COURSE OUTLINE
Module 1: Sexual health
This module recognises that sexual health is a significant component of a woman’s well-being and sexual difficulties can undermine relationships, impair self-esteem, mood and quality of life. This module examines the complex, multifactorial etiology of sexual dysfunction and proposes an evaluation and treatment approach that addresses the biological, psychological, sociocultural, and relational factors. The role of the doctor to broach the subject of sex is addressed and the course guides practitioners in overcoming their apprehensions. Taking a detailed sexual history is outlined as the basis for treatment, prevention, education and empowerment to embrace healthy, satisfying, and responsible sexual behaviour. The module offers education and suggestions for some of the most common sexual health problems such as difficulty achieving orgasm and reduced libido. The final unit weighs the impact of changing hormone levels on the sexual function of menopausal women and examines the role of menopause hormone therapy.
Module 1: Premature ovarian insufficiency
This module focusses on premature ovarian insufficiency (POI). The module commences with definitions of early and premature menopause including risk factors and causes of spontaneous POI. Iatrogenic POI caused by chemotherapy, radiotherapy or surgery. Information about clinical presentations of POI, diagnosis criteria, patient history, examinations, investigations, and ongoing monitoring are listed in unit two. Health consequences may include psychological distress, osteoporosis, cardiovascular disease, cognitive impairment, sexual dysfunction and other health concerns. The management of POI from initiating care and coordinating care may include a multidisciplinary approach. Information is provided on managing symptoms of menopause, sexual health difficulties and psychological issues. When managing patients with this condition, consideration needs to be given regarding prevention of bone loss, osteoporosis and prevention of cardiovascular disease.
Module 3: Infertility
The experience of infertility or subfertility is often unexpected, confronting and can cause feelings of defectiveness, depression, and loss of identity. This module reviews the delicate and complex processes of ovulation, fertilisation, and implantation. It explores factors that contribute to infertility and subfertility including sex, mechanism, lifestyle and environmental factors, recreational drug use and concurrent illness. The module explores the psychological, social, physical, and financial burden of subfertility and infertility, and outlines intervention approaches. Patient case studies illustrate assessment and investigations required to construct a management plan for fertility problems. Content includes reproductive technologies such as in-vitro fertilisation, ovulation induction and DIY artificial insemination including the benefits and implications of these interventions. Adoption and surrogacy are also considered. Finally, the pivotal role of the practitioner in prevention, education, management, and support of women experiencing recurrent pregnancy loss is addressed.
Module 4: Pregnancy 1
This module on pregnancy (part 1) includes guidelines to optimize maternal and foetal health throughout the stages of an uncomplicated pregnancy and creates a detailed model for screening and counseling. The three stages of pregnancy care: preconception care, antenatal care and postnatal care are outlined including considerations and procedures for screening and monitoring individual cases. A typical regimen for screening and indications for monitoring and further investigation is included. The course identifies common symptoms and complications during the antenatal and postnatal stage of pregnancy and considers risk factors, typical presentations, and potential maternal and foetal impact. Both pharmacological and non-pharmacological methods for the management of specific conditions are included.
Module 5: Pregnancy complications
This module considers four common complications of pregnancy - miscarriage, obesity, gestational diabetes mellitus and postnatal depression. It includes clinical presentation, assessment, important considerations and management options. For example, when considering a management plan for miscarriage, a woman’s emotional distress and her need for control needs to balance with her physical welfare. Investigations of recurrent miscarriages are included. The increased risks of adverse outcomes associated with pre-conceptional obesity and excessive weight gain during pregnancy are covered including potential antenatal, intrapartum, and postpartum obesity-related complications. It also discusses how to conduct sensitive conversations about managing gestational weight gain. A classification of the risk factors for gestational diabetes introduces the adverse complications for both mother and infant including epigenetic dysregulation. In conclusion, the role of the practitioner is discussed as a crucial point of care for perinatal depression and comorbid anxiety symptoms.
Module 6: Pregnancy complications advanced part 1
This module discusses advanced maternal age pregnancies and potential complications for the mother and the child. It examines fertility decline and possible early pregnancy complications including spontaneous abortion, ectopic pregnancy, chromosomal abnormalities and congenital malformations. Late pregnancy complications discussed include hypertension, pre-eclampsia, gestational diabetes mellitus, placental complications and increased risk of caesarean sections. Possible foetal complications including low birth weight, preterm delivery and stillbirth are included and then leads into definitions of twin pregnancies and possible maternal and foetal complications. Antenatal care, timings and mode of birth are included. Unit three defines pre-eclampsia, identifying women at risk, the effects on the body, and the pathophysiology and management of this condition including the complexities of managing this condition in rural areas. Pregnancy-related skin concerns are reviewed including skin pigmentation, stretch marks and thinning of hair. Benign and sinister specific dermatoses of pregnancy are described and examples are shown.
Module 7: Pregnancy complications advanced part 2
This module discusses advanced pregnancy complications including how the immune system may respond to possible infections in pregnancy. These infections include chlamydia, syphilis, Hep B/C, HIV, GBS, rubella and varicella, HSV, listeria, parvovirus, cytomegalovirus, toxoplasma and COVID- 19. Clinical management of these conditions is outlined. The causes of antepartum haemorrhage including risk factors and clinical management of this condition are outlined. Preterm birth/labour (PTL) discusses the causes, risk factors, risk reduction, assessment and management of this condition. Vaginal/perineal tears and episiotomies, including definitions, risk factors and tear-associated morbidity are described. Episiotomy incisions are outlined and when this procedure should or should not be performed, including possible complications. The content outlines faecal and anal incontinence after pregnancy and childbirth including the definition, assessment history, examination and management of this condition.
Module 8: Menopause
This module on menopause provides comprehensive information about the definitions, features and underlying causes of menopause and discusses the typical process and duration for each of the four stages: perimenopausal, menopausal, early postmenopausal and late postmenopausal. Methods for assessment and differential diagnosis of menopausal symptoms are outlined including indications for further investigation. Management options including lifestyle modifications, “natural” or complementary therapies, non-hormone pharmaceutical options and menopause hormone therapy (MHT) are discussed. Different types of MHT are reviewed including potential benefits and risks, safety considerations and testing methods. It also acknowledges potential contraindications for MHT and statistics that suggest a lack of observable effectiveness in treating some health conditions. The module outlines effective courses of action for adjusting treatment and managing complications.
Extension module: Post-menopause health issues
As estrogen deficiency begins to dominate in post-menopause, women may experience health issues and escalated risks. This module examines the aetiology, compounding factors and socioeconomic burden. Content includes the medical and complementary management of osteoporosis, genito-urinary syndrome, mood disorders and cardiovascular disease. It provides an outline of the risk factors associated with osteoporosis and fragility fractures. It discusses the tools to assess fracture risk as well as the criteria for, and interpretation of DXA scans. Lifestyle interventions and pharmacotherapy are also considered. Together with general care, non-hormonal measures and the role of topical or systemic estrogen therapy are considered. Genito-urinary syndrome caused by the hypogenic state of post menopause is discussed. The importance of a mental health assessment for post-menopausal women is emphasised including risk factors and management of depression and anxiety. The module concludes with an overview of cardiovascular disease, the risk factors (including the impact of estrogen deficiency), and the evidence and parameters for hormone therapy.
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Upon successful completion of the exam, course participants will receive an Advanced Certificate of Sexual & Reproductive Health.
