Login:
 

Symposium: Women's health

Investigating the cause of heavy menstrual bleeding

25 Mar 2019Registered users

Heavy menstrual bleeding has been defined as ‘excessive menstrual blood loss which interferes with a woman’s physical, social, emotional, and/or material quality of life’. Heavy menstrual bleeding affects 25% of women of reproductive age and is estimated to be the fourth most common reason for gynaecological referrals. Women should be asked about pelvic pain which might suggest endometriosis and pressure symptoms which might suggest significant fibroids. Examination is appropriate if there is intermenstrual or postcoital bleeding and, if the woman is actively bleeding, may identify the source of the bleeding.

Diagnosis and management of premenstrual syndrome

25 Mar 2019Registered users

The term premenstrual syndrome (PMS) refers to a constellation of mood and physical symptoms that occur during the luteal phase of the menstrual cycle. The National Association for Premenstrual Syndrome suggests that: ‘If PMS symptoms affect personal and/or social and/or professional quality of life then this should be regarded as being clinically significant PMS.’ Some women give a clear history of onset during the luteal phase of the menstrual cycle, with improvement taking place within a few days after the onset of menses. However, other women present with fluctuating symptoms without making a connection with their menstrual cycle. There are no diagnostic tests for PMS; diagnosis is dependent on the history. 

Symptom recognition key to diagnosing endometriosis

22 Mar 2018Registered users

Endometriosis affects around one in ten women of reproductive age in the UK. NICE guidance highlights the importance of symptoms in its diagnosis. A normal abdominal or pelvic examination, ultrasound, or MRI should not exclude the diagnosis. Endometriosis should be suspected in women and adolescents who present with one or more of: chronic pelvic pain, significant dysmenorrhoea, deep dyspareunia, period-related or cyclical GI or urinary symptoms, or infertility. If endometriosis is suspected or symptoms persist, patients should be referred for further assessment.

Managing osteoporosis in postmenopausal women

22 Mar 2018Paid-up subscribers

Most patients with osteoporosis are asymptomatic unless they suffer a fragility fracture. A fragility fracture is a type of pathological fracture that occurs as a result of normal activities, such as lifting, bending, or a fall from standing height or less. There are three fracture sites said to be typical of fragility fractures: vertebral fractures; fractures of the neck of the femur; and Colles' fracture of the wrist. Following fracture risk assessment a dual energy X-ray absorptiometry (DXA) scan may be recommended.

Tailor management to the patient with fibroids

22 Mar 2017Paid-up subscribers

Fibroids are benign, hormone-dependent tumours of uterine smooth muscle and connective tissue. They are commonly asymptomatic, but can cause symptoms such as heavy menstrual bleeding and pelvic pressure symptoms. Around 20 to 30% of women with heavy menstrual bleeding have fibroids. Fibroids are most prevalent in women aged 30-50 years and there may be a genetic predisposition. They are more common in black women than white women. Other risk factors include obesity and nulliparity. Asymptomatic women should only be referred if their uterus is palpable abdominally, if fibroids distort the uterine cavity or the uterus is larger than 12 cm in length.

Preventing stroke and assessing risk in women

22 Mar 2017Paid-up subscribers

Ischaemic stroke is rare in premenopausal women but risk increases with advancing age and doubles in the ten years following the menopause. Up to the age of 75 years men have a 25% higher risk of suffering a stroke compared with women. However, the increased life expectancy of women ultimately results in a higher overall incidence. Twice as many women die from stroke compared with breast cancer. Women with cerebrovascular disease are more likely to present with atypical symptoms than men. Atrial fibrillation and hypertension, although less common than in men, are more potent risk factors for stroke in women.

Managing debilitating menopausal symptoms

21 Mar 2016Paid-up subscribers

Severity and duration of menopausal symptoms varies markedly. Eight out of ten women experience symptoms and on average these last four years, with one in ten women experiencing symptoms for up to 12 years. Menopausal symptoms can begin years before menstruation ceases. A recent study found that women whose vasomotor symptoms started before the menopause suffered longest, median 11.8 years. Women whose hot flushes and night sweats started after the menopause had symptoms for a median of 3.4 years.

