Symposium: Women's health

Tailor management to the patient with fibroids

22 Mar 2017Registered users

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. Between 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 2017

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 2016Registered users

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.

Be vigilant for perinatal mental health problems

23 Mar 2015Registered users

The postnatal period appears to be associated with higher rates of adjustment disorder, generalised anxiety disorder, and depression. Women who have a history of serious mental illness are at higher risk of developing a postpartum relapse, even if they have been well during pregnancy. Postnatal depression is more severe than baby blues, follows a chronic course and may relapse outside the perinatal period. Bipolar disorder may present as a first depressive episode in pregnancy or the postnatal period. In the postpartum period women have a high risk of severe relapse.

GPs have key role in early diagnosis of endometriosis

23 Mar 2015Registered users

Risk factors for endometriosis include early menarche, late menopause, delayed childbearing, vaginal outflow obstruction and a first-degree relative affected. Women commonly present to their GP with pelvic pain, painful intercourse or subfertility. Referral should be considered if pain is not controlled with simple analgesia or the diagnosis is suspected in a woman who is actively trying to conceive. Early referral should be considered in women with abnormal examination findings, or an abnormal ultrasound result.

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]

Detecting ovarian disorders in primary care

20 Mar 2014Paid-up subscribers

Ovarian cysts occur more often in premenopausal than postmenopausal women. Most of these cysts will be benign, with the risk of malignancy increasing with age. Symptoms which may be suggestive of a malignant ovarian cyst, particularly in the over 50 age group, include: weight loss, persistent abdominal distension or bloating, early satiety, pelvic or abdominal pain and increased urinary urgency and frequency. [With external links to the current evidence base]

Diagnosis and treatment of ectopic pregnancy

21 Mar 2013

The most common symptoms of ectopic pregnancy are pelvic or abdominal pain, amenorrhoea, missed period or abnormal period and vaginal bleeding. Women who are haemodynamically unstable, or in whom there is significant concern about the degree of pain or bleeding, should be referred directly to A&E, irrespective of the result of the pregnancy test. Stable patients with bleeding who have pain or a pregnancy of six weeks gestation or more or a pregnancy of uncertain gestation should be referred immediately to an early pregnancy assessment (EPA) service, or out-of-hours gynaecology service if the EPA service is not available. [With external links to the current evidence base]

Optimising the management of patients with infertility

21 Mar 2013Paid-up subscribers

Infertility affects around one in seven couples of reproductive age. The main causes of infertility are female factor (anovulation, tubal damage, endometriosis and ovarian failure), male factor (low or absent numbers of motile sperm in the ejaculate, and erectile dysfunction), or unexplained infertility. A woman of reproductive age who has not conceived after a year of regular sexual intercourse, and has no known cause of infertility, should be offered referral for further clinical assessment and investigation with her partner. [With external links to the current evidence base]


Clinical reviews: Obstetrics and gynaecology

Termination of pregnancy via telemedicine service safe and effective

22 Jun 2017Registered users

Women using an online telemedicine service for medical termination of pregnancy (MTOP) reported good outcomes, a study has found.Women using an online telemedicine service for MTOP reported good outcomes, a study has found. The study authors analysed data on all women from the Republic of Ireland and Northern Ireland who contacted the Women on Web telemedicine helpdesk, between January 2010 and December 2012. (In both countries termination is not available through the formal healthcare system except in restricted circumstances).

Gestational diabetes is on the increase

23 May 2017Paid-up subscribers

The prevalence of gestational diabetes mellitus (GDM) has been increasing over the past three decades, a large retrospective cohort study from the US has shown.

Uncomplicated menorrhagia can be effectively managed in primary care

24 Apr 2017Paid-up subscribers

A UK primary care study comparing the use of the levonorgestrel-IUS (LNG-IUS) with usual medical treatments for heavy menstrual bleeding (HMB) showed both to have very good outcomes.

Risk factors for antepartum stillbirth

22 Mar 2017Paid-up subscribers

Antepartum stillbirth is a complex syndrome associated with a range of risk factors, a prospective observational study has concluded.

