Women's health 3
Track 2
| Sunday, October 29, 2023 |
| 10:35 AM - 12:30 PM |
| Pyrmont theatre |
Overview
Session will be between 1035 - 1140 hours
Speaker
Dr Karen Nicholls
Chair, RACGP Aboriginal and Torres Strait Islander Health
Royal Australian College of General Practitioners
Chairperson
Biography
Dr Munawwara Talat Uppal
Director
Womens Health Road
Management of Heavy Menstrual Bleeding in a multidisciplinary team setting
10:35 AM - 10:50 AMSummary
Aim: Reflections on setting up a Multi-disciplinary Team based service for Women's Health
Women’s Health Road is a Medical Centre located opposite Northern Beaches Hospital in Frenchs Forest, with on-site sessions from both GP and non-GP Specialists.
The practice is a digitally integrated structured service providing multidisciplinary, holistic medical care including women’s health.
Heavy menstrual bleeding (HMB) is common in peri menopause and has been defined as ‘excessive menstrual blood loss which interferes with the woman’s physical, emotional, social and material quality of life, and which can occur alone or in combination with other symptoms.'
GP management of HMB is dependent on the severity and likely cause of bleeding, future fertility plans, medical contraindications, and personal preferences.
The six quality statements from the HMB clinical care standard released by Australian Commission on Safety and Quality in Health Care, are relevant to general practice, highlight some areas for quality improvement.
This presentation will cover the management of women, particularly at midlife with heavy menstrual bleeding in the context of multiple services under one roof, including access to pelvic ultrasound, a digitally empowered health care HMB pathway using the digital patient portal and proactive iron replacement in the medical centre. Discussion will briefly include what happens after referral for surgical management and use of Menopause Hormone therapy for suitable women.
This presentation is hence an overview of end-to-end HMB management and the benefits of a proactive approach to this condition that unfortunately many women suffer so much morbidity and loss of quality of life, from.
Women’s Health Road is a Medical Centre located opposite Northern Beaches Hospital in Frenchs Forest, with on-site sessions from both GP and non-GP Specialists.
The practice is a digitally integrated structured service providing multidisciplinary, holistic medical care including women’s health.
Heavy menstrual bleeding (HMB) is common in peri menopause and has been defined as ‘excessive menstrual blood loss which interferes with the woman’s physical, emotional, social and material quality of life, and which can occur alone or in combination with other symptoms.'
GP management of HMB is dependent on the severity and likely cause of bleeding, future fertility plans, medical contraindications, and personal preferences.
The six quality statements from the HMB clinical care standard released by Australian Commission on Safety and Quality in Health Care, are relevant to general practice, highlight some areas for quality improvement.
This presentation will cover the management of women, particularly at midlife with heavy menstrual bleeding in the context of multiple services under one roof, including access to pelvic ultrasound, a digitally empowered health care HMB pathway using the digital patient portal and proactive iron replacement in the medical centre. Discussion will briefly include what happens after referral for surgical management and use of Menopause Hormone therapy for suitable women.
This presentation is hence an overview of end-to-end HMB management and the benefits of a proactive approach to this condition that unfortunately many women suffer so much morbidity and loss of quality of life, from.
Takeaways
- Heavy Menstrual Bleeding is common and under recognised, GPs have a crucial role in the management of this treatable condition
- It is a problem with many solutions and the goals of treatment include diagnosis of underlying conditions if any and replacement of iron deficiency
- A holistic approach to HMB management during peri menopause includes contraception support and pelvic floor health.
- It is a problem with many solutions and the goals of treatment include diagnosis of underlying conditions if any and replacement of iron deficiency
- A holistic approach to HMB management during peri menopause includes contraception support and pelvic floor health.
Biography
Dr Talat Uppal is an Obstetrician & Gynaecologist who has a DDU sonographic qualification.
She is the Director of Women’s Health Road, and has set up an innovative integrated, multidisciplinary, family centered integrated health care model for women. WHR is accredited with RACGP, due to Dr Talat’ passion for valuing primary care as the bedrock of health care. She has a niche in GP Education.
