Women's Health Medicine最新文献

Oral contraception in women is available in two formulations; products containing both oestrogen and progestogen'combined oral contraceptives (COCs, the Pill); and those containing progestogen alone'progestogen-only pills (POPs, the Mini-Pill). COCs first became available in the UK in 1961 and have become an extremely safe, effective and popular method of reversible contraception. They also benefit from having non-contraceptive health benefits. This article aims to outline the advantages and disadvantages of taking oral contraception and important aspects of safe prescribing. Initially, the COC pill will be focused on, with the differences arising with the POP pill being outlined later.

Dysmenorrhoea literally means painful menstrual flow and refers to cramping lower abdominal pain occurring with the onset of menstrual flow. In cases of primary dysmenorrhoea the pain commences during the teenage years and occurs in the absence of any pelvic disease. In contrast, secondary dysmenorrhoea usually commences later in life and results from some kind of underlying problem like endometriosis. This paper investigates the prevalence, aetiology, the distinction of primary and secondary dysmenorrhoea and treatments that can be offered to women.

Puberty is the physical, emotional and sexual transition from childhood to adulthood. It involves five changes: breast, pubic hair, axillary hair development, the growth spurt and the onset of menstruation. In girls, pubertal development commences at around 8–9 years of age and lasts for 4–5 years. This review looks at the investigation into the absence of periods (primary amenorrhoea) if there is a failure to establish menstruation by the age of 14 years in girls without signs of secondary sexual development or by the age of 16 in the presence of normal secondary sexual characteristics. Primary amenorrhoea can be classified according to the presence or absence of secondary sexual characteristics. The onset of menstruation should usually occur within 2 years of the onset of breast development, pubic and axillary hair development and the growth spurt.

This paper assesses the basic steps of management and treatment of dysfunctional uterine bleeding (DUB) – the irregular bleeding arising from anovulation. After menarche, the hypothalamic-pituitary-ovarian axis can take several years to mature resulting in anovulatory and therefore irregular cycles. During an anovulatory cycle, the corpus luteum fails to form, causing failure of normal cyclical progesterone secretion. This results in continuous unopposed production of estradiol, stimulating overgrowth of the endometrium. Without progesterone, the endometrium grows thicker and thicker eventually outgrowing its blood supply, leading to necrosis. The end result is very heavy bleeding.

STIs are common, particularly in young women. Sexual history-taking is eased by private and comfortable surroundings, establishing a good professional relationship, having a non-judgemental attitude, and choosing words that are both appropriate to the consultation and readily understood by the woman. Genital examination is facilitated by privacy, careful and sensitive technique and the availability of the right equipment, including a gynaecological examination couch and a range of speculums. The screening investigations selected depend on the setting, local availability of investigations and prevalence of infections, and the presentation and wishes of the client. Sampling requirements are changing with the advent of new diagnostic techniques such as nucleic acid amplification tests for Chlamydia; these can be undertaken on samples taken by the woman herself (e.g. perineal swabs, urine), thereby avoiding the need for speculum examination in some circumstances.

Survival and later morbidity after extremely preterm birth are key issues to factor into the care of women and their children at borderline viability. Whereas we have robustly collected information on survival that shows some increases at 24–25 weeks of gestation, few data suggest any change in morbidity. Of babies born before 26 weeks of gestation around one quarter grow up with serious disability. Mild disabilities are common amongst the remainder. Overwhelmingly the major adverse outcome following extremely preterm birth is cognitive impairment, something that may not be apparent until school age, when we make increasing demands on children to perform. Despite these problems, studies of very preterm/very low birthweight children as adults seem to indicate good adaptation and integration into society.

HRT is indicated to manage problems caused when the ovaries stop producing estrogen at the menopause. Cessation of menses occurs naturally when the ovarian follicles are depleted at about 51 years of age, or following surgical removal of the ovaries with or without hysterectomy. The resulting hypogonadal state may cause symptoms and detrimental changes in estrogen target tissues, including the brain, skeleton and skin and the cardiovascular and genitourinary systems. The concentration and function of hormone receptors varies in these organs and systems; also, differences in genetics and general constitution may affect androgen production and levels of circulating estrogen. Thus, there is variation between women in the development of menopausal symptoms, in the functional reaction of the target tissues to estrogen deficiency, and in the response to HRT.

Postnatal care is often described as the ‘Cinderella’ of the maternity services. It is now becoming recognised that inadequate support, advice and treatment can impact quite considerably upon a woman’s daily life, her relationships with family and friends and her parenting abilities. This review provides an overview of the management of postnatal care and breastfeeding, and the factors most likely to promote mothers’ health and well-being.

Hormone Therapy (HT) is a valid option for women with climacteric symptoms. At present there is a controversy as to whether HT should be used chronically for prevention to each patient. This review investigates the basic use of oestrogens, progestogens, the HT regimens, bleeding problems in HT users and when HT is necessary.

Oestrogen is a highly effective treatment for menopausal symptoms. Although recent clinical trials do not support use of HRT for long-term protection against chronic disease, many women with unpleasant vasomotor symptoms elect to take HRT for symptom relief. Women who still have a uterus should be prescribed estrogen in combination with some form of progestogen. There are various delivery systems for HRT, though most women in the UK take it in tablet form. ‘No-period’ HRT formulations exist for women who are at least 1 year since their last natural period, though erratic bleeding may occur in the first few months of use. Blood pressure should be checked before prescribing HRT, but no other investigation is mandatory. Cervical screening and mammography should be performed according to national screening guidelines. Women with abnormal bleeding patterns on HRT that persist for more than 3 months should be gynaecologically investigated. There is no upper age limit for prescribing HRT, but it is often tolerated poorly when started in older women. HRT is not a method of contraception, and women who start HRT who are not yet truly postmenopausal should be advised to continue with a standard contraceptive method. There is no fixed duration of time for taking HRT, and women should be managed as individuals. Most women take it for about 2–5 years. Vasomotor symptoms often recur on discontinuation of HRT; if they are severe, women may need to consider taking HRT again.