Gynaecology

This is an updated guideline on ectopic pregnancy and miscarriage from NICE (published Apr 19). It was last updated in 2012 when I originally wrote this blog post. The 2019 update doesn't add very much to what we were already doing. There are two new elements: Expectant management of women with a miscarriage before 6/40. They have amended this to Continue Reading

This was an updated guideline from the FSRH on contraception in the over 40s. It came out in Nov 17, but as it is so useful, I thought it worth doing a summary. There were a few things that were new for me: If women over 50 are amenorrheic AND using a progesterone only method of contraception, then you can Continue Reading

This is a new guideline from RCOG on Bladder Pain Syndrome, which used to be called Interstitial Cystitis, among other things. As this is a new guideline and it is a common problem (affecting up to 6% of people), I will summarise the bits relevant to us. Definition This is a chronic pain syndrome and a diagnosis of exclusion. It's Continue Reading

NICE published an update to its guideline on heavy menstrual bleeding (menorrhagia) in March 2018. There are a couple of changes: Hysteroscopy is now the first line investigation for most women who need investigating for heavy menstrual bleeding, rather than ultrasound. There is no mention of age '45' now. In the old menorrhagia guideline, being over 45 was seen as Continue Reading

This is a statement from Jan 18, updated Mar 19, from FSRH giving information about Kyleena, which is a new levonorgestrel (LNG) containing intrauterine system (IUS). What is Kyleena? An IUS. It contains levonorgestrel, like Mirena does. It is licensed for 5 years of use, but only for contraception. It is not licensed for use in heavy menstrual bleeding, nor Continue Reading

This is a new guideline from NICE on managing endometriosis. I'll do a general summary of this as it is a new guideline. However I don't think it changes very much that we do. There is a good algorithm attached to the summary. Symptoms We should be suspecting endometriosis in women (even young women under 17) who present with at Continue Reading

This is a new guideline from the FSRH on contraception after pregnancy. There is nothing particularly new about specific methods, but there are a few new interesting points (including a reminder that the COC can be used when breastfeeding from 6 weeks after delivery). Contraceptive options should be discussed antenatally. Ideally the chosen method of contraception should be started before Continue Reading

This is a statement from the FSRH on a study recently published on risks with COC use. This study looks at how the different dose of oestrogen and how the different progesterone affect the risk of PE, CVA and MI. Bottom line - we should be advising women choosing the COC that a 20mcg ethinylestradiol/levonorgestrel pill may have lower thrombotic Continue Reading

This is a new guideline from RCOG on diagnosing and managing endometrial hyperplasia. This is a very common condition, so highly relevant for us and I had no idea on some of the management options. I am therefore doing a general summary. Types Endometrial Hyperplasia without atypia - fewer than 5% will progress to cancer over 20 yrs and most Continue Reading

This is a new guideline from the RCOG on managing ovarian hyperstimulation syndrome (OHS). Most patients will ultimately be managed in secondary care, but we need to be aware of it, as most women apparently attend the GP first. Two important points if you read no further! Most women present with abdominal pain and distention after their 'trigger injection'. NSAIDs should Continue Reading

This is a guideline from the FSRH about a new pill, Eloine, which contains 20mcg ethinylestradiol and 3mg drospirenone. There is a cheaper generic equivalent, called Daylette. In the USA it is known as Yaz. It is taken in a 24/4 regime, so 24 active pills and 4 placebo pills. Possible pros Lots of girls like having placebo pills as Continue Reading

This is a new guideline from Nice on managing the menopause, both in women undergoing premature ovarian failure and in women going through it at a more normal age. There isn't much earth shattering in this, but they are encouraging us to offer HRT routinely and to avoid doing unnecessary FSH tests. I'll highlight what they say about diagnosis and Continue Reading

This is an updated guideline from the FSRH on how to investigate and manage women with abnormal bleeding on contraception. I don't think there is much new here, but there are a couple of excellent flow charts which summarise the management. One nice point is that it gives advice that women don't all need to be investigated if the bleeding Continue Reading

This is an updated guideline from RCOG on managing vaginal vault prolapse after hysterectomy. There isn't really anything new here, just confirmation of what we probably all do. Pelvic floor muscle training is useful for mild prolapse. The evidence here is for one-to-one training. Pessaries (both shelf and ring) are useful for all prolapse other than the very mild. Surgery Continue Reading

RCOG's new guideline looks at the long term health problems with polycystic ovarian syndrome PCOS. There isn't very much that's new, but I think that generally we aren't very good at following these women up, so I'm doing a general summary. The biggest risk is with diabetes, both gestational and type 2 if you don't want to read on...  Risks  Type Continue Reading