{"id":4804,"date":"2026-06-02T11:14:11","date_gmt":"2026-06-02T10:14:11","guid":{"rendered":"https:\/\/gp-training.hee.nhs.uk\/bolton\/?page_id=4804"},"modified":"2026-06-02T11:14:12","modified_gmt":"2026-06-02T10:14:12","slug":"cases-for-womens-health","status":"publish","type":"page","link":"https:\/\/gp-training.hee.nhs.uk\/bolton\/teaching-programmes\/st2-programme\/st2-resources\/cases-for-womens-health\/","title":{"rendered":"Cases for Women’s Health"},"content":{"rendered":"\n

1 \u2013 Jennifer<\/strong><\/h2>\n\n\n\n

39y. PMH: nil. DH: COCP<\/h3>\n\n\n\n

I\u2019m worried because my sister has just been diagnosed with breast cancer. Do I need a referral because of my family history?<\/p>\n\n\n\n

Sister is 44<\/p>\n\n\n\n

No other family history of any cancers<\/p>\n\n\n\n

No Jewish heritage<\/p>\n\n\n\n

ICE: COCP – I\u2019ve heard it can increase breast cancer risk? Should I stop it?<\/p>\n\n\n\n

Should I get one of those private screening tests just to be safe?<\/p>\n\n\n\n

When can I get a mammogram?<\/p>\n\n\n\n

How can I reduce my risk?<\/p>\n\n\n\n

2 \u2013 Hannah<\/strong><\/h2>\n\n\n\n

28y. PMH: nil. DH: COCP<\/h3>\n\n\n\n

I was sent for an USS by the other doctor and I\u2019ve seen in my NHS app that it is normal. Does that mean there\u2019s nothing wrong?<\/p>\n\n\n\n

Always had heavy painful periods since menarche (age 13) but now pelvic pain too for the last 18\/12<\/p>\n\n\n\n

Pain is worse a week before periods start<\/p>\n\n\n\n

Loose and bloody bowel motions the week prior to and at start of period<\/p>\n\n\n\n

Dyspareunia<\/p>\n\n\n\n

Really struggling with work – having to take about a week off every month and getting in trouble<\/p>\n\n\n\n

Struggling with relationship with partner due to painful sex<\/p>\n\n\n\n

Struggling with mood due to all of the above<\/p>\n\n\n\n

Embarrassing episodes of flooding and spending \u00a3\u00a3\u00a3 on sanitary wear<\/p>\n\n\n\n

Want to TTC soon<\/p>\n\n\n\n

Not tried anything except paracetamol yet<\/p>\n\n\n\n

ICE: Would like a diagnosis, could it be endometriosis?<\/p>\n\n\n\n

Worried about impact on fertility<\/p>\n\n\n\n

Should she get referred?<\/p>\n\n\n\n

If pain and bleeding could be managed as well as any suggestions for work – happy to try<\/p>\n\n\n\n

3 \u2013 Anika<\/strong><\/h2>\n\n\n\n

30y. PMH: hypothyroidism. DH: levothyroxine 50mcg<\/h3>\n\n\n\n

Yes this pregnancy was planned<\/p>\n\n\n\n

LMP makes her around 6 weeks (regular periods)<\/p>\n\n\n\n

This is my first pregnancy<\/p>\n\n\n\n

Has not contacted CMW yet<\/p>\n\n\n\n

Made GP appointment as mother in law told her that\u2019s what you have to do, is it not?<\/p>\n\n\n\n

Not taking any pre-natal vitamins yet<\/p>\n\n\n\n

Has annual TFTs and has been stable on thyroxine dose for several years<\/p>\n\n\n\n

ICE: How can I best stay healthy, anxious about pregnancy given thyroid problem<\/p>\n\n\n\n

Will the baby have thyroid problems too?<\/p>\n\n\n\n

4 \u2013 Ola<\/strong><\/h2>\n\n\n\n

32y. PMH: nil. DH: recent acutes \u2013 cyclizine, prochlorperazine<\/h3>\n\n\n\n

The new tablets still aren\u2019t working<\/p>\n\n\n\n

I\u2019m now 8 weeks and still struggling with nausea. I\u2019m not vomiting much.<\/p>\n\n\n\n

I\u2019m a nurse and really struggling at work.<\/p>\n\n\n\n

I am eating small, bland foods and drinking fluids but not tolerating larger meals<\/p>\n\n\n\n

I\u2019ve tried two medications now and I\u2019m worried because the last GP told me that if this one didn\u2019t work there\u2019s not really anything else to try<\/p>\n\n\n\n

You don\u2019t really want to be off work<\/p>\n\n\n\n

You have been checking your urine at work for ketones.<\/p>\n\n\n\n

ICE: Is there really nothing else I can try? When will this stop?!<\/p>\n\n\n\n

5 \u2013 Zara<\/strong><\/h2>\n\n\n\n

23y. PMH: migraine.<\/h3>\n\n\n\n

My periods are so irregular<\/p>\n\n\n\n

Menarche aged 14, settled into a semi-regular pattern but then for the last 2 years or so have been all over the place<\/p>\n\n\n\n

I think I probably have a period every 12-16 weeks, I think I had 3 periods last year<\/p>\n\n\n\n

No IMB or PCB<\/p>\n\n\n\n

Not currently sexually active, not planning to become pregnant, not had intercourse<\/p>\n\n\n\n

