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Silent Epidemic
Vol. 19 No 4 | Summer 2017
Women's Health -> ANZJOG
From the editor’s desk


This article is 3 years old and may no longer reflect current clinical practice.

The August issue of ANZJOG commences with a fascinating invited editorial from Prof Rod Baber, entitled ‘Sex hormones, receptors and modulators’, in which he first explores the known history of sex hormones – apparently these were around for millions of years ‘before sex became interesting’!1 Rod goes on to describe the great increase in understanding of reproductive endocrinology that occurred from the early 20th century onwards, culminating in the recent development of selective oestrogen and progesterone receptor modulators (SERMs and SPRMs) that can be used in clinical practice. His editorial is a stimulating introduction to the important review it complements later in this issue, from Rozenberg et al, on the use of SPRMs and, in particular, ulipristal in gynaecology and women’s health.2 I believe this review will be of great interest to many of our readers.

Two papers among the original articles in gynaecology deal with the topic of abnormal cytology and detection of cervical cancer in women aged under 25. A paper from Morgan et al concludes that there is a very low incidence of cervical cancer in women under 25, irrespective of the age of commencing screening or the length of intervals between screening; the authors state that their findings lend ‘some support’ to the forthcoming changes in cervical screening guidelines in Australia.3 In the second paper, from Taghavi et al, the authors conclude that careful observation of CIN2 in women under 25 does not result in decreased ‘health-related quality of life’ or in undue psychological stress.4

Also in this issue, Harris et al review 525 cases of chronic vulval pain, reporting that the majority of these had a dermatological disease as the cause while a small proportion had neuromuscular conditions; both groups, the authors point out, are treatable. Other gynaecology original articles deal with endometriosis education,5 management of low-risk trophoblastic neoplasia6 and varying levels of anti-Müllerian hormone in infertile women.7

Among the obstetrics original articles, Waller et al report on multiple pregnancies conceived with overseas fertility treatments and subsequently managed in the sole tertiary maternity unit in WA; these constituted a third of all multiple pregnancies conceived with ART and managed over a two-year period in the hospital.8 The authors note a significant cost to the health system of what is now termed ‘cross-border reproductive care.’ In other papers, Hughes et al report from their dedicated high-risk Melbourne clinic on a decreased rate of preterm labour over a ten-year period, and examine the reasons for this;9 and Dunn et al from Brisbane find that although advanced maternal age doubles the risk of caesarean delivery in both nulliparous and multiparous women, the majority of older women nevertheless do have vaginal births.10

The October issue of ANZJOG will also be published by the time you read this. Prof Michael Permezel has contributed an incisive editorial on current O&G training,11 in conjunction with two articles looking at RANZCOG trainees’ working hours and reported fatigue levels that appear later in this issue.12 13 The editorial examines the shortcomings of the present system and makes some strong recommendations for change. Still on the topic of training, Bhoopatkar et al have reported an interesting study of the experiences of medical students in South Australia and New Zealand in learning pelvic examination; they detail both the opportunities available to students, and the obstacles they encountered in their attempts to gain sufficient experience in the techniques of intimate examinations.14

In an important Clinical Perspective, Hammond et al give an excellent account of the changes to the Australian National Cervical Screening Program that will be implemented from 1 December this year. The authors clearly address many of the concerns that have been expressed by some health professionals in regard to these changes; the article should be essential reading for all practitioners involved in women’s reproductive health.15 Also of great interest is the review article by Nicklin on robotic-assisted laparoscopic surgery and its role, present and future, in gynaecological surgery.16

In the area of obstetrics, ANZJOG is pleased to publish the executive summary of the SOMANZ guidelines for the investigation and management of sepsis in pregnancy; a comprehensive guide to the causes, diagnosis and management of all types of sepsis in pregnant women that will be invaluable for all obstetricians.17

Finally, in the Opinion section of the October issue, Tremellen and others argue against limitations to the access of obese women to assisted fertility treatments,18 while Robson and Norman strongly defend the ethical and clinical reasons for withholding assisted reproductive treatments from women with a high BMI.19

I wish you all enjoyable reading of these two issues.

