Why does primary care need to know about women’s health?
The 2022 women’s health strategy showed that women spend a
significantly greater proportion of their lives in ill health and disability
compared to men; a majority of women who responded to the survey felt that
there had been times when their voices were not listened to when accessing
healthcare. Specific concerns were that symptoms were not taken seriously, that
significant self-advocacy was needed to reach a diagnosis, and that there were
limited opportunities to discuss the possible treatments. There are a variety
of medical needs and life stages which are specific to women, including
cervical and breast screening, dysfunctional menstruation, the need for
contraception, care during pregnancy and the postnatal period, and management
of the menopause. Breast cancer, which is vastly more common in women than in
men, is the commonest UK cancer, with two other female specific cancers (uterus
and ovary) listed in the 20 most common UK cancers. Cancers of the cervix and
vulva are less common (with cancer of the cervix reducing in incidence due to
HPV vaccination), but it remains important that we maintain a high index of
suspicion for symptoms which could represent a malignancy of any part of the
female tract.
This hub concerns illnesses and life stages which are
relevant to those of the female sex, and so the words woman/women/female and
the pronouns she/her are used throughout the resources. Some of our patients
for whom these illnesses and life stages are relevant will have a gender
identity which is not female. Their chosen pronouns should be respected and
used.
Women’s health eLearning
This hub contains courses which cover the main female
cancers – endometrial, cervical, vulval and ovarian, as well as information
about prevention of, and screening for, breast cancer. The course on
endometriosis discusses the presentation and initial decision making process
around whether to treat empirically in primary care or refer for a diagnosis.
The decision on whether a formal diagnosis, only available via laparoscopy, is
necessary at first presentation, needs to be made by the woman and her GP and will
depend on a variety of factors including severity of symptoms and whether there
is a current wish to conceive. There is also a course on heavy menstrual
bleeding (HMB) which starts from the assessment of a patient with HMB and
discusses the current guidelines and how to assess the risk of endometrial
pathology and use this to make decisions about whether to treat empirically,
investigate in primary care, or refer at first presentation.
The course on contraception covers all currently available
methods and uses an interactive approach, case studies and videos to provide
education about the mode of action and efficacy of each method, the common
myths and how to refute them, and broader issues which women seeking
contraception may want to consider. Concepts such as quick-start and bridging
contraception are also discussed. The menopause and hormone replacement therapy
(HRT) is covered in a module aimed at generalists which discusses the identification
and management of the menopause and perimenopause, what women need to know
about HRT and how to start it, as well as the specific features that apply to
women with premature ovarian insufficiency (POI), many of whom will need
referral to secondary care.
The hub also contains a variety of podcasts. Some of
these cover the same subjects as the courses – a podcast sometimes allows more
in depth discussion of an aspect of care where management may not be clear-cut;
where there is a podcast and a course, they usually cover different facets of
the condition and so it is worth accessing both resources. There are also
podcasts on subjects which do not have a course on the hub, such as influenza
(flu) vaccination in pregnant women, and women’s health and migraine.
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