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The health problems faced by men and women differ because of important biological and anatomical differences. Many of these differences are explained, in one way or another, by the reproductive system. The January 2019 issue of Guidelines in Practice features three topics that bear particular relevance to women’s health; heavy menstrual bleeding (HMB), urinary tract infections (UTIs), and breast pain. 

Dr Rachel Brown explores the latest recommendations from NICE on the assessment and management of HMB. Diagnosis of HMB should be based on the woman’s symptoms and the impact they have on her quality of life, rather than a quantified measure of blood loss. 

Dr Brown discusses the recent advances in diagnostic techniques, which can help to identify or exclude causes such as adenomyosis, fibroids, or endometriosis. There are now more treatment options available and the guideline emphasises that the woman’s preferences should be taken into account when agreeing treatment options. GPs also need to be aware of the restrictions around prescribing ulipristal acetate and the new requirements for monitoring for possible liver side-effects before, during, and after treatment. 

Urinary tract infections are more common in women than in men—symptoms associated with urinary tract infections are one of the most common, acute reasons for women to seek health care. Studies suggest that of all women with a suspected UTI who are prescribed an antibiotic and have urine sent for culture, only one-quarter to two-thirds have a confirmed UTI. Possible differential diagnoses of UTI differ between men and women—prostatitis is an important consideration in men presenting with UTI symptoms, while for women it is necessary to exclude vaginal and urethral causes of urinary symptoms before considering a diagnosis of UTI. 

Public Health England has produced a quick reference tool for diagnosing UTIs in primary care with the aim of optimising diagnosis and reducing unnecessary antimicrobial prescribing. Rosalie Allison and Professor Cliodna McNulty explain how the quick reference tool was developed and how it should be used. Diagnostic flowcharts are used to describe the different strategies for women aged under 65 years, older people aged over 65 years, and infants and children aged under 16 years with suspected UTI. Diagnostic points for men aged under 65 years are also discussed. 

Breast pain is another common reason why women present to primary care. Breast pain can be a normal physiological event (e.g. before a period or during early pregnancy) or it can represent pathology such as a mastitis. Dr Toni Hazell uses case studies to illustrate possible causes of breast pain and how the different conditions should be managed in primary care. Dr Hazell describes important factors to consider when diagnosing cyclical breast pain or when mastitis is suspected, as well as associated symptoms and examination findings that indicate referral to secondary care, highlighting NICE referral criteria for suspected breast cancer. 

Breast abscess

Breast pain: what’s the diagnosis?

Image source: © CNRI/Science Photo Library

Dr Toni Hazell

The risks, symptoms, and outcomes of cardiovascular disease differ significantly between men and women—cardiovascular diseases are typically under recognised and under diagnosed in women. While these differences are not discussed in this issue (perhaps it is a topic we should consider in future), Dr Alan Begg reviews the latest recommendations from the Scottish Intercollegiate Guidelines Network (SIGN) on cardiac arrhythmia.

Coronary heart disease (CHD) is associated with many cardiac arrhythmias. People with multiple risk factors for CHD should be offered appropriate interventions to reduce their risk. Dr Begg discusses the important role of primary care clinicians in preventing CHD through early detection of cardiac arrhythmias, and highlights the need for more people to be trained in cardiopulmonary resuscitation. 

In this month’s View from the ground, Dr Heather Ryan writes about the challenges she faced when she made the bold move from GP training straight to GP partnership. 

Lastly, I just wanted to give you a quick update on this year’s Guidelines Live. The 2-day event will take place on 19–20 November 2019 at Olympia Conference Centre, London. There will be sessions on a range of clinical areas, all delivered by experts, to keep you up to date with new and updated clinical guidance and best practice. You can find out more and pre-register for a place at: