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.
Abnormal proliferation of placental tissue inside the uterus leads to a spectrum of rare benign and malignant lesions that include molar pregnancy and together constitute gestational trophoblastic disease (GTD). GTD can be challenging to diagnose, and primary healthcare professionals should be aware of its signs and symptoms to ensure prompt and appropriate referral.
Breast pain, also known as mastalgia and mastodynia, is the commonest reason for consultation about breast problems in both UK primary care and breast units. Most women can be managed by their GPs with reassurance, advice and first-line treatments, but it is essential to identify women who need referral, especially the small minority presenting with pain as a symptom of breast cancer.
What if you do not understand why you are in a strange room, what the word ‘surgery’ means on the door, and you have forgotten that it means you are there for a checkup? What if your GP or practice nurse wants to examine you, but you cannot remember the words to explain that you are confused and frightened? This can be the reality for people with dementia, and women are more likely than men to experience its impact, either as patients themselves or as family carers.
Outpatient hysteroscopic sterilisation procedures have been widely used across Europe and the USA for over 10 years, and are now becoming available across the UK. The outpatient hysteroscopic procedure offers women the choice of sterilisation with microimplants inserted into the fallopian tube via the vagina. This offers clear advantages over standard laparoscopic clip sterilisation, which involves a general anaesthetic and an intermediate surgical procedure.
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 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.
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.
The combined hormonal oral contraceptive pill (COC) has been available in the UK for the last 50 years. During this time, the dose of ethinyl estradiol has fallen from 100 mcg to 20-30 mcg, increasing patient acceptability and improving drug safety by reducing the risk of venous thromboembolism (VTE). At the same time, a number of non-contraceptive health benefits have emerged in association with combined hormonal contraception (CHC).
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.
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.
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.
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