 

Clinical reviews: Obstetrics and gynaecology

Comparing incontinence rates following caesarean vs vaginal delivery of twins

23 Jan 2019Registered users

Urinary stress incontinence is more likely following vaginal than caesarean section (CS) delivery of twins, a multinational randomised controlled trial has shown.

Labour induction vs expectant management in nulliparous women

24 Sep 2018Registered users

Induction at term significantly reduced the Caesarean section rate, compared with expectant management, in low-risk nulliparous women in a large multicentre trial from the US. However, it did not confer any benefits in terms of perinatal outcomes.

Active surveillance vs immediate treatment for CIN2

25 Jun 2018Registered users

Active surveillance may be a suitable option in selected, particularly younger, women with CIN2, a systematic review and meta-analysis has concluded.

Bicarbonate for dystocia improves maternal and fetal outcomes

23 Apr 2018Registered users

Administering a drink of sodium bicarbonate dissolved in water to women with dystocia an hour before oxytocin treatment resulted in better outcomes for both mother and child, compared with standard oxytocin treatment alone, a small trial from Sweden has found.

Women with endometriosis at raised risk of ovarian cancer

22 Mar 2018Registered users

The risk of ovarian cancer is increased in women with endometriosis, a large cohort study from Scotland has shown. The study also found that women with endometriosis are likely to undergo more surgical procedures compared with women who do not have the condition.

Maternal sleeping position may raise the risk of late stillbirth

22 Feb 2018Registered users

Pregnant women who went to sleep in a supine position had a two-fold increased risk of late stillbirth, a UK study has shown.

 

Special report 2014

Diagnosis and management of miscarriage

22 May 2014Paid-up subscribers

Miscarriage is the most common complication of pregnancy. It is defined as a pregnancy failure occurring before the completion of 24 weeks of gestation. It has been estimated that 10 to 15% of all pregnancies end in early spontaneous first trimester miscarriage i.e. before the end of the completed twelfth week of pregnancy. The risk of miscarriage decreases with increasing gestational age, and late miscarriages, from 12 to 24 weeks’ gestation, occur in only 1-4% of cases. While miscarriage is rarely associated with significant health problems, it can cause significant psychological distress to the woman and her partner. [With external links to the current evidence base]

 

Urinary incontinence

Improving the management of urinary incontinence

20 Mar 2014Paid-up subscribers

Urinary incontinence is a common condition that is likely to be under-reported. Its frequency increases with age, parity, high BMI, and associated comorbidities. The history should include the circumstances in which the incontinence occurs, the duration and how it affects the patient’s quality of life. The initial assessment should include enquiring for symptoms of urinary tract infection and carrying out a urine dipstick test. [With external links to the current evidence base]

Overactive bladder and irritable bowel syndrome often co-exist

24 Jun 2013Registered users

The link between overactive bladder (OAB) and irritable bowel syndrome (IBS) suggests that it is worth GPs asking about bowel symptoms when assessing patients with symptoms suggestive of OAB, a study from Japan concludes. The researchers investigated the prevalence of OAB and IBS using a large-scale internet-based survey. Questionnaires were sent to 10,000 patients, 5,000 men and 5,000 women, with 1,000 of each gender represented from each decade from 20-29 through to 60 and over. [With external links to the current evidence base]

Urinary incontinence in women: diagnosis and management

21 Mar 2010Registered users

Urinary incontinence can affect women of all ages. Incontinence may seriously influence the physical, psychological and social wellbeing of affected individuals, and the impact on the families and carers may also be profound. There are more than 3.5 million sufferers in the UK. [With external links to the current evidence base]

Improving compliance in overactive bladder syndrome

16 Feb 2010Registered users

Having a full discussion with patients, before commencing treatment, about the pros and cons of medications for overactive bladder (OAB) syndrome and the role of lifestyle measures could improve adherence to therapy. This was the conclusion of a survey conducted in the United States used families participating in a large nationwide market research panel of 600,000 households. [With external links to the current evidence base]

