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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.

Underestimating risk in women delays diagnosis of CVD

21 Mar 2016Registered users

CVD remains the most common cause of mortality in women. There has been an increase in the prevalence of MI in women aged 35 to 54, while a decline in prevalence was observed in age-matched men. Although men and women share classic cardiovascular risk factors the relative importance of each risk factor may be gender specific. The impact of smoking is greater in women than men, especially in those under 50. Diabetes is a more potent risk factor for fatal CHD in women than men.

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]

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]

Which patients should be offered caesarean section?

21 Mar 2012Paid-up subscribers

Rates of delivery by caesarean section (CS) have steadily risen from 10% of all deliveries in the 1980s to a current figure of around 23.8%. Approximately 75% of CS are emergency procedures and only 25% are elective planned deliveries. When deciding whether to offer CS, it is important to consider the psychological implications for the patient as well as the physical and mental sequelae in future pregnancies. The updated NICE guideline helps clinicians to be consistent in the management of patients requesting and having a CS. [With external links to the current evidence base]

GPs should be vigilant for pelvic inflammatory disease

23 Mar 2011Paid-up subscribers

Pelvic inflammatory disease (PID) typically results from ascending infection through the endocervix, from the lower to the upper genital tract. This leads to inflammation of the endometrium, uterus, fallopian tubes, adnexal structures or pelvic peritoneum. It is extremely common and accounts for one in 60 GP consultations by women under the age of 45 years. PID may cause significant short- and long-term morbidity. Whereas most patients are asymptomatic, others may present acutely unwell with pelvic peritonitis and septicaemia. The long-term effects of PID include chronic pelvic pain, subfertility and ectopic pregnancy. However, there may also be substantial psychological morbidity in the form of guilt, isolation, and stigma associated with the diagnosis.  Although PID may occur following pelvic surgery, after instrumentation of the uterus and even in the puerperium, the most common cause is sexually transmitted infection (STI).

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]

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]

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]

GPs have a vital role in managing pelvic pain

29 Mar 2009Paid-up subscribers

Pelvic pain is a common symptom that accounts for a large proportion of consultations in primary care. There is a steady monthly incidence and prevalence of 1.58/1,000 and 21.5/1,000 respectively.Chronic pelvic pain presents as frequently as migraine or low back pain and needs to be managed appropriately and effectively.

Investigating infertility in primary care

29 Mar 2009Paid-up subscribers

Approximately 1 in 4 couples will see their GP for infertility problems. Infertility is thus a very common condition with around 1 in 7 couples of reproductive age being diagnosed as infertile. 

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]