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.
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.
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.
Genital herpes is a common sexually transmitted infection, especially among young adults. It may be associated with complications, notably in pregnant women, but it is not usually life-threatening. However, the diagnosis continues to attract stigma, and patients need reassurance and support as well as effective treatment.
One of the great by-products emerging from the Primary Care Women’s Health Forum (PCWHF) is connectivity. Our members are becoming more aware of local initiatives in other parts of the country, and are connecting with and learning from other clinicians to share best practice in women’s healthcare.
Premenstrual disorders (PMD) are common and have a major impact on the lives of women. Until recently there has been confusion around definitions, leading to difficulties in diagnosis and management. This article describes a new consensus definition and diagnostic criteria for PMD, and advises on the choice of evidence-based treatment.
Individualising choice of oral contraception to each woman is important to ensure safety, and enhance patient acceptability and adherence. However, tailoring should extend beyond simply deciding whether to use a combined or progestogen-only pill. Prescribers should also bear in mind the non-contraceptive benefits of each product, and consider alternative regimens for women with hormone-related medical conditions or those who wish to avoid menstrual bleeds.
If you have fertility problems, it means you have difficulty in conceiving (becoming pregnant) despite having regular sex without using contraception. Before you begin to worry, remember that many couples take several months to conceive. Over eight in 10 couples conceive within a year of trying, while about nine in 10 conceive within two years.
Urinary incontinence and related conditions have a high prevalence and a major impact on a patient’s quality of life. Drug therapy can be very effective and forms an important part of the treatment armoury when managing women with incontinence. Unfortunately, medication can be associated with adverse effects, but there are approaches that can be used to maximise a drug’s effectiveness and limit problems that reduce adherence to treatment.