapter 7. GYNAECOLOGY AND OBSTETRICS
Page
INTRODUCTION ........................................................................................... III-7-1
GYNAECOLOGICAL DISORDERS ............................................................ III-7-1
Menstrual disturbances .............................................................................. III-7-1
Dysmenorrhoea .................................................................................... III-7-1
Pre-menstrual syndrome ....................................................................... III-7-1
Endometriosis ............................................................................................. III-7-1
Gynaecological surgery .............................................................................. III-7-2
PREGNANCY ................................................................................................. III-7-2
Pilots and pregnancy ................................................................................... III-7-2
Air traffic controllers and pregnancy .......................................................... III-7-4
Termination of pregnancy ........................................................................... III-7-4
ICAO Preliminary Unedited Version — November 2009 III-7-1
INTRODUCTION
In assessing gynaecological problems and pregnancy in relation to medical certification, the medical
examiner should be familiar with the ways in which such conditions can affect the female applicant in the
carrying out of her duties.
The guidance material contained in this chapter does not have any regulatory status; its main purpose is to
aid in the implementation of Annex 1 provisions.
GYNAECOLOGICAL DISORDERS
MENSTRUAL DISTURBANCES
The provisions of Annex 1 state, for all classes of Medical Assessments, that:
6.3.2.18 (6.4.2.18, 6.5.2.18) Applicants with renal or genito-urinary disease shall be assessed as unfit, unless adequately
investigated and their condition found unlikely to interfere with the safe exercise of their licence and rating privileges
Dysmenorrhoea is a common condition with symptoms ranging from mild discomfort to severe
abdominal pain, headache and backache, nausea and vomiting, diarrhoea, dizziness and fatigue. Usually,
the condition is limited to 24-48 hours around the onset of the menstrual flow, and fitness for aviation
duties is rarely reduced to a significant degree. Treatment with oral contraceptives and NSAIDs (nonsteroidal
anti-inflammatory drugs) is very efficient and is generally well tolerated. The use of oral
contraceptives is acceptable in the aviation environment, but when medication with an NSAID is first
used, an initial off-duty trial should take place so that the medical examiner can ascertain that there are no
significant side effects such as gastro-intestinal symptoms, visual disturbances and drowsiness. In severe
cases, especially when an underlying disease such as endometriosis or pelvic inflammatory disease is
suspected (secondary dysmenorrhoea), appropriate diagnostic evaluation is important and specialist
opinion should be sought.
Premenstrual syndrome (PMS) may occur during the week before the onset of menstruation. The
symptoms are partly mental such as mood swings, anxiety and depression, partly physical such as
bloating, headache and poor coordination.
Because of the broad spectrum of symptoms and their varying severity and the many different kinds of
medication usually prescribed, each case has to be assessed on its own merits. In most cases
pharmaceutical therapy will prove unsatisfactory, and fitness for aviation duties is often reduced for a
number of days every month.
ENDOMETRIOSIS
Although a benign disease, endometriosis can cause quite severe discomfort such as lower abdominal or
suprapubic pain, usually just before or during the first days of the menstruation period. There are several
medical and surgical treatment options.
If symptoms are well controlled by oral contraceptives or mild analgesics, this condition is usually
compatible with aviation duties. Those who undergo surgical treatment with a successful outcome will
normally be cured and able to fly safely after a suitable period of recovery. The middle group, consisting
of patients with moderate symptoms but on medication and with decreased fitness several days per month,
ICAO Preliminary Unedited Version — November 2009 III-7-2
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Manual of Civil Aviation Medicine 2(7)