Dr Talat Uppal is also a Clinical Senior lecturer at Macquarie University . Her past, decade long role was based at Many and Mona Vale Hospitals, as Senior Obstetrics Staff Specialist and Clinical Director of Women’s, Children & Family health. She is the past Chair of both the NSW State Reference Committee and NSW RANZCOG Education Subcommittee.
She is a RANZCOG media spokesperson and fluent in three languages.
Mrs Marianne Natvik
University of Oslo
Do women want information about menopause? A cross-sectional survey among women in Norway
10:50 AM - 11:05 AMSummary
Background
Information about menopause is not systematically given to women. Studies have shown that this might be helpful when entering this period in life, both in relation to her attitude to menopause and to cope with symptoms.
Aims
To increase our knowledge about drivers and inhibitors of women’s information needs about menopause: If, when and from whom they request information.
Methods
A cross-sectional survey was conducted autumn 2022 in 53 Norwegian general practice clinics. Medical students recruited women that answered the survey in the clinic’s waiting room. Data was analysed using IBM SPSS Statistics 29.
Results
Of the 804 responses, 789 were included. Mean age was 46.5 years. The women had 50 different nationalities: majority being born in Norway (85%). Among the participants 52% defined themselves as premenopausal, 20 % menopausal, 29% postmenopausal and, 8% did not know. In all, 52% answered that they wanted information about menopause and 74% (n=305) of these wanted their general practitioner to inform them from a mean age of 43. Among premenopausal women, 60% wanted information and 61% among menopausal women. A main driver of information need was to obtain self-management in the present (65%, n=241) and the future (61%, n=225). In all 39% (n=305) did not want information. In this group 39% were premenopausal, 17% menopausal, and 40% postmenopausal. Main reasons were they already possessed sufficient information (33%), would take menopause as it comes (27%) or were already postmenopausal (32%). The gender of the woman’s general practitioner did not influence the results.
Conclusion
The majority of women wanted information about menopause and the general practitioner plays an important role in this. The general practitioner needs to make room for this conversation and to be up to date on recommendations and treatment options.
Information about menopause is not systematically given to women. Studies have shown that this might be helpful when entering this period in life, both in relation to her attitude to menopause and to cope with symptoms.
Aims
To increase our knowledge about drivers and inhibitors of women’s information needs about menopause: If, when and from whom they request information.
Methods
A cross-sectional survey was conducted autumn 2022 in 53 Norwegian general practice clinics. Medical students recruited women that answered the survey in the clinic’s waiting room. Data was analysed using IBM SPSS Statistics 29.
Results
Of the 804 responses, 789 were included. Mean age was 46.5 years. The women had 50 different nationalities: majority being born in Norway (85%). Among the participants 52% defined themselves as premenopausal, 20 % menopausal, 29% postmenopausal and, 8% did not know. In all, 52% answered that they wanted information about menopause and 74% (n=305) of these wanted their general practitioner to inform them from a mean age of 43. Among premenopausal women, 60% wanted information and 61% among menopausal women. A main driver of information need was to obtain self-management in the present (65%, n=241) and the future (61%, n=225). In all 39% (n=305) did not want information. In this group 39% were premenopausal, 17% menopausal, and 40% postmenopausal. Main reasons were they already possessed sufficient information (33%), would take menopause as it comes (27%) or were already postmenopausal (32%). The gender of the woman’s general practitioner did not influence the results.
Conclusion
The majority of women wanted information about menopause and the general practitioner plays an important role in this. The general practitioner needs to make room for this conversation and to be up to date on recommendations and treatment options.
Takeaways
1. Women in Norway want information about menopause.
2. They want the information before entering menopause.
3. The women see their GP as an important provider of information.
2. They want the information before entering menopause.
3. The women see their GP as an important provider of information.
Biography
Marianne Natvik lives in Oslo, Norway. A medical doctor, specialised as a general practitioner, with a passion for women's health. She works as a Ph.D.-student at the University of Oslo. Her project is about women's information needs related to menopause and the role of GPs in dissemination information.
Natvik works with patients both in general practice and in a youth health station. She is the leader of the Gynaecology Group at the Norwegian Association for General Practice and is committed to educating others about women's health. She regularly gives lectures and organizes courses in gynaecology, stress management, and self-care for general practitioners and other health care workers. She also teaches medical students at the University of Oslo.
