The human papillomavirus (HPV) is responsible for 99% of cervical cancers, and vaccines are now available that make it possible to protect girls before they become sexually active. However, vaccinating schoolgirls against a virus that is contracted through sexual contact is a controversial topic, provoking questions from young women and their parents. To encourage young women to accept this potentially life-saving vaccine, it is important that GPs and practice nurses are able to answer patients’ questions about HPV.
New approaches to managing risk of familial breast cancer
Women with a family history of breast cancer are increasingly proactive in seeking help. As a result, breast centres and cancer genetics departments have seen an increase in referrals. This has no doubt had repercussions for workload in primary care, especially given the updated guideline on familial breast cancer from the National Institute for Health and Care Excellence (NICE). These recommendations have lowered the threshold for genetic testing, and have introduced the possibility of chemoprevention with tamoxifen or raloxifene.
Gynaecology referrals: on the right track
Gynaecology rapid-access clinics allow prompt assessment by specialists of women with suspected gynaecological malignancy, with the aim of improving cancer outcomes and patient experience, and ultimately reducing mortality. However, the ability of trusts to assess and treat women within specified targets relies on appropriate referral from primary care. Without this, fast-track services become overwhelmed with women who could be assessed by a routine referral, potentially delaying the review of women with suspected malignancy and creating unnecessary patient anxiety.
Fracture liaison services: reducing fractures and improving care
Fracture liaison services (FLS) systematically target high-risk patients, offering assessment and intervention to reduce fractures. Despite official guidance, less than two thirds of local health services have established an FLS. The Crawley FLS is an example of a community-based, integrated service that has helped to reduce local hip fracture rates and save NHS costs for the local health service.
Subfertility: time is of the essence
More couples are now starting their families later in life, a social trend that coincides with a rise in the number of people requesting referral for treatment of subfertility. In response, the National Institute for Health and Care Excellence (NICE) has updated its fertility guidelines to enable more patients to receive timely, appropriate and successful treatment.
Lung cancer: A rising risk for women
In the UK, more women die from lung cancer than any other cancer, including breast cancer. Smoking is by far the commonest cause, and lung cancer rates are continuing to rise in women who started to smoke in the 1960s. It is never too late for anyone to give up smoking, even after a diagnosis with lung cancer, when early intervention may result in cure or significantly prolong life.
Supporting women with genital herpes
Genital herpes is a common sexually transmitted infection, especially among young adults. It may be associated with complications, notably in pregnant women, but it is not usually life-threatening. However, the diagnosis continues to attract stigma, and patients need reassurance and support as well as effective treatment.
Connecting for Women’s Healthcare
One of the great by-products emerging from the Primary Care Women’s Health Forum (PCWHF) is connectivity. Our members are becoming more aware of local initiatives in other parts of the country, and are connecting with and learning from other clinicians to share best practice in women’s healthcare.
Take a new approach to premenstrual disorders
Premenstrual disorders (PMD) are common and have a major impact on the lives of women. Until recently there has been confusion around definitions, leading to difficulties in diagnosis and management. This article describes a new consensus definition and diagnostic criteria for PMD, and advises on the choice of evidence-based treatment.
Made to measure: Tailoring oral contraception to each woman
Individualising choice of oral contraception to each woman is important to ensure safety, and enhance patient acceptability and adherence. However, tailoring should extend beyond simply deciding whether to use a combined or progestogen-only pill. Prescribers should also bear in mind the non-contraceptive benefits of each product, and consider alternative regimens for women with hormone-related medical conditions or those who wish to avoid menstrual bleeds.
Fertility problems
If you have fertility problems, it means you have difficulty in conceiving (becoming pregnant) despite having regular sex without using contraception. Before you begin to worry, remember that many couples take several months to conceive. Over eight in 10 couples conceive within a year of trying, while about nine in 10 conceive within two years.
Practical prescribing to promote urinary continence
Urinary incontinence and related conditions have a high prevalence and a major impact on a patient’s quality of life. Drug therapy can be very effective and forms an important part of the treatment armoury when managing women with incontinence. Unfortunately, medication can be associated with adverse effects, but there are approaches that can be used to maximise a drug’s effectiveness and limit problems that reduce adherence to treatment.