Significant acne and hirsutism<\/p>\n\n\n\n

BMI normal<\/p>\n\n\n\n

I have migraine with aura<\/p>\n\n\n\n

ICE: Older sister had similar and was told had PCOS after USS – will I have to have one? Worried re: TVUSS<\/p>\n\n\n\n

I also googled PCOS and it looks like COCP is recommended – can I try that? Worried about risk of endometrial hyperplasia. Would not want coil as not sexually active.<\/p>\n\n\n\n

6 – Karen                         <\/strong><\/h2>\n\n\n\n

50y. PMH: anxiety. DH: sertraline<\/h3>\n\n\n\n

Sorry to bother you, I know you\u2019re busy, I was hoping to get a blood test first and then come to you if needed. But your receptionists, they really gatekeep don\u2019t they, wow<\/p>\n\n\n\n

I wanted the blood test to see if I\u2019m menopausal or not, there was an article about it online<\/p>\n\n\n\n

Periods have become more erratic and heavier last 6\/12 or so<\/p>\n\n\n\n

Feeling much more irritable, snapping around husband and children<\/p>\n\n\n\n

Really feeling like I can\u2019t function at work and that\u2019s not an option, I work as a regional manager so have a lot of responsibility<\/p>\n\n\n\n

Low libido and dry down below<\/p>\n\n\n\n

Flushes and poor sleep at night<\/p>\n\n\n\n

Thought you needed a blood test, is that not the case?<\/p>\n\n\n\n

On sertraline but I don\u2019t think this feels the same as what I started that for<\/p>\n\n\n\n

Not had a hysterectomy, had 2x children NVD 20\/25 years ago<\/p>\n\n\n\n

Not using any hormonal contraception, rarely have sex – I\u2019m too old to get pregnant now??<\/p>\n\n\n\n

ICE: Open to HRT, aware of risks and benefits<\/p>\n\n\n\n

7 – Margaret<\/strong><\/h2>\n\n\n\n

74y. PMH: polymyalgia. DH: prednisolone<\/h3>\n\n\n\n

I don\u2019t see what all the fuss is about, I spent long enough waiting at that hospital<\/p>\n\n\n\n

It\u2019s only a little break to the wrist, nothing I can\u2019t handle<\/p>\n\n\n\n

Fell putting the washing out tripped over dog, standing height<\/p>\n\n\n\n

Neighbour saw and made go to A&E, what a fuss<\/p>\n\n\n\n

No previous falls<\/p>\n\n\n\n

Non-smoker, partial to a sherry most evenings<\/p>\n\n\n\n

I take these steroids for that Polymyalgia, marvellous things they are don\u2019t you ever take them off me<\/p>\n\n\n\n

Menopause donkeys years ago (at age 40 when pressed)<\/p>\n\n\n\n

Live alone, fiercely independent, want it to stay that way. Neighbour keeps an eye, sons miles away in Australia but they do call, guilt calls I call it<\/p>\n\n\n\n

Never had a bone scan<\/p>\n\n\n\n

Not under rheum for PMR just GP and been on steroids for ages<\/p>\n\n\n\n

Diet is ok, not much fun cooking for one so mainly just have ready meals<\/p>\n\n\n\n

ICE: don\u2019t understand why have been called back by GP, don\u2019t want a fuss, does NOT want to stop prednisolone<\/p>\n\n\n\n

8 \u2013 Beatrice<\/strong><\/h2>\n\n\n\n

68y. PMH: recurrent UTIs. DH: recent acutes \u2013 5x prescriptions for nitrofurantoin in last 3 months<\/h3>\n\n\n\n

I tried to request some more antibiotics because my symptoms haven\u2019t gone away this time but reception said it had been declined. I don\u2019t see why, I got them this way in the past?<\/p>\n\n\n\n

I get recurrent UTIs, I always get antibiotics. Sometimes it settles it sometimes it doesn\u2019t\u2026if I\u2019m honest usually it doesn\u2019t. Maybe it\u2019s more that the symptoms go away for a bit then come back.<\/p>\n\n\n\n

Also had some from the pharmacy and from the OOH GP<\/p>\n\n\n\n

Also tried some thrush treatment to see if that helped but it didn\u2019t<\/p>\n\n\n\n

Burning\/stinging sensation down below, worse when PU, but the sensation is there even when not PU<\/p>\n\n\n\n

No suprapubic pain or flank pain<\/p>\n\n\n\n

No fevers, no vomiting<\/p>\n\n\n\n

Feeling like need to PU all the time<\/p>\n\n\n\n

Aren\u2019t these symptoms of UTI? My friend has the same issue, her GP just gives her the antibiotics<\/p>\n\n\n\n

If I think back probably have felt these symptoms for months if not years.<\/p>\n\n\n\n

Just assumed it was part of getting older<\/p>\n\n\n\n

Menopause – around 55, did not have HRT as symptoms weren\u2019t too bad<\/p>\n\n\n\n

If asked yes is affecting sex life, pretty much don\u2019t have intercourse any more as too painful<\/p>\n\n\n\n

No bleeding no discharge, regular sexual partner (husband)<\/p>\n\n\n\n

ICE: annoyed script for antibiotics was rejected, normally it\u2019s not a problem I don\u2019t see what the fuss is about. Open to discussing topical oestrogen if offered, anything to help the symptoms. Will that stop me getting UTIs??<\/p>\n","protected":false},"excerpt":{"rendered":"

1 \u2013 Jennifer 39y. PMH: nil. DH: COCP I\u2019m worried because my sister has just been diagnosed with breast cancer. 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