Renewed publicity about the risk of venous thromboembolism (VTE) with combined hormonal contraception (CHC) may encourage busy GPs to prescribe progesterone-only pills to women declining long-acting reversible contraception (LARC). This article aims to put the bad press into context, outline the lifestyle and long-term health benefits of the combined methods, and offer advice about which CHC might suit which client.
Early pregnancy loss: can we improve our practice?
The majority of pregnancies progress successfully, but some result in a miscarriage or in an ectopic pregnancy. About two-thirds of the related maternal deaths are associated with substandard care due to late or missed diagnosis. Recent NICE guidelines aim to improve outcomes for women, and this article provides practical information on how the new recommendations impact on day-to-day practice in primary care.
Understanding combined oral contraception
Formulations have evolved considerably since the combined oral contraceptive pill (COC) became available more than 50 years ago. Understanding the sex-steroid hormones in currently available COCs is essential, as it helps to indicate the combination with the greatest potential benefit for each woman.
In this new article, Dr Paula Briggs goes back to the basic structure of the COC to explain how to choose the right pill for the right woman at the right time.
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.
Protect and survive: fighting back against HPV
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.
Contraception and sexual health for young people
Young people under the age of 18 present particular challenges for many health professionals, and a structured approach is essential when providing services for this age group. Health professionals have a responsibility to provide information in an approachable manner on all methods of contraception, including long-acting reversible contraception (LARC), and the prevention and testing of sexually transmitted infections (STIs). Professionals also need to be able to accurately assess a young person and undertake safeguarding as needed.
Evaluation of the Maternal Lighten Up Weight Management Service
Most overweight/obese pregnant women gain more weight than they should during pregnancy, which can lead to adverse maternal and neonatal outcomes. This study evaluated the Maternal Lighten Up service, in which obese pregnant women are referred by their midwives to a choice of several weight-management programmes. Weight is measured at the start and self-reported at the end of pregnancy. Of women referred, only 36% started a programme. The Health Trainers programme was most popular and most frequently attended, followed by Slimming World. Participants attending Slimming World and dietetic programmes were less likely to exceed Institute of Medicine guidance on weight gain during pregnancy, but these data are based on low follow-up rates of weight at the end of pregnancy. This study provides insight into the preferences and behaviour of obese pregnant women referred to different weight management programmes, and the findings may contribute towards shaping future maternal obesity weight management services.
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.
Back to Basics: Binge drinking
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.
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.
