Women's Health Medicine最新文献

Through a series of questions and answers on topics related to emergency contraception (EC), this review briefly assesses a number of primary concerns to help the practitioner understand the basic issues associated with emergency contraception.

Between 1995 and 2004, a frightening increase in most sexually transmitted diseases in the UK included a 223% rise in genital chlamydia, with 104,155 reported cases in 2004, making it the most commonly reported STD. Although many questions are yet to be answered after the release of the NICE review of the evidence for the effectiveness of screening for genital chlamydial infection in sexually active young women and men, the evidence seems to say a big ‘yes' to opportunistic screening of any patient under 25, whatever they have walked through the door for. However, NICE, in its evidence statements, did not consider the added value of partner notification/contact tracing – a job effectively managed in GUM clinics but not always undertaken by GPs.

Fortunately, it is extremely rare for one woman to experience all of the symptoms of the menopause; however, it is estimated that 75% of postmenopausal women do experience some acute symptoms, often starting before menstruation ends. This review offers an overview of the acute symptoms of the menopause and the treatments that are available.

This contribution considers links between different methods of contraception and the risk of acquiring sexually transmitted infections (STIs). This is a major public health issue, because STIs cause a huge disease burden that affects women disproportionately. Worldwide each year, there are 340 million new cases of curable STIs in 15–49-year-olds. In developing countries, STIs, even excluding HIV, are second only to maternal factors as causes of disease, death and life lost. There is particular concern about a putative link between hormonal contraception and STIs. However, the methodological problems facing investigation of a putative link are formidable. They include confounding between sexual behaviour and choice of contraceptive, choice of appropriate control group, and lack of precise measures of level of HIV/STI exposure and other risk factors. The current situation can be summarized as follows. The risk of acquiring HIV/STIs is substatially reduced by barrier methods of contraception. Hormonal contraception is a widely used, safe and highly effective method of preventing unintended pregnancy. Its relationship to HIV/STI transmission remains uncertain. In the absence of better evidence, current approaches to promoting hormonal contraception should continue. The importance and effectiveness of consistent condom use to protect against HIV/STI should be stressed, regardless of whether other contraceptive methods are being used. Future contraceptive research should focus on the dual goal of protection against HIV/STIs and unintended pregnancy.

Through a series of questions and answers on topics related to emergency contraception (EC), this review briefly assesses a number of primary concerns to help the practitioner effectively manage emergency contraception, including alternatives and the appropriate counselling.

Until relatively recently there has been a reluctance to accept premenstrual syndrome as a serious condition. Premenstrual symptoms occur in 95% of all women of reproductive age. Premenstrual syndrome (PMS) occurs in about 5% of those women. PMS patients appear more susceptible to their normal ovarian hormone cycle. The increased sensitivity may be due to neurotransmitter dysfunction (possibly serotonin). However, the definitive aetiology is not known. PMS results from ovulation and appears to be caused directly by the progesterone produced following ovulation in women who have enhanced sensitivity to this progesterone. Treatment can thus be achieved by suppression of ovulation or reducing progesterone sensitivity; the latter seems achievable by the administration of selective serotonin re-uptake inhibitors. Ovulation can be suppressed by a variety of methods, and oestrogen is frequently employed with success. Here, the authors describe an evidence-based approach to the management of PMS.

This review briefly assesses what a practitioner should do when a couple has problems conceiving. Around one in four couples present to their GP to discuss infertility, and the majority of them will ultimately have a child. It is therefore appropriate to take a positive approach, and to see this first consultation as an opportunity to discuss pre-pregnancy care. This maximises the couple's chances of having a healthy baby and provides an opportunity to assess factors which might affect their fertility. The review offers a number of brief questions and answers on how to assess ovulation indicators and referral, basic infertility treatments, assisted reproduction technologies and the relevance of the NICE national guidelines on managing infertility treatment.

Through a series of questions and answers on topics related to emergency contraception (EC), this review briefly assesses a number of primary concerns to help the practitioner understand the effectiveness of emergency contraception.

Sir William Osler once said, ‘He who knows endometriosis, knows gynaecology.’ Endometriosis is a disease of complex aetiopathogenesis. The symptoms do not always match the extent of the disease. Not only are the physical effects of the disease extremely troublesome, but its psychological impact can also be devastating. Although the disease has been known for decades, it remains an enigma.

Combined oral contraception is now available as oral, transdermal, vaginal and injectable preparations. Only the pill and patch are currently marketed in the UK. Most of the data come from the oral preparation (the combined pill), which has been marketed for more than 40 years and used by millions of women. Used perfectly, combined hormonal contraception is highly effective (failure rate 1/1000), because it works by inhibiting ovulation. In typical use, however, mistakes are made, and pill failure rates are about 8%. Serious cardiovascular side-effects (heart attack, stroke and venous thromboembolism) are rare. The risk of venous thromboembolism varies with the type of progestogen. Breast and cervical cancer are both increased in users, though the absolute risk is small. Prescribing should not be over-medicalized.