The contraceptive needs of women aged over 40 years are very specific and many healthcare professionals are unsure about which methods should be prescribed to women in this age group. As highlighted by Dr Katie Boog and Valerie Warner Findlay: ‘Perimenopausal symptoms combined with increased background risks of certain health conditions mean that the the benefits and risks of contraception for this population are different from those relevant to younger women.

In their article, the authors discuss the latest recommendations from the Faculty of Sexual & Reproductive Health (FSRH) on contraception for women aged over 40 years, including which methods are safe and suitable, when contraception should be stopped, and how contraception should be used alongside hormone replacement therapy. Related mutiple-choice questions (MCQs) are also included in this issue so that you can test your updated knowledge after reading the article.

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Contraception for women aged over 40: what, when, and for how long

Image source: © Prof P. Motta, Dept of Anatomy, University La Sapienza, Rome; Science Photo Library

Dr Katie Boog and Valerie Warner Findlay

Liver blood tests are commonly used in primary care to diagnose or exclude a range of liver conditions. This month’s issue includes an article on the updated British Society of Gastroenterology (BSG) Guidelines on the management of abnormal liver blood tests. Dr Jez Thompson describes how liver blood tests can be used to investigate non-specific symptoms and explains when to request liver blood tests, how to interpret the results, and what actions to take if results of liver blood tests are abnormal. A further set of MCQs relating to the article can be found in this issue.

Continuing our popular ‘differential diagnoses’ series is an article by Dr Simon Somerville on low back pain. Dr Somerville presents a range of case studies demonstrating how to manage low back pain on a case-by-case basis, and discusses how risk-stratification tools can be used to assess a patient’s risk of ongoing disability.

This month’s top tips are on the primary care management of dyspepsia in adults. Dr Sophie Nelson distils recommendations from NICE into 10 tips about: 

  • diagnosing dyspepsia
  • testing for the presence of Helicobacter pylori
  • lifestyle, pharmacological, and surgical treatment options
  • how to involve the practice or community pharmacist
  • when to refer for endoscopy or to secondary care.

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Top tips: dyspepsia

Dr Sophie Nelson

Finally, Dr Satpal Shekhawat shares his experiences of a complex practice merger, which helped to solve recruitment problems, improve the work–life balance for practice staff, and increase the level of service offered to patients. Is working together an answer for capacity crisis?