She has experience as a general practitioner for several years in Oslo and in Lærdal and has also worked at Women's Clinics both at Akershus University hospital and at Oslo University Hospital, Rikshospitalet.
Professor Danielle Mazza
Head, Department of General Practice School of Public Health and Preventive Medicine
Monash University
Long-acting reversible contraception: A national survey of Australian general practitioner knowledge, attitudes and practice
11:05 AM - 11:20 AMSummary
Aim:
To investigate the knowledge, attitudes, and practices of Australian general practitioners in long-acting reversible contraception (LARC) provision.
Content:
General practitioners (GPs) are well-placed to support women’s access and provision of LARC. However, uptake in Australia is low (11%), compared to other contraceptive methods.
A national survey was undertaken July to October 2021 exploring GP LARC knowledge, attitudes, and practices. This survey forms part of the Australian Contraception and Abortion Primary Care Practitioner Support (AusCAPPS) Network, a mixed-methods study aimed at improving access to LARC and early medical abortion in primary care.
Data were analysed using counts and proportions.
Of the 500 GP participants, 78% (n=388) identified as female, 54% (n=270) were from metropolitan areas, and most lived in Victoria (31%, n=156) or New South Wales (30%, n=148). To prevent pregnancy, most (97.6%;n=488) knew that LARCS were more effective than the contraceptive pill and that intrauterine devices (IUDs) are suitable for nulliparous women (91.8%;n=459). Contraceptive consultations about LARC were generally GP initiated either very often (45.3%;n=226) or always (40.3%;n=201). GPs were influenced by patient preference (94.4%;n=472), age (78.0%;n=390), and cost (72.8%;n=364) when recommending LARC. Regarding LARC insertion and removal, 76.2% (n=380) provided this for implants but only 26.9% (n=134) for IUDs. Most GPs answered “neither” when asked whether the possible side effects of implants (76.4%; n=382) and IUDs (78.6%; n=393) outweighed the benefits of their use.
To reduce barriers to LARC practice, AusCAPPS will be presented. This online platform was developed with support from key stakeholders in women’s health services with features including peer networking opportunities, a provider database, resources, and training links.
Goals
1. To present Australian GP knowledge, attitudes, and practices in LARC provision
2. To discuss the gaps for Australian GPs in LARC service provision
3. To discuss ways GPs can be supported to provide LARC services.
To investigate the knowledge, attitudes, and practices of Australian general practitioners in long-acting reversible contraception (LARC) provision.
Content:
General practitioners (GPs) are well-placed to support women’s access and provision of LARC. However, uptake in Australia is low (11%), compared to other contraceptive methods.
A national survey was undertaken July to October 2021 exploring GP LARC knowledge, attitudes, and practices. This survey forms part of the Australian Contraception and Abortion Primary Care Practitioner Support (AusCAPPS) Network, a mixed-methods study aimed at improving access to LARC and early medical abortion in primary care.
Data were analysed using counts and proportions.
Of the 500 GP participants, 78% (n=388) identified as female, 54% (n=270) were from metropolitan areas, and most lived in Victoria (31%, n=156) or New South Wales (30%, n=148). To prevent pregnancy, most (97.6%;n=488) knew that LARCS were more effective than the contraceptive pill and that intrauterine devices (IUDs) are suitable for nulliparous women (91.8%;n=459). Contraceptive consultations about LARC were generally GP initiated either very often (45.3%;n=226) or always (40.3%;n=201). GPs were influenced by patient preference (94.4%;n=472), age (78.0%;n=390), and cost (72.8%;n=364) when recommending LARC. Regarding LARC insertion and removal, 76.2% (n=380) provided this for implants but only 26.9% (n=134) for IUDs. Most GPs answered “neither” when asked whether the possible side effects of implants (76.4%; n=382) and IUDs (78.6%; n=393) outweighed the benefits of their use.
To reduce barriers to LARC practice, AusCAPPS will be presented. This online platform was developed with support from key stakeholders in women’s health services with features including peer networking opportunities, a provider database, resources, and training links.
Goals
1. To present Australian GP knowledge, attitudes, and practices in LARC provision
2. To discuss the gaps for Australian GPs in LARC service provision
3. To discuss ways GPs can be supported to provide LARC services.
Takeaways
1. Understand the current knowledge, attitudes and practices of Australian GPs in regards to long-acting reversible contraception (LARC).
