Category Archives: Gynaecology

Dyspareunia

Note that this may present indirectly; repeated failure to attend cervical screening, persistent dissatisfaction with contraception, describing disgust with her genitals, dissociating during examination. History Open questions, kept to a minimum; encourage description. ‘When do you get the pain?’ ‘Show … Continue reading

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Contraception in the perimenopause

DMPA and Sayana Press do cause decrease in bone density, but this is reversible and thus not considered an absolute contradiction to contraception over 45. Review every two years for other risk factors is advised. The FSRH do advise against … Continue reading

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HRT and heart disease

Well, we have an update on the days of the Million Women Study (though it’s still a cool trial name). Much of the data available then were from women starting HRT in their mid-sixties, and this skewed the data. It … Continue reading

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Endometriosis

Some points from a recent BMJ article: A normal examination and pelvic USS don’t rule out endometriosis. On the other hand, they may not need to; in a lot of cases, you’re only going to be treating the symptoms anyway, … Continue reading

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Diagnosis of polycystic ovarian syndrome

The criteria I learned for diagnosis of PCOS were two of the following three: Oligomenorrhoea Clinical or biochemical signs of hyperandrogenism Polycystic ovaries on scan But, according to an article in the latest BMJ, different groups differ on these criteria. … Continue reading

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Pelvic congestion syndrome

I distantly remembered reading something about this many years ago; when a patient’s ultrasound showed pelvic varices, I realised I’d need to refresh my memory. Presentation Dull aching or throbbing pain, typically on one side of the pelvis although can … Continue reading

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The physiology of PCOS

Another one from the archives. This one is an article in the July 2014 JFPRHC explaining the physiology behind PCOS and our treatments, by W. Colin Duncan, clinical fellow and consultant in reproductive medicine at the University of Edinburgh. It’s … Continue reading

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