Use of infant simulators does not reduce teenage pregnancies

15 Dec 2016Paid-up subscribers

Providing teenage girls with an infant simulator doll for a few days appeared to increase rather than decrease the risk of pregnancy, in a study from Western Australia.


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.'


The menopause and HRT

Postmenopausal bleeding should be referred urgently

21 Mar 2012

All women with postmenopausal bleeding should be referred urgently. Endometrial cancer is present in approximately 10% of cases. First-line investigation is a transvaginal ultrasound scan. A normal TVUS is reassuring, and if examination is normal further investigation is not required, providing the bleeding has stopped. There is no evidence to indicate whether different patterns of postmenopausal bleeding such as one-off bleeding or more frequent bleeds are more likely to be associated with malignancy. [With external links to current evidence and summaries]

Management of fibroids should be tailored to the patient

22 Mar 2011Paid-up subscribers

At least one in four women will develop one or more fibroids during their lifetime. They are most common in women aged 30-50 years and can run in families. Patients often have multiple fibroids, although some women have just one. Fibroids are three times more common in women of Afro-Caribbean descent than Caucasian women. Risk factors for the development of fibroids are:age; nulliparity; race; family history; obesity. There appears to be a decreased risk in smokers. Fibroids may be found during a routine examination or by chance during a scan for some other reason. On bimanual examination the uterus appears irregular in outline. An ultrasound scan can confirm the diagnosis. Women with menorrhagia and fibroids >12 cm and/or a palpable uterus should be referred to a specialist for further opinion. [With external links to current evidence and summaries]

Weighing up the benefits and risks of HRT

21 Feb 2011Registered users

An observational study from Canada has shown that a decline in the use of HRT over the past decade was followed by a reduction in the incidence of breast cancer. Data on HRT prescriptions dispensed for women aged 50-69, during the years 2001-2006, was collated from a national registry. Information about current HRT use was obtained by telephone from a sample of 1,200 women in this age group already enrolled in the National Population Health Survey. However, the data are observations of association only, and are not controlled for other risk factors for breast cancer such as parity and alcohol intake. The absolute risk of breast cancer to an individual user of HRT is small (and smaller still in oestrogen-only formulation users). The potential benefits need to be weighed up against the risks for each individual patient. [With external links to current evidence and summaries]

Do HRT patches increase the risk of stroke?

20 Oct 2010Registered users

Low-dose transdermal oestrogen patches do not appear to raise the risk of stroke. However, high-dose patches, oral HRT using oestrogen alone or combined with a progestagen, are associated with an increased risk. A total of 15,710 cases of stroke were identified, from a cohort of nearly 900,000 women aged 50-79, on the General Practice Research Database; giving an incidence of 2.85 per 1,000 woman-years. The average age at stroke was 70 years. Four matched controls were selected for each case. [With external links to current evidence and summaries]

Premature menopause linked to CVD and osteoporosis

22 Mar 2010Paid-up subscribers

Premature menopause can mean the end of fertility. The condition affects 1% of women under the age of 40, one in 1,000 under the age of 30 and one in 10,000 under the age of 20. In the UK, each year, 110,000 women will experience premature menopause between the ages of 12 and 40. [With external links to current evidence and summaries]

HRT increases cardiovascular risk in older women

01 Oct 2007Paid-up subscribers

There has been much discussion over the years about the effects of hormone replacement therapy (HRT) on cardiovascular disease. Results have recently been published from the WISDOM trial, a multicentre, randomised, placebo-controlled, double-blind trial recruiting from primary care centres in the UK, Australia and New Zealand. The trial was stopped early following adverse cardiovascular outcomes in the HRT arm of the American Women's Health Initiative (WHI) trial. By this time the WISDOM trial had screened more than 56,000 postmenopausal women aged 50-69 years (mean age 63), and 5,692 had started treatment. Although WISDOM never reached its full potential, its message is broadly similar to the WHI trial: HRT increases cardiovascular and thromboembolic risk when started in older postmenopausal women. [With external links to current evidence and summaries]

