9. Women’s Health

9. Women’s Health
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9. Women’s Health

By Andrew Harris
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Hi everyone!

When was the last time you gave your mum a call? Mums are special people in our lives. Take a few minutes today to give mum a call, send her a message or organise some flowers to be delivered. Sometimes a little affirmation is all you need to get through the day.

This article is about women’s health.

Women’s health was always an area of difficulty for me. This is partly because I have no personal experience with being a woman, and partly because throughout medical school I had very little exposure doing vaginal examinations, or performing cervical screening. I don’t think I’m unique in this experience as it is common for many male doctors. But that just means for people like me, it is an area which needs special attention when studying. Read every article, ask questions from female doctors and take every clinically appropriate opportunity that is presented to you to deal with women’s health issues.

Menopause is an area where a well-versed GP can provide significant improvement to a patient’s quality of life. Recognising the symptoms of menopause – such as altered moods, tiredness, vaginal dryness and hot flushes, is the first step in assisting a patient feel better. The eTG has a very clear and thorough section on hormone replacement therapies, as do the Jean Hailes and Australian Menopause Society websites. Read them well!

Contraception is an area of medicine you need to learn well. The choice of contraception is very individualised and should reflect the patient’s situation, finances, reliability, symptoms and risk factors. The UKMEC guidelines are used extensively in Australia to help determine a patient’s risk when prescribing contraception. When a patient presents for “just the pill thanks Doc”, always double check the risk factors (such as migraine, clots, new vaginal bleeding, blood pressure etc) before blindly giving them the prescription. You can’t be assured that the doctor before you has checked.

Be kind to yourself, and show a little love towards the females in your life this week.

Dr Andrew Harris
Director of Amadeus Education.

Did you know?

According to BEACH data, 4.2% of all encounters in General Practice were specifically related to the female genital system. Consider this as you are preparing for your exams. (Source: General practice activity in Australia: 2015-16. https://bit.ly/2c4d8Em)

Presenting complaints:

These are the common presenting complaints that should be covered for this topic:

Vulvar discomfort and irritation (https://bit.ly/2ROAhh6)

Common conditions:

These are the common conditions that should be reviewed for this topic:

Topics

Important reading

Contraception

Abnormal bleeding – including menorrhagia, post-menopausal bleeding, amenorrhoea

  • The management of irregular bleeding in women using contraception. AFP, October 2017. (https://bit.ly/2FGFgbu)

  • Abnormal vaginal bleeding in pre-, peri- and post-menopausal women: a diagnostic guide for general practitioners and gynaecologists. Cancer Australia, 2011. (https://bit.ly/2fHuTWv)

  • Heavy menstrual bleeding: diagnosis and management. Jean Hailes, March 2017. (https://bit.ly/2FPQWd4)

Cervical abnormalities – including cervical cancer, screening

Vaginal abnormalities – including discharge, vaginismus, dyspareunia, prolapse

Pregnancy – including termination of pregnancy, miscarriage, antenatal care/post natal care, early pregnancy bleeding

Breast abnormalities – including breast lumps, breast cancer

  • In the wake of Angelina: Managing a family history of breast cancer. January/February 2014. (https://bit.ly/2ODcv3q)

  • Newly diagnosed early breast cancer: AN update on pre-operative assessment and staging. AFP, November 2012. (https://bit.ly/2YHhlBy)

  • Lactational mastitis and breast abscess: Diagnosis and management in general practice. AFP, December 2011. (https://bit.ly/2YCSAGB)

Ovarian abnormalities – including PCOS, Ovarian pathology

Fertility

Premenstrual syndrome

Menopause – including HRT

Domestic violence

Endometriosis

Libido

Lesbian and bisexual patients

Medication doses:

These are the medications and doses that should be learned for the exam:

Condition

Medication

Contraception

  • Microgynon 50 (ethinyloestradiol 50/levonorgestrel 125)

  • Levonorgestrel-releasing intrauterine system (mirena) 52mg. Replace every 5 years.

Pelvic inflammatory disease

  • Sexually acquired:

    • Ceftriaxone 500mg in 2ml of 1% lidocaine IM injection AND

    • Azithromycin 1gm oral STAT AND

    • Metronidazole 400mg oral 12 hrly for 14 days PLUS

      • Doxycycline 100mg 12 hrly for 14 days

        OR

      • Azithromycin 1gm oral STAT one week later (pregnant or non compliant to doxy)

  • Non-sexually acquired:

    • Amoxycillin + Clavulanate 875+125mg (Aug DF) oral 12 hrly for 14 days AND

    • Doxycycline 100mg 12 hrly for 14 days

Menorrhagia

  • Non-hormonal:

    • Tranexamic acid 1-1.5g PO, 6-8 hourly for the first 3-5 days of menstruation

    • Ibuprofen 200-400mg orally, 3-4 times per day

    • Mefenemic acid 500mg orally, 3 times per day

  • Hormonal:

    • Levonorgestrel-releasing intrauterine system (mirena) 52mg. Replace every 5 years.

    • COCP

    • Oral progestrins (norethisterone 5mg orally, 2-3 times daily on days 1-21 of 28 day cycle for up to 6 months.

Mastitis

  • Flucloxacillin 500mg orally 6 hourly for 6 days

CHECKS:

Here are the list of recommended Checks that would be useful in your study for GP exams (accessed via subscription from http://gplearning.racgp.org.au):

  • Female reproductive system, May 2018
  • Abuse and violence, January-February 2018
  • Perinatal health, July 2017
  • Women’s health, August 2016
  • Women’s health, September 2014
  • Antenatal issues, June 2012
  • Breast symptoms, September 2011
  • Menstrual disorders, June 2011

Focus on clinical skills:

Here is a brief focus on some OSCE preparation topics related to this topic:

  • Contraception counselling
  • Pelvic examination
  • Cervical screening with counselling
  • New pregnancy counselling
  • Antenatal examination: https://bit.ly/2RVoBZR
  • Menopause counselling
  • Hormone replacement therapy counselling
  • Breast examination

Focus on medicolegal:

Here is a brief focus on the medicolegal issues covered in Australian Family Physician: Breast screening and failure to diagnose breast cancer. AFP, April 2009. (https://bit.ly/2W8A8o6)

Copyright © 2021 Andrew Harris

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