Sperm cryopreservation as a means of preserving the fertility potential of men has existed for over 50 years, but oocytes (eggs) are such large, delicate structures (imagine a fluid-filled bubble the size of a pin point) that until recently there was little we could offer young women facing a choice between the chemotherapy that could save their lives and the certainty of premature menopause and sterility. The first ‘frozen egg’ baby was born in 1986, but the success rate (100 eggs to produce one baby) was so low that ‘egg freezing’ was neglected for years. Two exciting technological developments (ICSI and dehydro-cryoprotectant) have transformed this picture and now young women who have frozen their eggs can be offered the same chance of a live birth per embryo transfer as women undergoing conventional IVF treatment. Young female oncology patients should now be routinely offered the chance to freeze their eggs before embarking on chemotherapy or radiotherapy. Modern treatment protocols mean that a delay of only 2–3 weeks is required before cancer therapy can be started and even patients with ‘hormone sensitive’ tumours such as breast cancer are not necessarily excluded. Other groups of patients may also want to consider ‘egg freezing’ as a ‘fertility extending’ option such as couples with ethical objections to embryo freezing, women who are not in a position to undertake motherhood yet, women considering becoming egg donors or mothers of baby girls diagnosed with Turner's Syndrome.
Offering a patient's perspective, Julia Clough tells how she was finally diagnosed with PCOS in December 2001, aged 31. The diagnosis was a result of numerous visits to her GP regarding sleeplessness, anxiety and depression which she suffered for up to five days, every month or every other month. Julia had also put on approximately four stone in the previous four years with no apparent explanation. The scan confirmed Julia's GP's suspicions and PCOS was diagnosed. Julia followed her doctor's advice (based at the Endocrinology department at St Mary's Hospital) and managed to lose three stone, unfortunately some of that weight has crept back on but she is back losing weight again and exercises regularly. Julia's symptoms have improved through healthy eating, exercise and stress management. Julia has also found that sleeping tablets prescribed by the GP help with her insomnia which she now suffers very irregularly.
Women often have different outcomes and experiences with mental illness compared to men. However, there is still a ‘gender-blind’ approach to the understanding and development of new treatments for mental illness. The emphasis is on: women and schizophrenia, depression in women and existing sex differences in anxiety disorders (including phobias, agoraphobia, panic disorder, generalised anxiety disorder and post-traumatic stress disorder). Utilizing gender differences in the onset, course and outcomes of mental illness may enable a better development of best outcomes for women with mental illness.
Acute infections of the breast have become less common in the UK with improvements in personal hygiene and the prescription of antibiotics. Breast infection is divided into lacational and non-lactational. Either can cause abscess formation, which can be avoided by the early prescription of appropriate antibiotics, although once established an abscess requires aspiration or incision and drainage. Lactational infection (including neo-natal mastitis) comprises around 25% of breast infections. They are usually caused by skin commensal organisms such as Staphylococcus aureus, and the route of infection is usually through a defect in the skin such as a cracked nipple. Treatment is with flucloxacillin or erythromycin. Non-lactational infection, perductal mastitis, affects young women. The most common organisms are Staphylococcus aureus, enterococci, anaerobic streptococci and bacteroides. Non-lactational breast infection is treated with co-amoxiclav, flucloxacillin or erythromycin, and metronidazole. It usually presents as periarelor inflammamation and will form an abscess if left untreated. If the abscess discharges or requires incision a mammillary duct fistula is likely to develop, which will require definitive surgical treatment by total duct excision and excision of the fistula.