Balancing the risks and benefits of HRT

27 Jul 2007Paid-up subscribers

A paper from the influential Million Women Study has shown that the risk of developing ovarian cancer is increased by HRT use. The question is: how should these data be incorporated into HRT consultations in primary care? A total of 1.3 million women were originally recruited to the study, beginning in 1996. Data were collected over an average of 5.3 years from nearly 950,000 women. Half the women had used HRT, 30% of whom were current users. [With external links to current evidence and summaries]

Tailor treatment to the patient in endometriosis

01 Mar 2007Paid-up subscribers

Endometriosis is a common gynaecological condition found almost exclusively in women of reproductive age. It is most common in patients aged 25 to 35 years. The signs and symptoms are diverse and the clinical course is highly variable and unpredictable. [With external links to current evidence and summaries]


Online only

SI - Women's health 3: 2012-2013

30 Apr 2013Paid-up subscribers

This document can be saved directly into your personal development plan folder on your computer or for review in the PDF reader on your tablet computer

  • Diagnosis and treatment of ectopic pregnancy 2013
  • Optimising the management of patients with infertility 2013
  • Postmenopausal bleeding should be referred urgently 2012
  • Which patients should be offered caesarean section? 2012
  • Identifying patients at risk of perinatal mood disorders 2012

SI - Women’s health 2: 2012

15 Apr 2013Paid-up subscribers

This document can be saved directly into your personal development plan folder on your computer or for review in the PDF reader on your tablet computer

Symposium articles
Postmenopausal bleeding should be referred urgently
Which patients should be offered caesarean section?

Special reports
Identifying patients at risk of perinatal mood disorders


Editorials 2014

Women with diabetes at greater risk of CHD than men

23 Jun 2014Registered users

A recent large meta-analysis has confirmed that women with diabetes have more than a 40% higher risk of incident coronary heart disease (CHD) than men. For GPs this is a timely reminder to consider CHD as a high risk in women with diabetes, and to treat risk factors vigorously. This is especially important because routine screening in the healthy population accustoms us to women being generally at lower risk than men using the current CHD risk tools.

HPV vaccination uptake lowest in young women at greatest risk

22 Apr 2014Registered users

Teenage girls most at risk of cervical cancer are least likely to be offered HPV vaccination and, those who are, less likely to complete the course, a cross-sectional study of sexual health service users has found. [With external links to current evidence and summaries]



Hormonal contraception use and acquisition of HIV

23 Feb 2015Paid-up subscribers

There is a small increased risk of HIV infection in women using depot hormonal contraception, a meta-analysis of studies from Sub-Saharan countries has found. No increased risk was seen for users of oral contraception in the general population.

Hormonal contraceptive prescribing in teenagers rises

22 Jan 2015Paid-up subscribers

Use of hormonal contraceptives by adolescents has increased over the past decade, a  UK national retrospective cohort study has found. Data were obtained from the IMS Disease Analyzer (IMS DA) database, on girls aged 12-18 years who had had at least one prescription for a contraceptive drug between 1 January 2002 and 31 December 2011.

Has the QOF influenced GP prescribing of LARC?

22 May 2014Registered users

Prescribing of long-acting reversible contraception (LARC) in primary care rose after introduction of the new QOF contraception indicators in 2009, a study has shown. Quarterly prescribing (PACT) data were used from a random sample of 581 general practices in England from April 2007 to March 2012. [With external links to current evidence]

Exploring women’s misconceptions about IUDs

24 Feb 2014Registered users

Myths and misconceptions about intrauterine contraception abound, a study in women seeking termination of pregnancy has shown. This study took place at the Royal Infirmary of Edinburgh which provides up to 80% of abortion services in Lothian, Scotland. Women undergoing abortion were recruited to complete a short questionnaire regarding their beliefs about intrauterine contraception. [With external links to the current evidence base]