References

  1. Baber, R. Sex hormones, receptors and modulators. ANZJOG. 2017;57(4):391-2.
  2. Rozenberg S, Praet J, Pazzaglia E, et al. The use of selective progestin receptor modulators (SPRMs) and more specifically ulipristal acetate in the practice of gynaecology. ANZJOG. 2017;57(4):393-9.
  3. Morgan EL, Sanday K, Budd A, et al. Cervical cancer in women under 25 years of age in Queensland, Australia: To what extent is the diagnosis made by screening cytology? ANZJOG. 2017;57(4):469-72.
  4. Taghavi K, Morell S, Lamb J, et al. Initial observation of CIN2 does not appear to reduce quality of life in women under 25 years of age. ANZJOG. 2017;57(4):473-8.
  5. Bush D, Brick E, East MC, Johnson N. Endometriosis education in schools: A New Zealand model examining the impact of an education program in schools on early recognition of symptoms suggesting endometriosis. ANZJOG. 2017;57(4):452-7.
  6. Verhoef L, Baartz D, Morrison S, et al. Outcomes of women diagnosed and treated for low-risk gestational trophoblastic neoplasia at the Queensland Trophoblastic Centre (QTC). ANZJOG. 2017;57(4):458-63.
  7. Gorkem U, Kucukler FK, Togrul C, Gungor T. Anti-Mullerian hormone exhibits a great variation in infertile women with different ovarian reserve patterns. ANZJOG. 2017;57(4):464-68.
  8. Waller KA, Dickinson JE, Hart RJ. The contribution of multiple pregnancies from overseas fertility treatment to obstetric services in a Western Australian tertiary obstetric hospital. ANZJOG. 2017;57(4):400-4.
  9. Hughes K, Sim S, Roman A, et al. Outcomes and predictive tests from a dedicated specialist clinic for women at high risk of preterm labour: A ten year audit. ANZJOG. 2017;57(4):405-11.
  10. Dunn L, Kumar S, Beckmann M. Maternal age is a risk factor for caesarean section following induction of labour. ANZJOG. 2017;57(4):426-31.
  11. Permezel M. How can safe working hours produce a safe specialist obstetrician & gynaecologist? ANZJOG. 2017;57(5):491-2.
  12. Tucker PE, Cohen PA, Bulsara MK, Acton J. Fatigue and training of obstetrics and gynaecology trainees in Australia and New Zealand. ANZJOG. 2017;57(5):502-7.
  13. Acton J, Tucker PE, Bulsara MK, Cohen PA. Working hours of obstetrics and gynaecology trainees in Australia and New Zealand. ANZJOG. 2017;57(5):508-13.
  14. Bhoopatkar H, Wearn A, Vnuk A. Medical students’ experience of performing female pelvic examinations: Opportunities and barriers. ANZJOG. 2017;57(5):514-19.
  15. Hammond I, Canfell K, Saville M. A new era for cervical screening in Australia: Watch this space! ANZJOG. 2017;57(5):499-501.
  16. Nicklin J. The future of robotic-assisted laparoscopic gynaecologic surgery in Australia – A time and a place for everything. ANZJOG. 2017;57(5):493-8.
  17. Bowyer L, Robinson HL, Barrett H, et al. SOMANZ guidelines for the investigation and management sepsis in pregnancy. ANZJOG. 2017;57(5):540-51.
  18. Tremellen K, Wilkinson D, Savulescu J. Should obese women’s access to assisted fertility treatment be limited? A scientific and ethical analysis. ANZJOG. 2017;57(5):569-74.
  19. Robson SJ, Norman RJ. It is ethical to recommend against assisted reproductive treatment for women with a high body mass index. ANZJOG. 2017;57(5):575-8.

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