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.
It has been a busy end-of-year for the Primary Care Women’s Health Forum. We have been hard at work preparing for our Annual Conference. But Forum members have also been active in responding to the media on women’s health issues – further recognition of our increasingly important profile as advocates for women’s health.
This supplement was originally published in 2011 and has since been updated and peer-reviewed in January 2012.
Polycystic ovary syndrome (PCOS) is the commonest endocrinopathy, affecting 5-12% of women. Every aspect has been controversial from its nomenclature to its management. But accurate diagnosis based on consensus guidelines ensures that treatment can be tailored effectively to each woman’s symptoms and needs.
Have you ever felt like it is groundhog day? You are having the same conversation with the same patient and with the same outcomes. You are being very sympathetic and trying hard to help the patient make positive changes. But every suggestion you make garners the response: “Yes but I can’t do that because…”, “Yes but I’ve tried that”, “Yes but my friend said there was a tablet I could take”. That “yes but” is an indicator that motivational interviewing (MI) is likely to be helpful.
Although there is a natural fall in fertility with age, women still need reliable contraception to avoid unintended pregnancies during the perimenopause. No contraceptive method is contraindicated by age alone, but women must be individually assessed, based on the risks and benefits of each method.
Most often described as a burning pain, vulvodynia is a chronic pain syndrome that affects all or part of the vulva. Diagnosis of this distressing condition is frequently delayed and management is challenging. But careful diagnosis and appropriate referral can help to minimise pain and enable women to regain control of their lives.
Urinary continence problems are common in women, and result in significant costs to patients, carers and the NHS, both for treatment and coping strategies such as pads and appliances. Despite this, continence rarely gets the attention that some other, less prevalent conditions receive, and there is evidence of both under-diagnosis and inadequate management.
Colposcopy – detailed examination of the cervix under magnification – remains the standard assessment tool for cervical abnormalities found on screening. An invitation to attend the colposcopy clinic can cause anxiety, but women can be reassured that it is a safe procedure and that many problems can be treated in just one visit.
It looks like it is going to be a long hard winter. The media have already been reporting restrictions on referrals and rising waiting times. It is likely that things can only get worse given the pressures on primary care trusts and local authorities. At times of economic stringency, women’s sexual and reproductive health can seem an easy target. But this is short-sighted and probably not costeffective given the UK’s high rates of teenage pregnancy and sexually transmitted infections. It is time for an approach to service configuration that goes beyond knee-jerk slash and burn.
Half of post-menopausal women will suffer a fracture during their lifetime, mainly because of osteoporosis. Currently available medication can halve the risk of future osteoporotic fractures. Yet many at-risk women are still unidentified, and only half of all patients persist with treatment for more than a year.
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