Category Archives: Gynaecology

Vulval itch

Another one from the same old BMJ. Questions to ask: The usual; duration, affect on life (ask about sex life), exacerbating/relieving factors Vaginal discharge (?thrush) Anything used in that area for toiletries, treatment, fragrances, also condoms/spermicides/lubricants STI risk Other skin … Continue reading

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Coming off HRT

I’ve started to go through a stash of very old articles I saved from journals such as Pulse and GP in my pre-blog days, so that I can put the useful snippets of information on here and throw the rest … Continue reading

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Dyspareunia

(A really old one; BMJ practice pointer article from 2018) 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 … Continue reading

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Managing menopause

(Notes from BMJ module) From 45 yrs onwards, menopause/perimenopause can be diagnosed on history only. FSH or other blood tests are not actually helpful in diagnosis in the >40s because of the wide fluctuation in levels in the perimenopause. FSH … Continue reading

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Vaginal dryness

(Note that this comes from a Pulse Learning module that was actually sponsored by Replens; I hadn’t realised it was sponsored when I clicked on it, so, lesson learned, I will look more carefully in future. It did have some … 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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