Anticholinergics can help improve bothersome overactive bladder symptoms

01 Oct 2009Registered users

This study is directly applicable to patients seen in primary care. It would suggest a safe strategy of initiating an alpha-blocker in patients with mixed storage and voiding symptoms, reviewing at 4-6 weeks, and adding an anticholinergic for those patients whose storage symptoms remain bothersome. It is always possible to trial removing the anticholinergic after a few months of bladder retraining, particularly to see if a placebo effect had a significant role, with therapy reintroduced if storage symptoms relapse. [With external links to the current evidence base]

 

Clinical reviews relating to women's health

Bipolar disorder associated with adverse outcomes in pregnancy

21 Feb 2013Paid-up subscribers

Babies of women with bipolar disorder are more likely to be born preterm, irrespective of whether the mother had received mood stabilising drugs, a Swedish cohort study has found. Infants whose mothers had untreated bipolar disorder had an increased risk of microcephaly and neonatal hypoglycaemia.

Statins are as beneficial in women as men

21 Mar 2012Paid-up subscribers

A large meta-analysis has shown that statins are just as effective in women as in men for reducing cardiovascular events and all-cause mortality. The analysis included 141,235 patients, 40,275 of whom were women, from studies such as JUPITER, ALLHAT-LLT, ASCOT-LLA, the Heart Protection Study, PROVE-IT and TNT.

Use of SSRIs in pregnancy increases risk of persistent pulmonary hypertension in the newborn

21 Mar 2012Paid-up subscribers

A population-based cohort study from the Nordic countries has found that women who take SSRIs during the second half of pregnancy are more than twice as likely to give birth to children with persistent pulmonary hypertension of the newborn (PPHN). However, the absolute risk remains very low. Data were obtained from national registers of births, deaths and dispensed prescriptions. Exclusion criteria were multiple births and a gestational age of less than 33 weeks. More than 1.6 million infants, born between 1996 and 2007, were included in the study.

Which women with GDM are at risk of future diabetes?

24 Jan 2012Paid-up subscribers

Impaired glucose tolerance, low HDL cholesterol and age > 35 were the strongest predictors of developing diabetes in women with gestational diabetes mellitus (GDM), a study from Vienna has found. Commenting on the study, Dr Chris Barclay, GP with an interest in O&G, Suffolk, writes: ' The development of type 2 diabetes appears to be a continuously progressive process which can last for years or even decades. The metabolic stress of pregnancy appears to unmask this tendency temporarily, even though most women will become euglycaemic after delivery. The underlying metabolic disorder for many of these women will however continue to progress. GDM is an independent risk factor for diabetes. The opportunities for timely intervention and prevention here are obvious. Primary care is best placed to offer this help.'

 

Sexual health: women and men

Orgasm induced by non sexual behaviour

20 Dec 2018Registered users

Orgasm may be a neuropsychological process associated with diverse forms of stimulation, according to the findings of a study published in the International Journal of Sexual Health. The investigators analysed comments from 919 individuals who responded to an anonymous post in 2013 on the website PostSecret.com. The individual, unknown to the research team, described having an orgasm during exercise. The respondents posted comments about their own experiences of non genital/non sexual orgasms.

GP training programme improves HIV testing rates

22 Nov 2018Registered users

Sexual Health in Practice (SHIP), an educational programme tailored to general practice, increased GPs’ rates of HIV testing.

Intrauterine device use associated with reduced risk of cervical cancer

22 Oct 2018Registered users

Women who had used an intrauterine contraceptive device (IUD) were found to have a lower risk of cancer of the cervix in a systematic review and meta-analysis.

Patients at risk of STIs not attending sexual health services

25 Jul 2018Registered users

More than 80% of women and nearly 90% of men who reported having unsafe sex in the past year did not consult sexual health services, findings from the third National Sexual Attitudes and Lifestyles (Natsal 3) study have shown.

Exploring the barriers to fitting IUCDs in primary care

25 Jun 2018Registered users

A general practice study has revealed a reluctance among GPs and practice nurses to fit intrauterine contraceptive devices (IUCDs). An online survey was sent to 69 practices in the south east of England and 208 individuals responded. More than two-thirds of the respondents were GPs and nearly a third were nurses. When asked about statements relating to potential barriers to providing or recommending IUCDs, respondents who were not trained to fit IUCDs were more likely to identify with more barriers than those who had been trained.

