Making Best Practice, Every Day Practice
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This resource provides access to informative articles on the broad spectrum of obstetric and gynaecological issues managed in primary care including sexual and reproductive health.
These materials cover some of the most important topics in daily care including:
Contraception across different age groups
Early detection of gynaecological cancers
Pre-menstrual syndromes
Use of testosterone
Menstruation and abnormal uterine bleeding
Fertility treatment
and much more.
Compared to men, women report pain that is more frequent, severe and longer lasting. Women are also more likely to experience multiple pain conditions, increasing their risk for the onset of new pain disorders. But studies show that men are more likely to receive effective treatment. Women would benefit particularly if more multidisciplinary pain clinics were established in primary care.
Half of women with a hip fracture have already suffered a fragility fracture that went untreated. If these women had received secondary prevention, their future risk would have been reduced. The need to improve patient care, and the potential cost savings, form the rationale for a local multidisciplinary fracture prevention pathway.
Last year was momentous for the Primary Care Women’s Health Forum. We held two very successful meetings, and announced the first winner of our Best Practice Award. This year we aim to ensure that the Forum continues to flourish, so that we can support our members in working together to improve standards in women’s health in primary care.
Miscarriage is common, accounting for 75% of all gynaecological emergencies and about 50,000 hospital admissions each year in the UK. Although secondary care is usually responsible for immediate management, there is often no follow-up. So GPs and practice nurses have an important role in offering support and explanation to women and their partners.
Now that we have the details of the Spending Review, we know that times are going to be tough. So this might not appear to be the best time to be taking on extra work. But this is exactly the prescription for GPs from the King’s Fund. A research paper argues that as well as providing general health care, GPs should become more involved in maternity care, from before conception to after the birth.
Over 280,000 etonorgestrel (ENG) contraceptive implants (Nexplanon) are fitted in the UK each year. Continuation rates are good at 55% at two years. But almost one third of women who do discontinue the implant cite ‘bleeding problems’ as the reason. Healthcare professionals are often unsure what to do when faced with unscheduled bleeding, but help is at hand.
Vulval skin diseases are common after the menopause, but women can often be too embarrassed to seek medical help. This can result in much discomfort and morbidity and, more worryingly, progression to malignancy. However, women can be reassured that treatment is usually simple, well tolerated and highly effective.
The law allows doctors to perform abortion provided it is done within the legal framework. Although most NHS-funded abortions are now performed at less than 10 weeks gestation, the rate varies considerably between primary care trusts. Extending the role of nurses who provide abortion care would further improve access for women, potentially reducing the already small proportion of late procedures.
Ninety-five per cent of women of reproductive age experience physical and psychological changes during their normal menstrual cycles, particularly in the premenstrual phase. These are normal and usually do not greatly affect quality of life. But 20% of women have symptoms that have a significant impact on their lives both at home and at work. These women have premenstrual syndrome (PMS).
As we all know, these are challenging times. The Government is increasing NHS spending in real terms every year of this Parliament, but there will inevitably be financial pressures due to continuing innovation and improvement in treatment and the ever-increasing demand for healthcare from an ageing population. This makes it all the more important for services – including women’s healthcare – to be commissioned by people who have the best overview of the health needs of local people – and these experts are GPs.
Depression is one of the commonest complications of childbearing, affecting about 13% of women in the first few months after delivery. The consequences for mother and baby can be profound. Effective treatment is, however, available and most women can be managed in primary care by their GP or practice nurse.
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