Gynaecology

CPD | Contraception in the over 40s

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…
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Heavy menstrual bleeding (menorrhagia)

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…
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Latest endometriosis NG73 guidelines from NICE

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…
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Post pregnancy contraception

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…
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RCOG | Endometrial hyperplasia

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…
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RCOG | Ovarian Hyperstimulation Syndrome

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…
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Nice | Managing the menopause

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…
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