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NIHR Signal MRI scan does not help to find the cause of pelvic pain in women
MRI scans are not sufficiently accurate to find the cause of chronic pelvic pain in women and should not replace laparoscopy (keyhole surgery), which can be used for diagnosis and often treatment. MRI only correctly ruled out a gynaecological condition in half of women judged to have no obvious cause and missed half of women who did have a treatable gynaecological condition. Pinpointing the origin of chronic pelvic pain is often difficult due to the number of possible causes. If initial tests a...
NIHR Signal Prescribing anti-inflammatories for urine infection reduces antibiotic use but increases complication risk
Urinary tract infection symptoms resolved by three days for 80% of women given antibiotics compared with 54% given anti-inflammatories. Anti-inflammatories reduced antibiotic use, but 5% of women developed more severe infection of the kidneys. Urinary infections are the second most common reason for prescribing antibiotics in general practice, after respiratory infection. As such, this use may be contributing to increasing antibiotic resistance. This Swiss trial provided an important head-to-h...
NIHR Signal Diabetes drug aids fertility in women with polycystic ovaries
The diabetes drug metformin may help women with polycystic ovarian syndrome who are having problems getting pregnant, but it is unclear whether it works better than an alternative fertility drug that stimulates the ovaries. This study updates a previous review of trials that compare metformin with placebo, no treatment or with the fertility drug clomifene. It summarised results of 48 studies, including 4,451 women. The study found that metformin may work better than placebo or no treatment and ...
NIHR Signal Using mesh does not improve results in vaginal prolapse surgery
Using a synthetic mesh or biological tissue graft is no better than standard surgical repair, without the use of these materials, in women with vaginal wall prolapse. Some women had problems from the mesh. This large pragmatic study looked at over 3000 women with vaginal prolapse. Half of these were randomised; the rest contributed data but were not part of the main evaluation. The study separately compared mesh and biological grafts to a repair without these additions. It also took account of ...
NIHR Signal Treatments for reducing menopausal hot flushes are ranked for effectiveness
A combination of oestrogen and progestogen via patches is the best treatment for menopause symptoms. Other options may be less beneficial, including tablets combining oestrogen and progestogen, and non-hormonal treatments, isoflavones and black cohosh, though they may have other benefits. There is no evidence to support the use of antidepressants. Menopause affects women’s personal life and work life, but many don’t seek help from healthcare professionals. It is important to identif...
NIHR Signal Physical activity in the community improves mobility for cancer survivors
Programmes to encourage physical activity for people with cancer at home or in local communities have a positive impact on physical function. The changes were generally small to moderate, for example those receiving rehabilitation could walk on average 28 metres further in six minutes. The studies mostly included older people with breast cancer, in whom these small improvements may be important. Cancer survivors experience changes to their physical function resulting from cancer and its treatme...
NIHR Signal Pelvic floor exercises may reduce need for further treatments for pelvic organ prolapse
Pelvic floor muscle training reduced symptoms at two years slightly more than the improvement seen in women who just received a leaflet with lifestyle advice. In addition to this 1 point change on a 28 point scale, 8% fewer women who had training needed further treatment for prolapse. This randomised controlled trial included 412 women with relatively minor prolapse but who had not had any previous treatment. The basic training was provided by physiotherapists in five treatment sessions with ad...
NIHR Signal Delaying chemotherapy after breast cancer surgery may reduce survival chances
Delaying chemotherapy after breast cancer surgery may slightly decrease a woman’s chances of survival. A review found about a 5% increase in therelativerisk of death. Many women are offered chemotherapy soon after breast cancer surgery, called adjuvant chemotherapy. Chemotherapy is usually started after the surgical wounds have healed but the effect of any delay to this was unclear. These researchers calculated the risk from outcomes for almost 30,000 women treated with adjuvant chemother...
NIHR Signal Self-testing kits for HPV could be a useful option to tackle low cervical screening rates in young women
Human Papilloma Virus (HPV) self-sampling kits and the opportunity to book appointments had the largest effect in improving cervical screening uptake for those not responding to initial prompts. However, uptake improved only slightly from 27% to 30%, when the kit was sent. A survey of non-attenders showed they value the convenience and privacy of self-testing. This large NIHR trial tested a range of interventions to increase uptake among women eligible for their first cervical screening test. S...
NIHR Signal Some treatments for abnormal cervical cells increase risk of preterm birth
Women who receive the more radical treatments (like loop excisions) for abnormal cells on the cervix are more likely to experience preterm birth and other adverse pregnancy outcomes than those receiving more local treatments or those not needing treatment at all. Abnormal cells – termed cervical intraepithelial neoplasia (CIN) – can be picked up on cervical screening. These non-cancerous changes can develop into cancer in the future if left untreated. Various treatment options are av...
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