There are 890 million adults worldwide who are living with obesity and the prevalence continues to rise. Obesity is a complex multisystem disease that causes metabolic dysfunction. The endometrium is vulnerable to the effects of obesity at all life stages. Obesity is associated with heavy menstrual bleeding, infertility and miscarriage, polycystic ovary syndrome, endometrial hyperplasia and endometrial cancer. Obesity is the aetiological driver in 50% of endometrial cancers. Hyperestrogenism, hyperinsulinemia and chronic inflammation are considered the underlying mechanisms. Health optimization in people living with obesity relies on clinicians providing quality health education about the effects of obesity on gynaecological health. Progestins can protect the endometrium against obesity-associated proliferation and are recommended for the management of obesity-associated endometrial disorders. Weight reduction and maintaining a healthy weight improves endometrial health and reproductive outcomes. Clinicians can initiate discussions about weight and signpost or refer to weight management services where appropriate.
Recurrent first trimester pregnancy loss is a multifactorial condition, affecting approximately 1% of couples, with definitions varying across professional bodies. Although most women will subsequently achieve a successful pregnancy, recurrent miscarriage can have a profound emotional and psychological impact. The aim of investigation and management is to identify potentially treatable causes, including genetic, anatomical, endocrine, and autoimmune factors. In many cases, however, no specific cause is found, highlighting the importance of supportive care, clear counselling, and individualised management. A practical approach begins with a comprehensive history, including medical, surgical, obstetric/gynaecological, family, and lifestyle factors. Baseline investigations, such as blood tests and pelvic imaging, are arranged to identify common associations. More personalised investigations and management are guided by individual risk factors and findings. This structured, stepwise approach allows clinicians to provide targeted interventions and tailored counselling, supporting couples both medically and emotionally.
Pelvic masses are common and present diagnostic and management challenges. The differential diagnosis list is broad, and the main aim of the assessment is to rule out malignancy. Focused history and detailed examination are vital in eliciting concerning signs and symptoms of malignancy and guide further investigations. The first line investigations for pelvic masses are transvaginal ultrasound scan (USS) and CA125 tumour marker. Additional tumour markers might be needed in younger patients, including alpha fetoprotein and human chorionic gonadotropin. USS reporting systems have been developed to standardise the lexicon used when characterising pelvic masses, most commonly IOTA and O-RADS US systems. MRI scan can offer additional insight into the nature of the pelvic mass, particularly when incorporating O-RADS MRI system. The role of CT is limited in characterising pelvic masses but remains essential for diagnosing disseminated disease and metastasis when ovarian cancer is confirmed or highly suspected. Management of pelvic masses is largely dependent on the result of the investigation workup and the associated risk of malignancy. Conservative management could be considered in benign-looking lesions, while diagnostic surgery is warranted for lesions with an intermediate risk of malignancy. Lesions with high probability of being malignant should be referred to specialised gynaecological oncology centres for further management.
Gestational trophoblastic disease (GTD) is a heterogeneous group of early pregnancy disorders encompassing the non-neoplastic partial and complete hydatidiform moles and the malignant conditions of invasive mole, choriocarcinoma, placental site trophoblastic tumour and epithelioid trophoblastic tumour. It also includes other entities such as placental site nodules (PSN) and non-molar abnormal villous lesions. Hydatidiform mole (HM) pregnancies develop due to abnormal proliferation of the villous trophoblast resulting from abnormal conceptions characterized by over-expression of the paternal genome. Patients are often asymptomatic with vaginal bleeding, positive pregnancy test and suggestive ultrasound features continue to be the most common presenting picture of HM. Earlier detection due to advances in ultrasound scanning (US) and first trimester US, facilitates accurate and timely diagnosis and ensures appropriate follow up and management. Cure rate is achieved in 98–100% of cases through effective registration in the well-developed national UK registry, appropriate follow up and treatment programme in one of recognized GTD treatment centres.