2. Understand the gaps in Australian LARC service provision.
3. Gain insight into how they can be supported to deliver LARC care through the Australian Contraception and Abortion Primary Care Practitioner Support (AusCAPPS) Network.
2. Understand the gaps in Australian LARC service provision.
3. Gain insight into how they can be supported to deliver LARC care through the Australian Contraception and Abortion Primary Care Practitioner Support (AusCAPPS) Network.
Biography
Dr Sharon James is an experienced primary health care nurse and APNA Board Director who completed her PhD about lifestyle risk factor communication in 2020. She currently works as a Research Fellow and Project Manager with Monash at the Department of General Practice on the Australian Contraception and Abortion Primary Care Practitioner Support Network Project. Her other interests include women’s health, communication, preventive care, interconception health and nursing roles in primary health care.
Dr Annapurna Nori
Senior Medical Consultant and Phd Candidate
SA Health / University of Adelaide
The Functional Health Status of older Kaurna and Ngarrindjeri women
11:20 AM - 11:35 AMSummary
The Care Project is a community-requested participatory research project developing a model of care to improve the wellbeing of older Kaurna and Ngarrindjeri women (self-defined by the women as ≥45 years). A core aim is to understand the health status of these older Aboriginal women. Triangulated data sources included in-depth interviews with older Kaurna and Ngarrindjeri women (community participants), staff interviews at two Aboriginal health services, a clinical file audit of medical records, and a functional health assessment (FH) of the community participants. FH was included since as WONCA states “Functional status relates to the patient, not to the health problem, disease or episode of care”.
The WONCA-COOP charts are a valid and reliable means of assessing FH. They have also been tested for ease of use and acceptability in several countries and population groups including Indigenous peoples. Use of the WONCA-COOP charts has been limited to clinical care and its utility in research is largely untested.
We used these charts for their ease of administration, validity of use in Indigenous people and the 1st author’s extensive experience with them in clinical practice.
16 community participants ranging in age from 47 – 79 years assessed their functional health in 8 domains: physical fitness, feelings, daily activities, social activities, pain, overall health, social supports and quality of life (QoL). A descriptive analysis was conducted enriched by insights from interview data.
From the traditional disease-oriented (pathogenic) view, the results support the common narrative that Australian Indigenous people have significant physical and mental problems. From a health promoting (salutogenic) view, the women have preserved their QoL despite reduced physical and emotional wellbeing. This contradicts the stereotype of Aboriginality being synonymous with disadvantage.
The FH results, strengths and limitations of FH assessment, and the role of cultural determinants in preserving wellbeing will be presented.
The WONCA-COOP charts are a valid and reliable means of assessing FH. They have also been tested for ease of use and acceptability in several countries and population groups including Indigenous peoples. Use of the WONCA-COOP charts has been limited to clinical care and its utility in research is largely untested.
We used these charts for their ease of administration, validity of use in Indigenous people and the 1st author’s extensive experience with them in clinical practice.
16 community participants ranging in age from 47 – 79 years assessed their functional health in 8 domains: physical fitness, feelings, daily activities, social activities, pain, overall health, social supports and quality of life (QoL). A descriptive analysis was conducted enriched by insights from interview data.
From the traditional disease-oriented (pathogenic) view, the results support the common narrative that Australian Indigenous people have significant physical and mental problems. From a health promoting (salutogenic) view, the women have preserved their QoL despite reduced physical and emotional wellbeing. This contradicts the stereotype of Aboriginality being synonymous with disadvantage.
The FH results, strengths and limitations of FH assessment, and the role of cultural determinants in preserving wellbeing will be presented.
Takeaways
1. An understanding of salutogenic approaches to health
2. The utility of a functional health assessment in clinical practice and research
3. Cultural determinants of health
2. The utility of a functional health assessment in clinical practice and research
3. Cultural determinants of health
Biography
Annapurna is a public health physician, GP, and scholar. She is a Settler on Kaurna Land, with extensive experience working in Aboriginal Primary Care. She is currently undergoing PhD study to develop a model of care to improve the wellbeing of older Kaurna and Ngarrindjeri women. Annapurna is recognised for her commitment to improving health outcomes for the Aboriginal communities she works with. She brings a strong clinical, academic, and public health perspective to her work, and was at the forefront of working with SA Aboriginal communities in implementing COVID-19 related activities including vaccine hesitancy.