Despite the high number of osteoporotic fractures sustained in the UK per annum there remains uncertainty in the cost associated with each fracture type, with literature estimates either conflicting, being non-existent or dated. With prescribing policies more frequently driven by health economic analyses errors in the estimated costs of fracture will lead to inefficient use of the healthcare budget. We present the estimated costs for each fracture type using a common methodology. UK data has been used wherever possible, however where this did not exist, or was inapplicable, data from Sweden was used as a proxy. Where both UK and Swedish data were available it was seen that in comparison costs are greater in the UK and thus our values are likely to be conservative. The average lengths of stay per fracture and cost per bed-day have been used to calculate the inpatient costs incurred by those admitted to hospital. Ratios of inpatient to out-patient costs from Sweden have been used to estimate the cost of out-patient care, which was also assumed equal to the costs incurred by patients with a clinical fracture where hospitalisation was not required. Whilst fractures at the hip, pelvis and other femoral sites incur the largest costs, it is seen that the costs of fractures at the tibia, fibula, spine, proximal humerus and humerus shaft are far from insignificant and should be included in all health-economic analyses of osteoporosis interventions.
Until relatively recently there has been a reluctance to accept premenstrual syndrome as a serious condition. Premenstrual symptoms occur in 95% of all women of reproductive age. Premenstrual syndrome (PMS) occurs in about 5% of those women. PMS patients appear more susceptible to their normal ovarian hormone cycle. The increased sensitivity may be due to neurotransmitter dysfunction (possibly serotonin). However, the definitive aetiology is not known. PMS results from ovulation and appears to be caused directly by the progesterone produced following ovulation in women who have enhanced sensitivity to this progesterone. Treatment can thus be achieved by suppression of ovulation or reducing progesterone sensitivity; the latter seems achievable by the administration of selective serotonin re-uptake inhibitors. Ovulation can be suppressed by a variety of methods, and oestrogen is frequently employed with success. Here, the authors describe an evidence-based approach to the management of PMS.
Hormone Therapy (HT) is a valid option for women with climacteric symptoms. At present there is a controversy as to whether HT should be used chronically for prevention to each patient. This review investigates the basic use of oestrogens, progestogens, the HT regimens, bleeding problems in HT users and when HT is necessary.
This contribution discusses the history of breast implants and the materials used, and provides a review of the risks associated with implants. The surgical techniques, clinical applications and complications of augmentation mammaplasty and breast reduction and mastopexy are covered, in addition to reduced scar breast reduction and mastopexy techniques.
Through a series of questions and answers on topics related to emergency contraception (EC), this review briefly assesses a number of primary concerns to help the practitioner understand the effectiveness of emergency contraception.
Through a series of questions and answers on topics related to emergency contraception (EC), this review briefly assesses a number of primary concerns to help the practitioner understand the basic issues associated with emergency contraception.
This review article examines the aetiology, physical assessment, treatment and pharmacological therapies for hirsutism. Hirsutism is defined as the presence in a female of terminal hair in a distribution more typically associated with the adult male. The condition can have a significant negative psychosocial impact on an individual as well as being a sign of underlying endocrine abnormality. Hirsutism develops as the result of the sensitisation of androgen-dependent hair follicles converting vellus hair to darker and thicker terminal hair. Over seventy percent of women with androgen excess demonstrate hirsutism, however, not all women with hirsutism will have detectable androgen excess. In these cases increased end-organ sensitivity to androgen plays an important role. Future developments for assessing and treating hirsutism are discussed.
Although many breast cancers are diagnosed early, some women still require a mastectomy for widespread ductal carcinoma in situ or they may chose to have a prophylactic mastectomy. In many of these cases women also choose reconstruction either to be performed at the time of the mastectomy or at a later date. There are a number of methods, including sub-pectoral tissue expander and the use of myocutaneous flaps such as a latissimus dorsi flap. An autologous tissue technique is the TRAM reconstruction, which gives the best cosmetic result but can be associated with a significant morbidity and a longer recovery period.
Osteomalacia is characterized by defective mineralization of bone, leading to an accumulation of unmineralized bone matrix (osteoid). Rickets represents the occurrence of this defect in growing children before the closure of epiphysis. In osteomalacia, there is a reduction in the mineralized bone:matrix ratio, unlike osteoporosis, where this ratio remains normal. There is sufficient bone volume, but the bone has reduced calcification. This contribution discusses the: aetiology, clinical features, investigations and management of osteomalacia.
Until relatively recently there has been a reluctance to accept premenstrual syndrome as a serious condition. Premenstrual symptoms occur in 95% of all women of reproductive age. Premenstrual syndrome (PMS) occurs in about 5% of those women. PMS patients appear more susceptible to their normal ovarian hormone cycle. The increased sensitivity may be due to neurotransmitter dysfunction (possibly serotonin). However, the definitive aetiology is not known. PMS results from ovulation and appears to be caused directly by the progesterone produced following ovulation in women who have enhanced sensitivity to this progesterone. Treatment can thus be achieved by suppression of ovulation or reducing progesterone sensitivity; the latter seems achievable by the administration of selective serotonin re-uptake inhibitors. Ovulation can be suppressed by a variety of methods, and oestrogen is frequently employed with success. Here, the authors describe an evidence-based approach to the management of PMS.
A wide spectrum of benign changes may occur within breast tissue. These inlcude non-neoplastic conditions such as fibrocystic change and benign neoplasms (tumours). Conditions such as fibrocystic change are very common in middle-aged and elderly women, but vary enormously in degree and extent between individuals. Fibroadenomas are common causes of benign breast masses in young women. Benign breast conditions may clinically simulate malignancy and therefore result in the requirement for pathological examination of the tissue as part of ‘triple assessment’ (i.e., the diagnostic process for patients with potential breast disease). It is therefore essential that pathologists can identify these benign conditions accurately. Benign breast disease may not require surgical treatment over and above that needed to confirm the diagnosis, but some forms of cellular change (e.g. florid epithelial hyperplasia, radial scar, intraduct papilloma) may be associated with co-existent malignancy (i.e. breast cancer) and/or an increased risk of subsequent malignancy.
This paper specifies the scale and nature of the challenge for women’s forensic services. It reviews recent information on patterns of female offending and mental ill health in relevant populations. It discusses both the origins of current secure services for women and the recent proposals of alterations to them. This is in light both of a better clinical understanding of mentally disordered female offenders and changing perceptions of their security needs. Mentally disordered female offenders are now more widely recognised to have been vulnerable to abuse in childhood. Within the last twenty years, there has been a developing view that women are rarely in need of high secure hospital services, but there continues to be a lack of consensus about how and where their needs would best be met.
Sir William Osler once said, ‘He who knows endometriosis, knows gynaecology.’ Endometriosis is a disease of complex aetiopathogenesis. The symptoms do not always match the extent of the disease. Not only are the physical effects of the disease extremely troublesome, but its psychological impact can also be devastating. Although the disease has been known for decades, it remains an enigma.
Dysmenorrhoea literally means painful menstrual flow and refers to cramping lower abdominal pain occurring with the onset of menstrual flow. In cases of primary dysmenorrhoea the pain commences during the teenage years and occurs in the absence of any pelvic disease. In contrast, secondary dysmenorrhoea usually commences later in life and results from some kind of underlying problem like endometriosis. This paper investigates the prevalence, aetiology, the distinction of primary and secondary dysmenorrhoea and treatments that can be offered to women.
The psychology of ageing encompasses a variety of approaches and experimental traditions which, while complementing the clinical sciences, nevertheless remain rooted in the psychology of human development. Two of these ‘experimental traditions’ provide the focus for this contribution: speed of performance (as measured by reaction times) and intellectual performance (as measured by cognitive tests). Superficially representing the ‘physical’ and the ‘mental’, and closely related to the most enduring stereotypes of ageing (which hold that we inevitably become slower and duller with advancing years), speed and intellectual performance are among the longest studied of all phenomena in experimental psychology. Understanding how these two aspects of functioning interrelate and change with normal ageing provides useful insights into psychological adaptation across the lifespan, and helps to identify opportunities for constructive intervention.