Overactive bladder (OAB), as defined by the International Continence Society (ICS), is characterised by urinary urgency, usually accompanied by increased daytime frequency and/or nocturia, with urinary incontinence (OAB-wet) or without (OAB-dry), in the absence of urinary tract infection or other obvious pathology. It affects up to 40% of women, with increasing incidence with age. Diagnosis relies on self-reported symptoms and/or bladder diary assessments. Management follows a stepwise approach: first-line interventions include lifestyle modifications, bladder training, and pelvic floor muscle exercises. Pharmacological therapy, such as anticholinergic agents or beta-3 adrenoreceptor agonists, is considered second-line, though caution is advised with anticholinergics due to potential cumulative anticholinergic burden. Approximately 25–40% of women with OAB are refractory to first- and second-line treatments; these patients may benefit from advanced therapies, including intradetrusor Botulinum toxin A, neuromodulation, or reconstructive surgery.
An adverse incident in obstetrics can be catastrophic and life changing with clinical negligence claims in obstetrics continuing to represent the highest value claims. High costs arise because birth injury including brain injury can have catastrophic effects over a lifetime. The patients and their families who are harmed suffer the direct effects of clinical negligence, but the strains are felt throughout the system. Spending on clinical negligence is escalating and as such is a major drain on NHS resources and its long-term sustainability. Obstetrics is a high risk specialty and as such almost all clinicians will be involved in some form of litigation. Litigation cannot be avoided in the current climate, there will always be risk in obstetrics and adverse outcomes.
Screening for trisomy 21 (Down syndrome) screening has been part of clinical practice for over 5 decades. During this time, substantial advances have improved the accuracy, safety, and range of options available to women considering antenatal screening for chromosomal aneuploidy. In the UK, the National Screening Committee has played a pivotal role in setting national standards for screening and guiding improvements in detection rates while reducing false positive results, thereby lowering the number of unnecessary invasive diagnostic procedures such as amniocentesis and chorionic villus sampling, and the associated risk of miscarriage. Non-invasive prenatal testing (NIPT), which analyzes cell-free fetal DNA in maternal plasma, represents the most recent major development in this field. NIPT offers very high sensitivity for common aneuploidies and is now incorporated into the NHS Fetal Anomaly Screening Programme as a contingent test, offered to women who receive a high-chance result from first or second-trimester (combined or quadruple test). This approach is expected to further reduce the number of invasive diagnostic procedures while maintaining current detection rates for trisomy 21, trisomy 18, and trisomy 13.
This article provides an overview of pelvic organ prolapse, a condition affecting around 40% of women over the age of 40, with significant implications for quality of life. It outlines the anatomical, physiological, and risk factors contributing to the development of prolapse, such as childbirth, advancing age, and increased body mass index. The article emphasizes the importance of thorough clinical assessment, including the use of the POP-Q staging system, to determine the severity and type of prolapse. Special focus is given to the role of vaginal pessaries as a conservative management option, highlighting their utility in symptom alleviation and maintenance of quality of life for women who may not be suitable for or wish to avoid surgery. We describe in detail different types of pessaries for use as well as information regarding the benefits of teaching patients to self-manage their pessaries.
Primary dysmenorrhoea is a common gynaecological condition affecting adolescents and women of reproductive age, with substantial impact on quality of life, education, and productivity. It is characterized by cyclical menstrual pain in the absence of pelvic pathology and is primarily driven by excessive prostaglandin-mediated uterine activity, with increasing recognition of central pain sensitization. While first-line pharmacological management with non-steroidal anti-inflammatory drugs and hormonal contraception remains unchanged, recent years have seen a growing evidence base for non-pharmacological and adjunctive interventions. This update summarizes key developments in recent years, including advances in understanding pathophysiology and new data on adjunctive treatment options such as transcutaneous electrical nerve stimulation, acupuncture, exercise, manual therapy, and educational approaches. These modalities support a multimodal, patient-centred approach to management, particularly for women who have an incomplete response to standard treatments or wish to avoid hormonal therapy. Ongoing challenges include heterogeneity of outcomes and limited long-term data, highlighting priorities for future research.
Rates of chronic liver disease among women of childbearing age are increasing, and with improvements in the management of the disease, pregnancies are becoming more common. The impact of liver disease on maternal and foetal outcomes depends on its aetiology, severity, and associated complications such as portal hypertension or hepatic decompensation. Comprehensive preconception counselling, optimization of maternal health, and specialist management throughout pregnancy and the postpartum period are essential to reduce adverse outcomes. Multidisciplinary care involving hepatology and obstetric teams can optimize maternal outcomes and support safe pregnancy in women with chronic liver disease.