Dr Ruth Kirk Ertmann
Associate Professor
Læge ruth Ertmann
Don’t worry be pregnant
11:35 AM - 11:40 AMSummary
Introduction:
The aim was to investigate whether common pregnancy-related symptoms – nausea, vomiting, back pain, pelvic girdle pain, pelvic cavity pain, vaginal bleeding, itching of vulva, pregnancy itching, leg cramps, uterine contractions and varicose veins – in the first trimester of pregnancy add to the identification of women at high risk of future pregnancy and birth complications.
Material and methods:
Survey data linked to national register data. All women booking an appointment for a first prenatal visit in one of 192 randomly selected GP practices in East Denmark in the period April 2015-August 2016. The GPs included 1491 women to this prospective study. From the Danish medical birth register two outcomes were collected: pregnancy complications and birth complications.
Result:
Among the 1413 included women, 199 (14%) experienced complications in later pregnancy. The most serious complication, miscarriage, was experienced by 65 women (4.6%). Other common pregnancy complications were gestational diabetes mellitus (n=11, 0.8%), gestational hypertension without proteinuria (n=34, 2.4%), mild to moderate pre-eclampsia (n=34, 2.4%), and gestational itching with effect on liver (n=17, 1.2%).
Women who experienced pelvic girdle pain, pelvic cavity pain or vaginal bleeding in the first trimester of pregnancy had a higher risk of pregnancy complications later on in later pregnancy. None of the other examined symptoms showed associations to pregnancy complications. No associations were found between pregnancy-related physical symptoms in first trimester and birth complications.
Conclusion:
Symptoms in early pregnancy do not add much information about the risk of pregnancy or birth complications although pain and bleeding may give reason for some concern. This is an important message to women experiencing these common symptoms and to their caregivers.
The aim was to investigate whether common pregnancy-related symptoms – nausea, vomiting, back pain, pelvic girdle pain, pelvic cavity pain, vaginal bleeding, itching of vulva, pregnancy itching, leg cramps, uterine contractions and varicose veins – in the first trimester of pregnancy add to the identification of women at high risk of future pregnancy and birth complications.
Material and methods:
Survey data linked to national register data. All women booking an appointment for a first prenatal visit in one of 192 randomly selected GP practices in East Denmark in the period April 2015-August 2016. The GPs included 1491 women to this prospective study. From the Danish medical birth register two outcomes were collected: pregnancy complications and birth complications.
Result:
Among the 1413 included women, 199 (14%) experienced complications in later pregnancy. The most serious complication, miscarriage, was experienced by 65 women (4.6%). Other common pregnancy complications were gestational diabetes mellitus (n=11, 0.8%), gestational hypertension without proteinuria (n=34, 2.4%), mild to moderate pre-eclampsia (n=34, 2.4%), and gestational itching with effect on liver (n=17, 1.2%).
Women who experienced pelvic girdle pain, pelvic cavity pain or vaginal bleeding in the first trimester of pregnancy had a higher risk of pregnancy complications later on in later pregnancy. None of the other examined symptoms showed associations to pregnancy complications. No associations were found between pregnancy-related physical symptoms in first trimester and birth complications.
Conclusion:
Symptoms in early pregnancy do not add much information about the risk of pregnancy or birth complications although pain and bleeding may give reason for some concern. This is an important message to women experiencing these common symptoms and to their caregivers.
Takeaways
Women who experienced pelvic girdle pain, pelvic cavity pain or vaginal bleeding in the first trimester of pregnancy had a higher risk of later pregnancy complications, but we found no significant associations between any early pregnancy symptoms and birth complications
Biography
I am associate professor at the University of Copenhagen, MD, PhD. I am a regular contributor to medical journals and textbooks. I train medicine students as well as specialist doctors. In addition, I am a General Practitioner and work part- time in my practice in Tingbjerg, an exposed residential area, in Copenhagen.
My primary interests are communication, sick children and pregnant women. My research is mainly based on interview, questionnaires and registers.
