Module 1: An approach to diagnosing pelvic pain
Pelvic pain is one of the most common symptoms experienced by women that can significantly impact quality of life. Given the complex anatomy of the pelvis and lower abdomen, pelvic pain presents a diagnostic challenge that requires clinical awareness to ensure the diagnosis of serious conditions including endometriosis and cancer. This module provides practitioners with clinical reasoning models to effectively assess and diagnose acute, chronic, or recurrent pelvic pain. It applies diagnostic models to the diagnosis and management of pelvic pain. These are shown to offer complementary approaches and thereby generate a wide-ranging list of possible diagnoses. The module also guides the practitioner through the elements of taking a thorough history including pelvic pain-specific questions and funnels this information into a clinical examination and appropriate investigations. Three case studies illustrate the application of Murtagh’s self-posed questions.
Module 2: Sexual health
Sexual health is an essential 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 module guides practitioners in overcoming their apprehensions. Taking a detailed sexual history is outlined as the basis for treatment, prevention, education, and the 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 3: Family Planning (Advanced)
This module discusses the role of general practitioners in contraceptive counselling with comprehensive information on long-acting reversible contraceptives (LARCs). The nature of LARCs means that there is no difference between typical and perfect use and recognised their contraceptive effectiveness. Medical eligibility criteria for contraceptive use is applied to the three types of LARC and elaborates upon important contraindications. It also presents discussion about the use of LARCs including how a clinician can reasonably exclude pregnancy and institute emergency contraception when warranted. Because of the suitability of LARCS for adolescents, the module examines issues of consent and identifies key points of legislation related to informed consent. It also considers the termination of unintended pregnancy from request for a termination of pregnancy through to clinical referral. Finally, there is a discussion about the “quick start” method of contraception for women at higher risk of unintended pregnancy.
Module 4: 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 the assessment and investigations required to construct a management plan for fertility problems. The module also explores reproductive technologies and covers the benefits and implications of interventions such as in-vitro fertilisation, ovulation induction and DIY artificial insemination. 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 5: Pregnancy complications
This module considers four common complications of pregnancy - miscarriage, obesity, gestational diabetes mellitus, and postnatal depression. It examines the clinical presentation, assessment, important considerations and management options for the general practitioner. For example, under miscarriage, when considering a management plan, a woman’s emotional distress and her need for control needs to balanced with her physical welfare. The investigation of recurrent miscarriages is addressed. 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 the far-reaching effect of epigenetic dysregulation. In conclusion, the module considers the role of the practitioners as a crucial point of care for women with perinatal depression and comorbid anxiety symptoms.
Module 6: Breast problems
Breast cancer prevention is dependent upon early detection, however screening and surveillance should be based upon each woman’s estimated risk. Risk assessment is therefore a crucial step and has a dual purpose of engaging women in discussions about risk reduction. This module categorises breast cancer-associated risk factors according to potency and mutability and includes validated tools with which a risk assessment can be undertaken. The module then discusses risk-appropriate screening strategies. Discovering a new breast symptom can be extremely worrisome for a woman and although most are benign, more than half of breast cancers are diagnosed this way. The module outlines the highly effective triple test approach which allows practitioners to evaluate a new breast symptom, rule a malignancy in or out and reassure or refer women, as necessary. The module also addresses the clinical presentation a raft of breast changes including mastalgia and breast cancers. For each condition, there is an examination of the relevant investigations, management and surveillance.
Module 7: Obesity and overweight management
The module discusses the role practitioners play in the primary prevention, screening, evaluation, treatment and ongoing monitoring of comorbidities in overweight and obese patients. Sustained behavioural change for these patients is predicated on a long-term, collaborative relationship patient and doctor. Guides are included for eliciting the patient's level of change-motivation and offers a framework for structuring a lifestyle counselling consultation. The module identifies four pillars of management: patient education and health literacy, lifestyle modifications, medication, and weight loss surgery. As a first-line therapy, education and lifestyle interventions including physical activity and diet, form the foundation for change. Beyond these interventions, the adjunctive role of medications is also discussed. The pharmacodynamic effects, administration and monitoring of three TGA-approved medications are considered in the context of what may be a life-long intervention. Bariatric surgery, the primary mechanism, the effectiveness and indications are also outlined. In conclusion, the module discusses the drivers of obesity and the practitioner’s role in primary prevention through education and advocation.
Module 8: Post-menopause
As estrogen deficiency begins to dominate in post menopause and women may experience health issues and escalated risks. This module examines the aetiology, compounding factors and socioeconomic burden, and considers 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. general care, non-hormonal measures and the role of topical or systemic estrogen therapy. Gentio-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.