Tales from the clinic: Contraception and perimenopause.

Effective contraception consultations are essential to delivering high-quality perimenopause care and reducing unplanned pregnancies. Contraception can be used independently, or in conjunction with hormone replacement therapy (HRT). Newer contraception options provide enhanced opportunities to individualise perimenopause care.

Management of unscheduled bleeding on HRT: A joint guideline on behalf of the British Menopause Society, Royal College Obstetricians and Gynaecologists, British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Faculty of Sexual and Reproductive Health, Royal College of General Practitioners and Getting it Right First Time.

Unscheduled bleeding on hormone replacement therapy (HRT) can affect up to 40% of users. In parallel with the increase in HRT prescribing in the UK, there has been an associated increase in referrals to the urgent suspicion of cancer pathway for unscheduled bleeding. On behalf of the British Menopause Society (BMS) an expert review panel was established, including primary and secondary care clinicians with expertise in the management of menopause, with representatives from key related organisations, including the Royal College of Obstetricians & Gynaecologists, the British Gynaecological Cancer Society, British Society for Gynaecological Endoscopy, Royal College of General Practitioners and Faculty of Sexual and Reproductive Health, and service development partners from NHS England and GIRFT (Getting it Right First Time).

Counselling of path_ carriers who are considering risk-reducing oophorectomy.

path_ 1/2 increases a woman's lifetime risk of breast and ovarian cancer. Interventions can be offered which manage cancer risk; annual breast screening from age 30, chemoprevention and, once a woman's family is complete, risk-reducing surgery. The latter is the most effective method of reducing cancer in path_ carriers; salpingo-oophorectomy reduces breast and ovarian cancer, respectively, by up to 50% and 95%.

The use of biomarkers and HPV genotyping to improve diagnostic accuracy in women with a transformation zone type 3.

Background: Twenty percent of women referred to colposcopy have a type 3 transformation zone-where colposcopic assessment for high-grade dysplasia (CIN2+) is not possible. This study examines the effectiveness of HPV biomarkers and genotyping in combination with techniques that sample an endocervical TZ.

Methods: A prospective diagnostic accuracy study.

Conversations between women with vulval lichen sclerosus: a thematic analysis of online forums.

Background: Vulval lichen sclerosus (VLS) is a common condition. Despite this, there is a paucity of research investigating the impact on women's lives. Some women with VLS utilise online forums to discuss their priorities and concerns.

Evaluation of a tertiary and district general hospital menopause service.

Objective: Requests for management of menopausal symptoms and hormone replacement are increasing in the UK. Referrals to specialist clinics have to be balanced with increasing recommendations within the NHS to improve efficiency and patient care.

Study Design: Retrospective evaluation of clinic records over two months at a district general (Poole Hospital) and tertiary (Guy's Hospital) menopause service.

Comparison of the Cervex-Brush alone to Cytobrush plus Cervex-Brush for detection of cervical dysplasia in women with a transformation zone type 3.

Introduction: Twenty percent of colposcopic assessments are inadequate due to a type 3 transformation zone (TZ3). In the absence of colposcopic or histological assessment, subsequent management is guided by the referral screening test. In the UK, routine cervical screening is completed by a Cervex-Brush alone.

Unsatisfactory colposcopy: clinical decision-making in conditions of uncertainty.

Background: Unsatisfactory colposcopy, where the cells of interest are not visible in women with a positive cervical screening test, is a common area of clinical uncertainty due to the lack of clear evidence and guidance. Colposcopists' opinions and experiences are likely to have a significant influence on service provision and the development of national policy. The aim of this study was to analyse decision-making when applied to women with unsatisfactory colposcopy.

Hybrid simulation compared to manikin alone in teaching pelvic examinations: a randomised control trial.

Introduction: Performing a pelvic examination is a core skill for all medical undergraduates. The use of hybrid simulation, manikin with patient actress, to attain technical and communication skills competencies and to improve the quality of care we offer women, has not been compared to other teaching methods before. Outcome measures were technical skills, communication skills and confidence in completing a pelvic examination.

The training value of a low-fidelity cervical biopsy workshop.

Introduction: Cervical biopsy increases diagnostic yield compared with cytology and reduces time between presentation with and diagnosis of cervical cancer. Procedural training however needs to evolve in line with legislated working time restrictions and patient safety concerns. This makes gynecologic procedures ideal for simulation training.

Chlamydia screening or prophylaxis before laparoscopy and dye hydrotubation: no readmissions, no worry, or is that so?

We present a retrospective analysis of 120 laparoscopy and dye hydrotubation procedures. Our aim was to assess chlamydia screening or prophylaxis before, and the rate of readmission after, such procedures. We found evidence of a chlamydia screening test performed in 109 cases.