Women’s health

Editorial

For over two years now, I have been worrying that my editorial will be out of date by the time you read it because the Department of Health has published its sexual health policy document. At the time of writing, the document has yet to appear (though the Department’s website still reassures us it is due to be published in 2012). So local authorities may be taking over responsibility for contraception and sexual health in a public health policy vacuum. If this is the case, it can only compound current variations in provision, especially of long-acting reversible contraception (LARC).

Guest editorial

Teenage conceptions continue to raise interest in the media, with young people often demonised about their early or allegedly frequent sexual activity. When conception rates are published, commentators waste no time in telling us how dreadful the situation is and how we compare with other Western European countries. Of course, we are not like our neighbours in Europe, as we do not have mandatory sex education for all young people, and we live in a highly sexualised society where sex is often the material for jokes.

Teach pelvic floor muscle exercises

Over the past 30 years a wealth of research has proved the benefits of pelvic floor muscle exercises (PFME) in treating both urinary incontinence and pelvic organ prolapse. However, patients in some areas may have to wait some time for an appointment with specialist continence services. So it makes sense for primary care professionals to know how to teach PFME to their patients.

Back to Basics: Uncomplicated urinary tract infections in women

Born still, but still born: Understanding stillbirth

After the second trimester, it is generally assumed that a pregnancy will end with the joy of a newborn baby. But the reality is that each year in the UK, one in every 200 – or around 4,000 – babies die in the third trimester before, or during, labour. This is one of the highest rates of stillbirth among high-income countries, and each death has profound effects on the woman, her family and health services.

Contraceptive choices for women with diabetes

Unplanned pregnancy with poor glycaemic control at conception is associated with major maternal and perinatal complications. However, contraception is used haphazardly by women with diabetes and is often not discussed by diabetes professionals. GPs and practice nurses need to be able to give appropriate advice about contraception to the increasing numbers of women of childbearing age with type 1 and type 2 diabetes.

Female genital mutilation: Time for action

Female genital mutilation (FGM) comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for nonmedical reasons. The practice has no known health benefits, is psychologically and physically harmful, and is a violation of human rights. About 70,000 women and girls living in the UK have had some form of FGM, and 20,000 young girls under the age of 15 years are thought to be at risk either in this country or abroad.

Ectopic pregnancy: The new NICE guidelines

Early detection and timely intervention have reduced maternal deaths from ectopic pregnancy, but women continue to die. New guidelines from the National Institute for Health and Clinical Excellence (NICE) aim to ensure that all health professionals are alert to the possibility of ectopic pregnancy and avoid missed opportunities for diagnosis.

Joints, hypermobility and hormones

Joint hypermobility is a common problem, particularly in women, and can cause significant morbidity to a minority of affected patients. In women, hormonal changes during menstruation, pregnancy and menopause can impact on symptoms of joint hypermobility, while manipulation of hormones can have both positive and negative effects for patients.

Editorial: Supporting women through menopause

All women, if they live long enough, will go through the menopause. For some women, especially if they have few symptoms, the menopause transition comes as a welcome relief from menstruation and the possibility of pregnancy. Others experience disabling menopausal symptoms, and may feel psychological distress from their loss of fertility. Supporting these women is one of the most rewarding parts of clinical practice, especially as there is now a much more balanced approach, at least among knowledgeable clinicians,1 to the risks and benefits of hormone replacement therapy (HRT).

Pinpointing the best treatments for UTIs

Urinary tract infections (UTIs) are very common, affecting about half of women at least once in their lifetime. Although UTIs can be painful and uncomfortable, they are usually limited in duration and treatable with antibiotics. The challenges are to manage the one in five women who experience recurrent UTIs, and to avoid complications in patients who do not respond to treatment.

Which HRT for which woman?

The gold-standard treatment for menopausal women experiencing symptoms of oestrogen deficiency is hormone replacement therapy (HRT). HRT prescribing should largely be initiated, and managed, in primary care. This article takes a step-wise approach to looking at the factors to take into account, and the questions to ask, when deciding which HRT to prescribe appropriately for which woman.

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