Comparing venous thrombosis risk in COCPs

22 Jan 2014Registered users

Both the progestogen used and the dose of ethinylestradiol affect the venous thrombosis risk associated with combined oral contraceptive pills (COCPs), a systematic review and network meta-analysis has found. A total of 3,110 publications were retrieved of which only 25 publications reporting on 26 studies were included. Incidence of venous thrombosis in non-users from two cohorts was 1.9 and 3.7 per 10,000 woman-years which is consistent with previously reported rates of 1-6 per 10,000 woman-years. COCP use increased the venous thrombosis risk compared with non-use, relative risk (RR) 3.5, (95% CI:2.9 to 4.3). All preparations were associated with more than a two-fold increased risk of venous thrombosis compared with non-use. [With external links to the current evidence base]

Exploring young women’s reasons for choosing an IUS

23 Sep 2013Registered users

More than a third of young women who decided to have an IUS inserted did so because they felt it was a ‘fit and forget’ method of contraception, a study from a university-based practice in the UK has found. Almost a quarter chose the method because they had had problems with oral contraception and one in ten cited the non-contraceptive benefits. [With external links to the current evidence base]

LARC more effective than other methods in all age groups

26 Jul 2012Registered users

Failure rates with long-acting reversible contraceptive (LARC) methods are lower than those of oral contraceptives, transdermal patches or vaginal rings in women of all ages, a prospective cohort study from the US has concluded. [With external links to the current evidence base]

Assessing VTE risk with non-oral hormonal contraception

20 Jun 2012Registered users

Women who use combined contraceptive transdermal patches or vaginal rings are at an increased risk of venous thromboembolism (VTE) compared with non-users of hormonal contraception but the absolute risk is low, a large cohort study has confirmed. [With external links to the current evidence base]

Annual IUD checks of little benefit

25 Feb 2012Registered users

Regular routine check ups on women fitted with intrauterine contraceptive devices (IUD) do not appear to confer any protection against adverse events, a UK general practice-based study has found. The medical records of women registered with one practice in Rugby, Warwickshire who had had an IUD fitted between 1976 and 2005 were examined. Only women who had a device in place for at least two years with a complete set of legible records covering the time between insertion and removal or study endpoint (March 2007) were included in this retrospective analysis. [With external links to the current evidence base]

Assessing risk of VTE with combined oral contraceptives

25 Feb 2012Registered users

Combined oral contraceptive pills (COCPs) containing desogestrel, gestodene or drospirenone appear to confer double the risk of venous thromboembolism (VTE) compared with those containing levonorgestrel, a large population-based study has found. Data on all women in Denmark aged 15-49 years were identified from four national registries during the period 2001-2009. [With external links to the current evidence base]

Timing of IUD insertion after termination

22 Nov 2011Registered users

Uptake of IUD insertion is greater when it is offered immediately after termination than when insertion is delayed for four to six weeks. Expulsion and bleeding were no higher in the early insertion group a study has found. The authors conclude that immediate insertion of a copper IUD after medical termination should be offered routinely to women. [With external links to current evidence]

Does COCP formulation affect patients' thromboembolic risk?

22 Jun 2011Registered users

Combined oral contraceptives containing drospirenone appear to carry a three-fold higher risk of non-fatal idiopathic venous thromboembolism (VTE) than those containing levonorgestrel, although the overall risk is still low. The study used data from the UK General Practice Research Database (GPRD) that gathers information from a large number of general practices and more than three million people in the UK, including demographic data, information about prescribed drugs, diagnoses, hospital admissions and deaths. [With external links to the current evidence base]

Tailoring contraceptive services to young people

25 May 2011Registered users

Anonymity and confidentiality are the key priorities for young people using contraceptive health services, a systematic review has found. Non-judgemental staff and accessibility are also deemed important. [With external links to current evidence]

Should pill dosage be adjusted for larger women?