Composition of vaginal microbiota may increase risk of chlamydia infection

22 May 2018Paid-up subscribers

 Lactobacillus iners-dominated vaginal microbiota was associated with increased susceptibility to Chlamydia trachomatis infection in women, in a Dutch nested case-control study.

Self-taken swabs can detect bacterial vaginosis and candidiasis

23 Jan 2018Registered users

Lower vaginal swabs taken by patients are as reliable as high vaginal swabs taken by clinicians for the detection of vulvovaginal candidiasis or bacterial vaginosis, a UK study has shown.

Dyspareunia in women associated with physical and mental health conditions

23 Nov 2017Paid-up subscribers

The third National Survey of Sexual Attitudes and Lifestyles in Britain (Natsal-3) has found a strong association between women reporting painful sex and poor physical health and depressive symptoms.

Chlamydia and HIV testing for young people in primary care

22 Jun 2017Registered users

Young men and women would be happy to be offered chlamydia screening, contraception and HIV tests from GPs, a UK study has shown.

 

Photoguide

Pregnancy related conditions

21 Feb 2011Registered users

  • Superficial thrombophlebitis
  • Polymorphic eruption of pregnancy
  • Chloasma
  • Naevi
  • Jaundice
 

Special reports

Early treatment vital in pelvic inflammatory disease

23 Apr 2018Registered users

Pelvic inflammatory disease (PID) is caused by infection ascending from the cervix. It can affect the uterus, fallopian tubes, ovaries, and peritoneum. Important sequelae include infertility, ectopic pregnancy and tubo-ovarian abscess. PID is associated with sexually transmitted infections. These are more prevalent in younger women. A diagnosis of PID should be considered in any sexually active woman with recent onset pelvic pain associated with tenderness on bimanual examination where other differentials have been excluded. Delay in commencing treatment for PID has been shown to increase the risk of long-term complications.

Diagnosis and management of miscarriage

22 May 2014Paid-up subscribers

Miscarriage is the most common complication of pregnancy. It is defined as a pregnancy failure occurring before the completion of 24 weeks of gestation. It has been estimated that 10 to 15% of all pregnancies end in early spontaneous first trimester miscarriage i.e. before the end of the completed twelfth week of pregnancy. The risk of miscarriage decreases with increasing gestational age, and late miscarriages, from 12 to 24 weeks’ gestation, occur in only 1-4% of cases. While miscarriage is rarely associated with significant health problems, it can cause significant psychological distress to the woman and her partner. [With external links to the current evidence base]

Identifying patients at risk of perinatal mood disorders

23 May 2012Paid-up subscribers

In perinatal mental illness not only does the patient suffer, but obstetric outcomes, mother-baby interactions and hence longer term emotional and cognitive development of the child are also affected. Perinatal mental illness also has an impact on other family members. The UK Confidential Enquiry into Maternal and Child Health has consistently found psychiatric disorders to be one of the leading causes of maternal death, often through suicide. Postnatal depression and puerperal psychosis are two disorders most commonly associated with the perinatal period: the first, because of its high prevalence, 13% in the first few months following birth, the second because of its potentially disastrous consequences, including suicide, neglect of the baby and infanticide. [With external links to the current evidence base]

Improving early detection of ovarian cancer

22 Jun 2011

Ovarian cancer is the fifth most common cancer in women. The incidence has increased over the past 20-25 years, particularly in the 65 and over age group. The outcome for women with ovarian cancer is generally poor, with an overall five-year survival rate of less than 35%. The survival rates for women with ovarian cancer in the UK are significantly lower than the European average. Despite recommendations, published by NICE in 2005, on referral of patients with suspected cancer, the majority of women diagnosed with ovarian cancer are not electively referred via the ovarian cancer two-week pathway. They are often referred to the wrong specialty or present as emergencies. NICE has now published a clinical guideline on the diagnosis and initial management of ovarian cancer.  [With external links to current evidence and summaries]