Women's Health

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  Breast cancer mortality and screening
This topic includes sections on breast screening, the NICE guidelines on early and advanced breast cancer, management of breast cancer and the assessment of genetic risk.
  Premature menopause
Many women of child-bearing age presenting with amenorrhoea are most afraid of this condition, traditionally known as premature menopause.
  Investigating amenorrhoea
The authors remind us that many of the common causes for both primary and secondary amenorrhoea are the same and so therefore are initial investigations.
  Vaginismus
This useful clinical review was published in the BMJ and considers this difficult condition in some detail. The estimated community prevalence is 0.5–1%.
  Genetic breast cancer
This update on the 2004 guidelines is different mainly in respect of the sort of surveillance women should be offered
  The studies that changed our thinking on HRT
The Women's Health Initiative (WHI) study and The Million Women Study
  Breast cancer
A number of drugs have been identified which have the potential to reduce the risk of breast cancer. A large meta-analysis published in 2009 identified tamoxifen, raloxifene and tibolone as potential agents (Ann Int Med 2009;151:703). The included studies were highly heterogenous in terms of risk stratification, patient age, etc.
  The menopause and HRT
Hopefully by now, most of us have a reasonable grasp of the big studies that changed the way we looked at HRT to a consideration of harms and benefits, rather than an automatic reaction to the menopause
  Urinary tract infections in women
Please note that this section on UTIs only applies to non-pregnant women aged 18–70!
  Endometriosis
Endometriosis is the presence of functional endometrial tissue in extra-uterine sites, most commonly the pelvic peritoneum, ovaries and rectovaginal septum. This is thought to originate through retrograde menstruation
  OTC tranexamic acid
Tranexamic acid is an antifibrinolytic drug which works by reducing the breakdown of fibrinogen to fibrin.
  Menorrhagia
I really enjoy consultations about heavy menstrual bleeding – to me they offer the opportunity for real patient-centred shared decision-making because there are a range of treatment options which in my experience appeal differently to different women.
  Breast infections
We commonly see breast infections in lactating women which can be distressing and debilitating and can interfere with early breast-feeding and bonding. The aetiology is different in non-lactating women and we need to consider whether further investigation is warranted.
  Premenstrual disorders
This is a complex area that we are often asked about as GPs and I suspect many of us find it difficult to help. This BMJ review offers some suggestions as to how to make a positive diagnosis and useful management strategies.