20 Apr 2011Registered users

The Clinical Effectiveness Unit of the Faculty of Sexual and Reproductive Healthcare currently advises that larger women need not take a higher dose of the progestogen-only contraceptive pill (POP) for effective contraceptive cover. However, a case report in the Faculty's journal casts doubt on this advice. Dr Chris Barclay reviews the paper and comments: 'I drew two conclusions from this interesting paper. First heavier women, >60-70 kg, using POP contraception, should be included in the decision about dosage. Second, that evidence-based medicine does not address every facet of day-to-day medical practice. Deploying clinical wisdom as the authors did here is, in my view, to be commended.' [With external links to current evidence]

Assessing risks and benefits of the combined oral contraceptive pill

18 May 2010Registered users

A large study conducted by the RCGP, amassing more than one million woman-years of data, has provided reassurance on the safety of the combined oral contraceptive pill (COCP). The study collected long-term data prospectively on more than 28,000 COCP users and a further 17,000 never-users. 'The authors controlled for age, parity, smoking and social class but did not have data on obesity, a variable significantly linked to cancer and mortality risk. Nevertheless this massive, well conducted study provides reassurance that if anything the COCP appears to have significant non-contraceptive health benefits, at least during and shortly after taking it.' [With external links to current evidence]

Exploring young women's attitudes to new methods of contraception

15 Jan 2010Registered users

Most teenage girls and young women have little, if any, knowledge of long-acting contraceptive methods, a qualitative study has found. [With external links to current evidence]

What factors influence young women's choice of contraception?

27 Aug 2009Registered users

The oral contraceptive pill (OCP) is still the contraceptive method of choice for most young women, a small study shows. Their use of, and views on, hormonal contraceptives: the OCP, progestogen-only pill and progestogen injection were explored in a qualitative study. The 20 participants were selected from a sample of a randomised trial of a school-based sex education intervention. [With external links to current evidence]

LARC is a cost effective option

27 Aug 2009Registered users

Contraceptive implants are highly cost effective when compared with oral contraception, a case-controlled retrospective study has shown. The costs of providing a sub-dermal contraceptive implant and oral contraception were compared in a cohort of 493 users of each type of contraceptive method. The study was conducted over a period of 36 months in a community sexual reproductive health clinic in south east Wales. [With external links to current evidence]

Does the type of intrauterine contraception influence vaginal flora?

01 Jun 2009Registered users

No significant difference could be shown in the development of abnormal vaginal flora in women fitted with an IUCD compared with IUS users, in a study from the UK. A total of 172 women requesting IUCD or IUS contraception were recruited to the study from contraceptive clinics between August 2000 and April 2003. In all, 78 women had a copper IUCD inserted and 94 had a progesterone-incorporated IUS. The women were assessed before and twice after fitting, using high vaginal swabs and Ison-Hay criteria for grading vaginal flora.

Women prefer primary care for contraceptive services

01 Feb 2009Paid-up subscribers

Nearly two-thirds of women use contraceptive services provided by their practice, according to a Natsal survey. Natsal is probably the most comprehensive survey of sexual health carried out on the adult British public using a sample that best represents the population (a "probability sample"). [With external links to current evidence]


Editorials 2011-2012

Pertussis vaccination in pregnant women will protect neonates

31 Oct 2012Paid-up subscribers

A temporary programme to vaccinate pregnant women against pertussis has been developed following an increase in cases in young infants in England and Wales.

MI often presents without chest pain in women

21 Mar 2012Paid-up subscribers

The textbook presentation of myocardial infarction (MI) is not difficult to recognize but in the undifferentiated world of primary care presentations it can be far from clear. This difficulty is compounded by the sex and ethnicity of the patient and the presence of comorbidities such as diabetes. Women are often older than men at hospitalisation for MI and present less frequently with chest pain. It is generally accepted that patients without chest pain tend to present later and are treated less aggressively than those presenting with more typical symptoms. Furthermore, those presenting without pain have almost twice the short-term mortality rate.



Pregnancy related conditions

21 Feb 2011Registered users

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

Special reports 2011-12

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 2011Registered users

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]