GynaecologyBMJ 1999; 319 doi: http://dx.doi.org/10.1136/bmj.319.7211.689 (Published 11 September 1999) Cite this as: BMJ 1999;319:689
- Con Kelleher, consultant obstetrician and gynaecologist,
- Peter Braude, professor of obstetrics and gynaecology (email@example.com)
- Division of Women's and Children's Health, Guy's, King's, and St Thomas's School of Medicine, and Guy's and St Thomas's Hospital Trust, St Thomas's Hospital, London SE1 7EH
- Correspondence to: P Braude
- Accepted 10 June 1999
Improvements in imaging technology, endoscopic equipment, drug treatment, and scientific innovation have all contributed to recent advances in gynaecology. Advances have also resulted from a change in the attitudes and practice of gynaecologists themselves, in response to the greater expectations and knowledge of their patients, who frequently seek new and innovative procedures on the basis of media publicity and access to non-peer reviewed information including the world wide web. It is increasingly recognised that gynaecological problems affect the quality of life of women in different ways, highlighting the value and importance of patient assessed health status measures to evaluate the subjective severity and treatment efficacy of common gynaecological conditions.1 2 Laparoscopic and hysteroscopic surgery, medical treatment, and expectant management are replacing major gynaecological surgery for many common gynaecological complaints. For example, ectopic pregnancy is being diagnosed earlier by the use of transvaginal ultrasonography and quantitative measurements of human chorionic gonadotrophin concentrations. Thus women can be treated either medically as outpatients with methotrexate injections 3 4 or by laparoscopic surgery, reducing stay in hospital and preserving tubal function in most cases.4–6 Minor procedure units for gynaecology, with one stop investigation and treatment (including ultrasonography and hysteroscopy), and early pregnancy assessment units, where bleeding in early pregnancy can be dealt with rapidly and sympathetically, are becoming more commonplace. The prolonged life expectancy of menopausal women and their higher expectations for health have encouraged new developments in hormone replacement therapy. The increased use of such therapy has also increased surveillance and thus recognition of other common problems affecting older women. Delaying childbearing has resulted in a greater demand for effective fertility treatments and for surgical procedures that preserve fertility.
Although hysterectomy is an effective treatment for menorrhagia, the appropriate use of medical treatment, the progestogen releasing intrauterine system, and …