Women's health

Cervical Cancer screening

Please come and have a smear test when you receive a letter suggesting you have one - we believe it is very important and do not want any of our patients to get cancer of the cervix. We are now using the more accurate Thin Prep testing method (please note our Department of Health suggests much less frequent testing than the Americans).

Women with low-grade abnormalities should have 3 negative smears at 6, 12 and 24 months before going back to routine recall.  Women with high-grade disease i.e. moderate dyskaryosis or worse now have to be followed up for 10 years post treatment; they will therefore have smears at six and 12 months post-treatment and then annually for the subsequent nine years.

The main symptoms of cervical cancer are unusual bleeding from the vagina when women are not having their period. This includes bleeding between periods, bleeding after sex or any bleeding at all in post-menopausal women. Other symptoms may include a vaginal discharge that smells unpleasant, or discomfort or pain during sex.

See also Cancer screening programmes

Osteoporosis

Over the years there has been much debate about how and when to treat osteoporosis.  NICE have at last produced their guidance on primary prevention for women who have never broken a bone and secondary prevention for women who have. Unfortunately they have not included men in their deliberations and there are other blind spots which we hope will be filled in future guidance.

• Osteoporosis -- primary prevention

• Osteoporosis - secondary prevention

Hormone replacement therapy

We strongly encourage women with an early menopause, whether it occurs naturally or following surgery, to take HRT to at least age 50. This will help to ensure bones reach their maximum strength before the bone loss, which occurs after the normal menopause, begins. This loss of bone is the major cause of osteoporosis.

The publication of the "Women's Health Initiative" trial in The Journal of the American Medical Association and more recently The Million Women Study has clarified that long term HRT can slightly increase the risk of breast cancer, coronary heart disease and stroke while reducing the risk of bowel cancer and hip fractures. It is interesting that prior to the publication of these studies the incidence of breast cancer rose year on year but since then the incidence in the USA has fallen 8.6%. This has has been associated with number of prescriptions of HRT falling by two thirds. See also Cancer research UK

A further analysis of the million women study published in April 2007 concluded that women who use HRT are at greater risk of ovarian cancer and of death due to it. The risk increases with duration of use: mean duration of use in the study population was 7.7 years and this was associated with a 20% increase in risk. It is related to current use, not past use, and falls back to baseline level soon after use is stopped. Crude incidence rate in the study population as a whole was 2.2 per 1,000 women; in never-users it was 2.2 per 1,000, and in users 2.6 per 1000 (rates for death from ovarian cancer 1.3, 1.3, and 1.6 per 1,000 respectively). From these figures, assuming that the differences are due to HRT the authors calculate that over a five year period there would be about one extra case of ovarian cancer for every 2,500 users (and one extra death per 3,300 users).
 

Very surprisingly, the study also showed that HRT with or without progestogen increased the risk of incontinence in women who were originally continent and made symptoms worse for women who already had problems. The risks were highest for stress incontinence: hormone replacement doubled the risk of new symptoms compared with placebo . Any kind of hormone therapy made existing symptoms more frequent, more bothersome, and more likely to limit women's activities compared with placebo

Doctors continue to advocate the use of HRT  for menopausal symptoms.  However, an expert panel has advised that we limit HRT use to five years only - see Net Doctor (NB 5 years = 5 years after usual menopause i.e. age 55)

Mammography

The Dorset Breast screening unit recalls women between 50 and 65 every three years for a mammogram. We  encourage women to attend -see Cancer screening programmes

Women over 65 will not be recalled but the screening unit is happy to arrange a mammogram if the woman herself phones 665558

You might be interested to read a review published March 2002 showing that breast screening between ages 50 – 70 significantly reduces women’s risks from breast cancer:

“The International Agency for Research on Cancer (IARC), which is an offshoot of the World Health Organisation, has reported that its own study examining the evidence for and against breast screening has found that overall the procedure is of benefit and that government programme should continue. The group found that, on average, women taking part in such a screening programme could expect a fall of up to 35% in their personal breast cancer risk. Or in other terms for every 500 women screened, over a ten year period, one of them will be saved by breast screening. The group also reported that there was only limited evidence of benefit for breast screening for those in their 40s, or over the age of 70.”

Figures published by the Department of Health in March 2004 show a marked increase in the number of breast cancers detected by breast screening in the UK. Detection rates have been steadily increasing for the last five years. In 1998/99 7,561 cases of breast cancer were detected, in 99/00 8,215 cases, 00/01 8,345, 01/02 8,545 and in 02/03 9,848 cases were detected, representing a 13% increase in detection rate compared with the previous year.

It is believed that the latest year's increase can be attributed to the introduction of two-view mammography. This involves taking two x-ray views of each breast at the screening appointment. Research has shown that this technique can increase the detection rate of small cancers by 42%.

Infertility

• The Human Fertilisation and Embryology Authority

Page last updated April, 2009